Prevalence and Risk Factors of Tungiasis Among Selected Regions of Ethiopia: A Meta-Analysis

Tungiasis, caused by the female sand flea Tunga penetrans, is a neglected tropical disease (NTD) with substantial health and socioeconomic burdens in low- and middle-income countries (LMICs). This systematic review and meta-analysis aimed to estimate the pooled prevalence of tungiasis and identify associated risk factors in Ethiopia's Oromia and Southern Nations, Nationalities, and Peoples' Region (SNNPR).

We systematically searched Scopus, Web of Science, PubMed, Science Direct, and African Journal Online (AJOL) for studies published between October 2015 and September 2024. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A random-effects meta-analysis model was employed to account for heterogeneity, quantified using I² statistics. Publication bias was evaluated via funnel plots, and Egger's regression test.

Across eight studies (n = 8502 individuals), the pooled prevalence of tungiasis was 39.0% (95% CI: 28.5-49.6). Subgroup analyses revealed regional disparities, with SNNPR exhibiting a higher prevalence (43.1%; 95% CI: 27.1-58.1) than Oromia (35.0%; 95% CI: 18.8-51.3). Temporal trends indicated a significant increase in prevalence post-2017 compared to earlier years. Low education levels (adjusted odds ratio [AOR]: 2.7, 95% CI: 0.6-4.9), lack of footwear use (AOR: 8.8, 95% CI: 0.1-17.4) and mud/earthen flooring (AOR: 4.9, 95% CI: 2.6-7.2) were significantly associated with tungiasis among selected regions of Ethiopia.

This meta-analysis demonstrates a significant burden of tungiasis in Ethiopia's Oromia and SNNPR regions. Therefore, we recommend implementing integrated interventions that combine: (1) provision of community-based health education programs to improve prevention awareness, (2) distribution of protective footwear to high-risk populations, (3) housing improvements focusing on floor hardening, (4) expanded access to safe treatment modalities, and (5) targeted animal reservoir control measures. Such coordinated efforts, embedded within existing NTD control platforms, could substantially reduce tungiasis transmission while addressing the socioeconomic determinants that perpetuate high infection rates in these endemic regions.