03639nas a2200397   4500000000100000008004100001260004400042653002400086653005700110653002100167653001400188653002000202653003900222653002000261653001800281653002600299653001100325100001300336700001200349700001500361700001300376700001400389700001300403700001400416700001300430700001600443700001500459700001600474700001500490245012400505856008400629300000900713490000700722520249800729022001403227       2023                            d  bSpringer Science and Business Media LLC10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aGeneral Medicine10aTungiasis10aTunga penetrans10aNeglected tropical diseases (NTDs)10a Neurocognition10aMental Health10aSchool-aged  children10aAfrica1 aOtieno B1 aElson L1 aMatharu AK1 aRiithi N1 aChongwo E1 aKatana K1 aNasambu C1 aMutebi F1 aFeldmeier H1 aKrücken J1 aFillinger U1 aAbubakar A00aNeurocognitive and mental health outcomes in children with tungiasis: a cross-sectional study in rural Kenya and Uganda  uhttps://idpjournal.biomedcentral.com/counter/pdf/10.1186/s40249-023-01154-4.pdf  a1-160 v123 a<p><strong>Background:&nbsp;</strong>Tungiasis, a neglected tropical parasitosis, disproportionately affects children. Few empirical studies have reported neurocognitive and mental health outcomes of children with ectoparasitic skin diseases like tungiasis. Pathophysiology of tungiasis suggests it could detrimentally affect cognition and behaviour. This study pioneered the investigation of neurocognitive and mental health outcomes in children with tungiasis.</p>

<p><strong>Methods:</strong> This was a multi-site cross-sectional study including 454 quasi-randomly sampled school-children aged 8–14 from 48 randomly selected schools in two counties in Kenya and a district in Uganda. The participants were stratified into infected and uninfected based on the presence of tungiasis. The infected were further classified into mild and severe infection groups based on the intensity of the infection. Adapted, validated, and standardized measures of cognition and mental health such as Raven Matrices and Child Behaviour Checklist were used to collect data. Statistical tests including a multilevel, generalized mixed-effects linear models with family link set to identity were used to compare the scores of uninfected and infected children and to identify other potential risk factors for neurocognitive and behavioural outcomes.</p>

<p><strong>Results:&nbsp;</strong>When adjusted for covariates, mild infection was associated with lower scores in literacy [adjusted β(aβ) = −&nbsp;8.9; 95% confidence interval (CI) −&nbsp;17.2, −&nbsp;0.6], language (aβ = −&nbsp;1.7; 95% CI −&nbsp;3.2, −&nbsp;0.3), cognitive flexibility (aβ = −&nbsp;6.1; 95% CI&nbsp;−&nbsp;10.4, −&nbsp;1.7) and working memory (aβ = −&nbsp;0.3; 95% CI −&nbsp;0.6, −&nbsp;0.1). Severe infection was associated with lower scores in literacy (aβ = −&nbsp;11.0; 95% CI −&nbsp;19.3, −&nbsp;2.8), response inhibition, (aβ = −&nbsp;2.2; 95% CI −&nbsp;4.2, −&nbsp;0.2), fine motor control (aβ =&nbsp;−&nbsp;0.7; 95% CI −&nbsp;1.1, −&nbsp;0.4) and numeracy (aβ = −&nbsp;3; 95% CI −&nbsp;5.5, −&nbsp;0.4).</p>

<p><strong>Conclusions:</strong> This study provides first evidence that tungiasis is associated with poor neurocognitive functioning in children. Since tungiasis is a chronic disease with frequent reinfections, such negative effects may potentially impair their development and life achievements. Graphical abstract</p>
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