Hannah McNeilly

Tungiasis is a widespread and debilitating zoonotic Neglected Tropical Disease (NTD). Manual extraction of the sand fleas with non-sterile sharp instruments is the most common but unsafe treatment method in affected communities. Topical application of a dimeticone oil formula (NYDA) has previously been shown to be a safe and effective method of killing embedded sand fleas. The objective of this study was to evaluate a two-year long humanitarian One Health tungiasis control project in 17 villages in Napak district, Karamoja region, Northeastern Uganda. The community-based intervention included quarterly systematic tungiasis detection and treatment with the dimeticone oil formula in residents and domestic animals in combination with community health promotion. In each of the eight quarterly tungiasis diagnosis and treatment rounds, between 3,674 and 5,155 residents were examined (coverage 73.6-89.9%). Overall, 12,540 tungiasis cases among residents were diagnosed and treated and 16 community dialogue meetings were held. Tungiasis prevalence among residents decreased from 62.8% to 5.7% in the two-year study period. While at baseline tungiasis was most prevalent in children and the elderly, at the end elderly women were the single most affected group. The prevalence of tungiasis-related walking difficulties in the community decreased from 11.5% to 0.5%, and pain and itching were greatly reduced. The number of animals present in the villages was low (between 79 and 414 per treatment round) and the prevalence of tungiasis in animals dropped from 14.2% to 0% throughout the two-year project. This implementation study shows that regular community-based treatment of tungiasis cases among humans and animals with dimeticone oil formula, combined with community engagement and health promotion, can reduce tungiasis prevalence and morbidity to very low levels within two years, even in a hyperendemic area where people live in extreme poverty.

Tungiasis (sand flea disease) is a neglected tropical disease that is endemic in Sub‐Saharan Africa and Latin America. Tungiasis causes pain, mobility restrictions, stigmatisation and reduced quality of life. Very severe cases with hundreds of sand fleas have been described, but treatment of such cases has never been studied systematically. During a larger community‐based tungiasis control programme in a hyperendemic region in Karamoja, northeastern Uganda, 96 very severe tungiasis cases were identified and treated with the dimeticone formula NYDA®. They were repeatedly followed‐up and treated again when necessary. The present study traces tungiasis frequency, intensity and morbidity among these 96 individuals over 2 years. At baseline, very severe tungiasis occurred in all age groups, including young children. Throughout the intervention, tungiasis frequency decreased from 100% to 25.8% among the 96 individuals. The overall number of embedded sand fleas in this group dropped from 15,648 to 158, and the median number of embedded sand fleas among the tungiasis cases decreased from 141 to four. Walking difficulties were reported in 96.9% at the beginning and in 4.5% at the end of the intervention. Repeated treatment with the dimeticone formula over 2 years was a successful strategy to manage very severe cases in a hyperendemic community. Treatment of very severe cases is essential to control the spread and burden of tungiasis in endemic communities.

Tungiasis (sand flea disease) is a neglected tropical disease that is endemic in sub-Saharan Africa and Latin America. Tungiasis causes pain, mobility restrictions, stigmatisation, and reduced life quality. Very severe cases with hundreds of sand fleas have been described, but treatment of such cases has never been studied systematically. During a larger community-based tungiasis control programme in a hyperendemic region in Karamoja, northeastern Uganda, 96 very severe tungiasis cases were identified and treated with the dimeticone formula NYDA®. They were repeatedly followed-up and treated again when necessary. The present study traces tungiasis frequency, intensity, and morbidity among these 96 individuals over two years. At baseline, very severe tungiasis occurred in all age groups, including young children. Throughout the intervention, tungiasis frequency decreased from 100% to 25.8% in this group. The overall number of embedded sand fleas in this group dropped from 15,648 to 158, and the median number of embedded sand fleas among the tungiasis cases decreased from 141 to 4. Walking difficulties were reported in 96.9% at the beginning and in 4.5% at the end of the intervention. Repeated treatment with the dimeticone formula over two years was a successful strategy to manage very severe cases in a hyperendemic community. Treatment of very severe cases is essential to control the spread and burden of tungiasis in endemic communities.

Tungiasis is a neglected tropical disease (NTD) that can cause significant suffering and disability. Health promotion is an important pillar in NTD control programs, assuming that better knowledge contributes to reduced risk behavior and reduced risk of infection. The study objective was to assess tungiasis-related knowledge and its translation into control practices in a rural and highly endemic setting in Karamoja, Northeastern Uganda. We applied a mixed-methods design on household and community level. A semi-quantitative questionnaire on knowledge, practices, and attitudes (KAP) regarding tungiasis was administered to 1329 individuals with the main caring responsibilities in the household. Additionally, eight community dialogue meetings were held and analyzed. Overall, knowledge of tungiasis in humans was high but knowledge of tungiasis in animals was low. Most questionnaire respondents knew the causative agent and clinical presentations of tungiasis in humans, risk factors, and preventive measures. This tungiasis-related knowledge was translated into simple prevention measures. However, adequate tungiasis control was impeded due to a lack of resources, such as access to water and effective medical treatment. In conclusion, health promotion campaigns should be integrated with support towards adequate tungiasis control measures, such as provision of safe treatment, hardening of non-solid floors in the houses, and improved access to water.

