High density rural settlements, parenting behavior and child disability are significant factors associated with tungiasis in Karamoja, northeastern Uganda: a case control study

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Matharu, Berrick Otieno, Herman Feldmeier, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7288997/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Mar, 2026 Read the published version in Tropical Medicine and Health → Version 1 posted 9 You are reading this latest preprint version Abstract Background Tungiasis is a neglected tropical skin disease caused by adult female fleas which burrow into the skin of people and animals, causing considerable pain and itching. The distribution of the disease is heterogenous, with Napak district, Karamoja sub-region of northeastern Uganda having the highest disease burden recorded globally. We aimed to determine the factors associated with this high prevalence to inform future intervention strategies. Methods We conducted a case: control study to identify factors associated with infection of individual children, adults and with the whole household. Infected children were identified through mass-screening of 1619 children aged 8 to 14 years between January and March 2022 in 25 villages. Infected (210) and uninfected (358) children were randomly selected, and their households were enrolled into the study. Observations were made of the homesteads, and structured interviews were conducted with the caregivers. All adults and children in the households were examined. Mixed effect logistic regression analysis was used to identify factors associated with infection of individuals or households. Results We found children who lived in high-density settlements (manyattas) had more than three times the odds of being infected than those in more open, low-density settlements (adjusted odds ratio aOR 3.51, 95% CI 1.57−7.83, p = 0.002). For the first time we demonstrate the association of household infection with having a child with a disability (aOR 5.38, 95% CI 1.92−15.03, p = 0.001) and a caregiver who did not show affection to their child (aOR 1.79, 95% CI 1.02−3.13, p = 0.041). For individual adults, those who reported drinking alcohol had four times the odds of infection than those who did not (aOR 4.74, 95% CI 1.93−11.68, p = 0.001). Frequency of washing feet, soap use and house cleanliness were also associated with household infection. Conclusion Control programs should be developed together with the caregivers to enable them to reduce alcohol use, improve their childcare, hygiene and sanitation practices. Trial registration: not applicable Tungiasis Neglected tropical diseases risk factors WASH disability Karamoja Figures Figure 1 Figure 2 Figure 3 Background Tungiasis has recently received renewed attention due to its addition to the World Health Organization’s list of Neglected Tropical Diseases[1], as a Neglected Tropical Skin Disease targeted for control [2] and now the adoption of a resolution by the 78th World Health Assembly of “Skin Diseases as a Global Public Health Priority”[3]. In the past few years epidemiological [4–7], entomological [8], genomic [9] and intervention studies [10] have been conducted to better understand the ecology and impact [11–13] of the parasite and how it might be controlled. Tungiasis, also known as sand flea disease or “jiggers” in Africa, is caused by female adult Tunga penetrans [14]. The disease is widespread in South America, the Caribbean, and Sub-Saharan Africa, mostly affecting extremely resource poor, marginalized families in rural and peri-urban communities [14]. The adult female flea (imago) burrows into the skin, usually of the feet, and grows 2000-fold in size as the eggs develop in its abdomen [15]. Eggs are deposited into the environment where they hatch and if conditions are suitable, the larvae will feed and develop into pupae and the adults will emerge approximately three weeks later [16]. The main location for off-host development is on the earthen floors of people’s sleeping rooms [8, 17]. The growing female flea induces a strong inflammatory response which causes considerable pain and itching which in turn cause difficulty in walking, sleeping and concentration in class [11, 13]. Children with tungiasis have been shown to have poor cognitive function [12], lower academic achievement [11], and to experience stigma and discrimination [18–20]. Although it is widespread, the distribution of tungiasis is extremely heterogeneous. In Kenya for example, the national prevalence in 2021 was estimated to be 1.35% through randomized school-based surveys, but prevalence in individual schools ranged from less than 1–22.5% among affected schools [4]. Multiple surveys conducted in different countries that targeted communities known to have tungiasis, have reported prevalences from 7% in a Kenyan village [7] to 58.7% in southern Ethiopia [21] and 62.8% in north-eastern Uganda [22]. To date, several risk factor studies have been conducted in affected communities in different countries in Africa and in Brazil in South America. After age (under 15 years and over 60) and sex (male), most factors identified are related to poverty including living in low standard housing with earthen floors [23–26], not wearing closed shoes [21, 26, 27], presence of domestic animals [23, 28, 29], practicing open defecation [23, 26], and not washing feet daily with soap [7, 25, 30]. In this study we aimed to determine what factors might be associated with tungiasis in Napak district of the Karamoja subregion where the prevalence was extremely high [22]. Methods Study design This was an exploratory case-control study of children