Children with tungiasis in Kenya have poor school performance and quality of life.

Tungiasis is a highly neglected tropical skin disease caused by the sand flea, Tunga penetrans. The flea burrows into the skin inducing a strong inflammatory response, leading to chronic pain and discomfort with potential impacts on quality of life. Few countries implement control efforts and there are few data on the impact of the disease to support policy decisions. We conducted a survey to determine the impact of tungiasis among primary school children across nine counties of Kenya. A total of 10,600 pupils aged 8 to 14 years were randomly selected from 97 primary schools and examined for tungiasis. Those with tungiasis (83) were interviewed with respect to their quality of life using a modified dermatological quality of life index. For these cases and 576 randomly selected controls, school attendance and exam scores for maths, English and science were collected from school records. Mixed effect ordered logistic and linear models were used to assess associations between disease status and impact variables. Compared to uninfected pupils, those with tungiasis missed more days of school (adjusted Incidence Rate Ratio (aIRR: 1.50, 95% CI: 1.03–2.21) and were less likely to receive a high score in maths (aOR 0.18, 95% CI: 0.08−0.40) and other subjects. Pupils with severe disease (>10 fleas) were five times more likely to experience severe pain and itching than those with mild disease (OR 5.0, 95% CI: 2.55−10.51) and a higher category of impact on their quality of life than those with mild disease (aOR 3.52, 95% CI: 1.22−10.17) when adjusted for covariates. This study has demonstrated tungiasis has a considerable impact on children’s lives and academic achievement, equivalent to other diseases. This indicates the need for integrated disease management for school-aged children to protect their physical and cognitive development and their future prospects. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the KEMRI Scientific and Ethics Review Committee (approval number KEMRI/SERU/CGMR-C/170/3895) as well as the Oxford Tropical Research Ethics Committee (reference number 38-19). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets and other materials supporting the conclusions of this article are available on KWTRP Research Data Repository at Harvard Dataverse through the following link: https://doi.org/10.7910/DVN/DFSTIZ Elson Tungiasis Impact dataset