Care for chronic illness in clinical and everyday settings is relational and underpinned by ethical dilemmas about kinship care responsibilities as much as it is about self-care practices and technologically aided living. Such is the central argument of this special issue, which explores kin care and ethics of responsibilities in the everyday lives of persons and families with chronic illness across different locations globally. Rather than outlining the importance of kin care in times and spaces where clinical attention and healthcare are absent, or examining kin care as a modality of care that is separate from, contradictory, and incompatible with the clinical one, we examine how clinical modes of attention dovetail with the ethics of kin care and relational knowledge. We explore redistributions of care responsibilities between the family and the clinic by paying attention to kinship dynamics and argue that chronicity and kinship co-constitute each other in everyday life and clinical settings.

This paper centers on Isabella, a Candomble follower who struggled with severe rheumatoid arthritis from an early age, arguing that care and self-care practices in Candomble are intertwined to such extent that they challenge the dichotomy of caring and being cared for. In contrast to a linear model of care that positions care-giver and care--receiver at opposite ends of care relationships, the concept of 'circular care' describes forms of care that are directed at others and simultaneously at oneself. Exploring the religious kinship in a Candomble house - with Candomble deities (orixas) and between humans - this paper shows how circular care blurs the distinction between self and other. The emic concept of 'the double mirror' illustrates the -'constitutive alterity' of humans and orixas who relate to each other through kinship building and collective care practices. Since circular care frames one's care for the orixas and the religious family as healing self-care, failing to provide the correct care may in turn be experienced as detrimental self-neglect. The concept of circular care thus enables a deeper understanding of complex dynamics of care and self-care in the contexts of chronic illness, religion, kinship, and beyond.

Neglected tropical diseases are known to be highly stigmatized conditions. This study investigates tungiasis-related stigma and control practices in the impoverished Napak District in rural northeastern Uganda, where tungiasis is hyperendemic and effective treatment is unavailable. We conducted a questionnaire survey with the main household caretakers (n = 1329) in 17 villages and examined them for tungiasis. The prevalence of tungiasis among our respondents was 61.0%. Questionnaire responses showed that tungiasis was perceived as a potentially serious and debilitating condition and that tungiasis-related stigma and embarrassment were common. Among the respondents, 42.0% expressed judging attitudes, associating tungiasis with laziness, carelessness, and dirtiness, and 36.3% showed compassionate attitudes towards people with tungiasis. Questionnaire responses further indicated that people made an effort to keep their feet and house floors clean (important tungiasis prevention measures), but lack of water was a common problem in the area. The most frequent local treatment practices were hazardous manual extraction of sand fleas with sharp instruments and application of various and sometimes toxic substances. Reliable access to safe and effective treatment and water are therefore key to reducing the need for dangerous treatment attempts and breaking the vicious cycle of tungiasis stigma in this setting marked by poverty.

Tungiasis is an important but highly neglected cause of morbidity in resource-poor communities in Latin America and sub-Saharan Africa. Data upon which implementation of control measures can be based are scarce. Before piloting an integrated tungiasis control program in three parishes of Napak district, Uganda, a cross-sectional survey involving the systematic examination of humans and domestic mammals was implemented to establish the occurrence patterns of tungiasis. The study population was 5482 residents, of which 4035 (73.6%) participated in the study. The prevalence of tungiasis in humans was 62.8% (95% CI: 61.3–64.3%), with slightly more males than females affected (p = 0.01). Age-specific prevalence and intensity of human tungiasis followed an S-curve pattern, with children of 5–14 years and the elderly (≥60 years) being the most affected. Half of all lesions (50%) had been manipulated by sharp objects. The prevalence of tungiasis in animals was lower (14.2%, 95% CI: 10.9–18.0) than that of humans (p < 0.001). Animal tungiasis occurred in decreasing order of frequency in pigs (80%), dogs (24%), goats (16.3%), cats (8.1%) and sheep (4.9%). In conclusion, human tungiasis was highly prevalent but animal infections were comparatively few in the study area. Nevertheless, effective control measures should be based on One Health principles.

Social distancing has been the central public health strategy for tackling the coronavirus pandemic worldwide. But the `Stay Home, Stay Safe' order in the United Kingdom and the consequent closure of nurseries and schools also created an unprecedented degree of proximity within households. Based on interviews with mothers of young children in Scotland, this article provides early insight into the ways that mothers manage the forced intimacies of family life under lockdown and the opportunities they create through the innovative management of space and time. The result is a more expansive understanding of the family in contemporary Scotland and a notion of intimacy characterised as much by the necessity of distance and distinction as by proximity and mutuality.

Background: Growing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice.Aim: To explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice.Design and setting: Comparison of audio-recordings of follow-up consultations in UK primary care.Method: Primary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use.Results: Of the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items.Conclusion: VC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.