aged 8 to 14 years and their households. The surveys were carried out between January and March 2022, the main dry season for the area. Study area and population The study was conducted in 25 villages in three sub-counties (Lotome, Matany, Lokiteded) of Napak District in northeastern Uganda (Fig. 1 ). The area is inhabited mostly by the Karamojong people who have traditionally been pastoralists practicing transhumance in which the men and adolescent boys migrate with their livestock to find pasture and recently also to avoid violent stock theft [31]. The women, children and elderly people mostly live in permanent high-density house groupings enclosed in a barrier of thorny hedges or aggregates of sticks, known as manyattas. Within the manyatta, crude stick fencing separates homesteads and households as illustrated in Fig. 2 . Those that do not live in a manyatta live in open homestead clusters of households as illustrated in Fig. 2 C. In this study a household was considered to be a family unit of people who usually sleep in one or two structures and usually eat together. Manyattas comprise multiple households who may or may not be related to each other. Historically the Karamojong have suffered multiple affronts to their livelihoods from marginalization, loss of traditional communal land for pastoralism to private developers, livestock diseases, desert locust swarms, crop diseases, drought, famine and armed conflicts [32–34]. Consequently, this area has the highest poverty rate of the country, the lowest literacy rate among people over 10 years (25% v 74% nationally) [35] and at the time of the study was in the midst of a famine with 80% of the population had limited access to, or no food [32]. Sample size Since the study was conducted as part of a larger project conducted in Uganda and in two counties in Kenya, the sample size calculation was the same. Our sample size was based on the assumption that any factor that may put families at risk of infection might be present in the same proportion of the population as have the disease. Since at the time of planning there was no prior data on the disease prevalence in each of the target districts/counties, we assumed a prevalence of 20%. For an un-matched case-control study with a ratio of two for uninfected children (controls) to infected children (cases), assuming that 20% of the controls were exposed, and a least extreme odds ratio of 2 to be detected, we would require 126 cases and 252 controls to have 80% power at a 95% confidence level (based on OpenEpi Version 3). However, based on the lack of sufficient baseline data to inform our assumptions and since we planned to implement a multivariable analysis to identify risk factors, we increased the sample size by 30% guided by rules of thumb [36] and practical considerations. Consequently, our target sample size was at least 160 case households and 320 control households in Napak. Procedures Napak district was purposively selected as an area known to have a high prevalence of tungiasis [22]. Recruitment was conducted in Lotome sub-county, but when insufficient control households (no family member infected) were found, the study then moved to recruit households in villages in the sub-counties of Matany and Lokiteded, some distance from the Lotome villages. In these villages the population was of the same tribe, but they lived in lower density house structures as illustrated in Fig. 2 B and D. Within each village the Village Health Teams (VHTs) were asked to invite all children aged 8 to 14 years to a central location where they could be examined by the study team. Each child washed their feet under supervision. Trained field officers examined children’s hands and feet as described below. During the enrollment and examination of children, basic demographic information was collected regarding their age, sex, whether their house was in a manyatta and the material of their house floor (Additional file 1). After all children had been examined in each village only those sleeping in a house with an earthen floor were selected since this factor has been well-established as a major risk factor for tungiasis [5, 23, 24] and we sought to identify other possible factors among this population. This group of children (living in houses with earthen floors) was then stratified into those infected (“cases”) and uninfected (“controls”). When possible, in each village, a total of 10 index cases and 20 controls were randomly selected using the paper lottery method. If too few cases or controls were present in a village, all were selected. The households of the selected children were visited to enroll them in the study. Prior to enrollment of control households, the uninfected status of all household members was first verified. Any potential control households found to have any infected members were provided with treatment and not enrolled in the study. Clinical assessment procedures All children aged 8 to 14 years had their height and weight measured. The foot examinations were conducted systematically by observing their hands and nine zones on each foot in order from the largest toe to the smallest toe, the medial side, lateral side, the sole and the heel as described previously [5]. The tools used to record the examinations are included in Additional File 1. Those children found to have sand fleas embedded in the feet were assessed for intensity of infection by counting the number of fleas that were alive (round white lesion with dark spot at center or a hyperemic itchy and painful zone with a dark spot in the center); dead (black, irregular-shaped lesion); manipulated (lesion from where a flea had clearly been removed) or