By Alanta Colley
In the past couple of months, the jigger infestation of the Busoga region has been a lead story in the Ugandan media and is now on the lips of many Ugandan politicians, policy makers, and health workers.
While jiggers themselves are not fatal, infestations can result in anaemia or secondary infections such as tetanus, gangrene, septic ulcers and others. Most of the time the site of the jigger bite will heal without complications, particularly if the jigger is removed in a timely manner, however several recent deaths in the Busoga region attributed to jigger related infections have highlighted the severity of the situation.
What is a jigger?
A jigger is a blood sucking sand flea that lives in warm and dusty environments. Both male and female jiggers feed on warm-blooded hosts from time to time, including pigs, goats, chickens, dogs, cats, and humans. The female however likes to burrow beneath toenails, fingernails, or into skin creases of animals and create a lesion where she feeds and lays her eggs.
In the early stages a small, black dot can be seen on the skin, which is the back half of the female jigger; her head buried in the skin. As the flea feeds the black dot increases in size up to a centimeter wide. She lays between 100-200 eggs which are pushed out by the flea and rest and incubate in exposed dirt and sand. After laying her eggs the female flea dies still buried in the skin. Incubated in the dirt, the eggs take 3-4 days to hatch and then 3-4 weeks to reach pupal stage where they will too seek hosts.
What has caused the jigger infestation?
There is no simple answer for why jiggers have come to plague the Busoga region so severely. While a social analyst might tell you ‘poverty’, a public health specialist might tell you ‘hygiene’. A teacher might tell you ‘poor education’, and a veterinarian might tell you ‘climate’, while a scholar might tell you ‘culture’. All the elements seem to have played a part.
The warm dusty environment of the Busoga region has certainly proved amenable to the breeding requirements of the jigger. More than this, exposed dirt floors, walls and compounds common among many village homes in Uganda mean that jigger eggs can incubate even inside the home. Many rural families keep their chickens and goats inside at night, and other animals such as cows very close to the house as a security measure. The close proximity of animals enables the transmission of jigger eggs from animal to human to happen with ease.
Going barefoot, as many young children are, increases vulnerability to jigger attacks. Many children attend dirt floor schools barefoot, where jigger transmission in the classroom becomes easy.
As well as this, the understanding of the cause of jiggers is a source of contention. Some in the village believe that jigger infestations are a result of witchcraft, and some have even claimed that the delay over the election of the new cultural King of Busoga; the Kyabazinga has brought a curse on the people of Busoga in the form of the jiggers. Such ideas have challenged the progress of education campaigns to help people prevent and treat jiggers.
Lack of access to health facilities also plays a role. A family in Kamuli who lost a baby to anaemia after their house was badly affected by jiggers told their local paper that they treated their jigger bites with local herbs, but never sought treatment from the health centre for the multiple infections resulting from the jiggers. Those most affected by the jiggers; young children and the elderly, are the least able to access treatment, particularly those who are so badly affected they can no longer walk.
Intense debate about jiggers has been raging over the past few years. In 2008 in the Ugandan Parliament legislators called for the arrests of people with jiggers, claiming that “it is total negligence for any sane Ugandan to suffer from jiggers”; and demanding arrests under the Public Health Act of people for failing to take care of their bodies. And more recently the network support agent called people suffering from jiggers “criminals”. Despite the fervour, this has not proved successful.
In the heat of the upcoming election, multiple candidates have claimed jigger eradication as their main platform.
In October the Ministry of Health, in partnership with several NGOs launched the National Jigger Campaign. The campaign involved a clinic in Kamuli, where over 300 people suffering from jiggers turned up to receive medical assistance in removing jiggers and having infections treated with antiseptics and antibiotics. The campaign also distributed free flip flops, towels, basins and soap, to encourage proper hygiene, to remove eggs and prevent infections. A local newspaper reported that many of these items were sold shortly after being received illustrating how poverty creates challenges to progressing the fight against jiggers.
What should UVP do?
Jiggers are known to affect the communities in which UVP works. UVP is now in discussion with the District Health Office about ways we can work together to educate people in the village about hygiene, separating animal and human living spaces, removing jiggers and when to seek treatment for jigger-related infections.
Through training and community sensitisation, UVP hopes to be part of the push to eradicate jiggers from Iganga district and the Busoga region.