large clusters of embedded fleas in which individual fleas could not be counted as they were too close together. All participants were also examined for signs of other skin infections which could have included fungal infections, scabies, podoconiosis, cutaneous larva migrans, myiasis and warts. Caregiver interviews Caregiver interviews were conducted at the home, in a location which afforded privacy, following which observations were made of the homestead structures accompanied by the caregiver. All family members who were present at the time of the visit were systematically examined for tungiasis as described above. During the examination, simple demographic information was collected for all participants: age, sex, relationship to the household head, disabilities, other illnesses and the building they slept in. All adults were also asked about their level of education completed, marital status, alcohol use, religion and occupation. All interviews and observations were conducted using structured questionnaires (available in Additional File 1) which had been translated into Karamojong and were pre-tested in villages neighboring the study villages. Interviews were conducted by trained field officers from the community. Explanatory variables We aimed to explore details of a child’s life and the circumstances of their household. Since the fleas spend a considerable part of their life in the environment [8, 16] and transmission depends on contact between hosts and imagoes (adult fleas), we investigated factors relating to the physical structures of the houses, the state of repair and sanitation (cleanliness) of the various buildings they owned and who slept in which building and room. Since past studies had indicated a role for hygiene [7], we included access to water, soap and sanitation as well as foot washing behavior of both the caregiver and the index child, and the caregiver’s assistance to children younger than 8 to 14 years. Since animals can be infected [37] and contaminate the environment with flea eggs and organic matter would provide feed for off-host stages, we explored ownership of domestic animals and where they were kept. The level of education of adults was included since this has been shown to impact child health [38]. Based on previous personal observations in affected villages we included whether the index child or other family members had any mental or physical disability (not related to tungiasis) and also other skin diseases or long-term illness which could increase the vulnerability of families. Since tungiasis is a disease of neglect we wished to explore if this extended to parenting styles which had never been explored before. To this end we included variables which were conceptually related to neglect such as whether the parent knew the friends of their child and those friends’ parents. We asked how much time the caregiver spent with the child and whether they hugged their child and if this had been different when they were younger. Sometimes children who do not live with their biological parents may be neglected and treated differently to other family members which could make them more vulnerable to poor health outcomes including diseases such as tungiasis [42]. Consequently, we explored the family structure, how the index child was related to the head of household and the caregiver, who they would prefer to talk to when they felt unwell and whether they felt they received the same amount of food as other family members. Data analysis Study data were collected and managed using electronic data capture tools using the REDCap application [43] on handheld devices and data uploaded daily to a password protected server. All analyses were conducted in Stata/BE 18. For all children and adults examined, the number and proportion (%) infected were calculated. Correlation of infection with variables was first tested with a chi 2 test. The infection intensity for each infected individual was calculated as the sum of all fleas (of any stage live, dead and manipulated) on both feet, plus the number of flea clusters multiplied by 5 (as an estimate for an average number of fleas/cluster). All cases were classified as mild if they had 10 fleas or less and severe if they had more than 10 fleas, as described previously [5]. Since infection intensities for cases were not normally distributed, medians and interquartile ranges (IQR) were calculated and differences between age groups tested using a Kruskall-Wallis test and differences between sexes using the Wilcoxon rank sum test. Height-for-age and weight-for-age z scores were calculated using the “zanthro” extension for Stata with the UK-WHO Term Growth Charts for adolescents provided [44]. The proportion of children considered to be moderately or severely wasted or stunted was calculated based on the standard thresholds of z-scores of -2.0 for moderate and − 3.0 for severe. To determine if there was an association with socioeconomic status (SES), ownership of assets such as phone, radio, bicycle, motorbike, solar power system and land was included. In addition, the source of income (occupation) for the family was included. A SES variable for households was generated using polychoric principal component analysis incorporating ownership of a radio, mobile phone, bicycle, motorcycle, solar and livestock as detailed in Additional file 2, section S1. The association of SES with other explanatory variables was assessed using bivariable linear mixed effect models with village ID as a random effect and outcomes are presented in Additional file 2, Table S5 . The difference in distribution of participants by infection status and all categorical variables was tested using Chi 2 and is expressed as a p-value in the population characteristics tables. To assess the association of tungiasis with possible risk factors (independent explanatory variables), three different sets of bivariable and corresponding multivariable multilevel, maximum likelihood, mixed effects logistic models were used as detailed in Table 1 . In the results section we refer to these models by these numbers. The unique village identifier numbers were included as random effects to adjust for bias related to clustering. The dependent variable for each of the three models is described in Table 1 . Initially, bivariable analyses were run for each independent variable and then any variable with a p-value less than 0.2 was included in the full multivariable model. Backward elimination was used to develop the final model using Akaike information criteria (AIC) to compare quality of the models. Wald tests were used to confirm the role of variables in the final models. Univariable outcomes are presented as odds ratios (OR) and multivariable outcomes as adjusted odds ratios (aOR) with 95% confidence intervals (CI) and p-values. When suitable, some of the original explanatory variables with multiple categories were collapsed into fewer categories to have sufficient observations to include in the models. Table 1 Details of the three mixed effect logistic models run to assess factors associated with tungiasis Model number Participants Data collection tool Dependent variable N a 1 Children aged 8 to 14 years examined in the villages Demographics collected during examination Child had at least one flea vs. no infection 1619 2 Households of selected case and control index children aged 8 to 14 years Caregiver questionnaire Household had at least one case vs. no cases 568 3 All adults examined at the households of selected case and control index children Demographics collected during examination Adults had at least one flea vs. no infection 693 a number of observations included in the final multivariable model Results Study population characteristics A total of 1,619 children aged 8 to 14 years from 25 villages were examined and just over a half (54.1%, n = 876) were found to have tungiasis (Fig. 3 ) of whom 210 were selected as index cases. Of the uninfected children, 358 were selected as index controls for the household observations and caregiver interviews. Although we aimed for a ratio of 2 controls for every case, due to the very high prevalence we only managed a ratio of 1.7 controls for each case. In the households of index cases, a total of 265 adults and 287 children were examined, of whom 201 (75.8%) adults and 216 (75.3%) children were found to be infected (Fig. 3 ). Infection intensity of all identified cases Among all the 1298 cases, the selected index children and their household members, the median infection intensity was 8 fleas (IQR 3−21). There was no difference in infection intensity between male and female cases, except in the 8 to 14 years age group where boys had a higher median infection intensity than girls (9 v. 6, Wilcoxon test p = 0.004, Additional File Table S2 ). There was a significant difference in infection intensity between the age groups, (Kruskall-Wallis test p = 0.008) with adults over 60 years having the highest (median 18 fleas (IQR 5−38) and the 15- to 24-years age group had the lowest (median 4, IQR 3−6) (Additional File 2 Table S2 ). Demographic factors associated with tungiasis among children aged 8 to 14 years (model 1) Of the 1619 children examined, 45.7% (739) were boys, 76% (1232) lived in a manyatta, 27.5% (445) were either moderately or severely wasted and 14.4% (233) were moderately or severely stunted (Table 2 ). Almost a quarter (22.7%, n = 367) of all the children examined had another skin condition other than tungiasis, half (51.5%, n = 189) of which were identified as dermatophytosis. Compared to uninfected children, significantly more infected children were male, lived in a manyatta, and were severely wasted or stunted (Table 2 ). Table 2 Characteristics of children aged 8 to 14, by infection status Variable category All (n a ) Uninfected (n) Infected n (% b ) Chi 2 p-value All 1619 743 876 (54.1) Sex Female 880 450 430 (48.9) < 0.001 Male 739 293 446 (60.4) Live in a manyatta No 386 323 63 (16.3) < 0.001 Yes 1232 420 812 (65.9) Other skin disease No 1249 589 660 (52.8) 0.079 Yes 367 154 213 (58.0) Dermatophytosis No 178 69 110 (61.5) 0.196 Yes 189 86 103 (54.5) Floor of room sleep in Mud/soil 1607 737 870 (54.1) 0.774 Concrete 12 6 6 (50.0) Wasted No 1174 556 618 (52.6) 0.003 Moderate 315 146 169 (53.7) Severe 130 41 89 (68.5) Stunted No 1136 643 743 (53.6) 0.035 Moderate 175 83 92 (52.6) Severe 58 17 41 (70.7) a Number, b Percent infected All these variables were significantly associated with tungiasis infection in the bivariable model and were included in the full multivariable model (Table 3 ). During backward elimination stunting was removed. Children who lived in a manyatta had more than three times the odds of being infected (aOR3.51, 95% CI 1.57–7.83, p = 0.002). The odds of boys being infected was nearly twice as high than for girls (aOR 1.85, 95% CI 1.45−2.36, p < 0.001), and age was negatively associated with infection. Children who had another skin condition had higher odds of also having tungiasis (aOR 1.43, 95% CI 1.06−1.93, p = 0.018). Children who were severely wasted (more than 3.0 standard deviations below the mean) had twice the odds of being infected (aOR 2.12, 95% CI 1.33–3.38, p = 0.001). Table 3 Risk factors for tungiasis among children aged 8 to 14 years (Model 1) Bivariable Final multivariable (n = 1614) Variables Categories N a OR b 95% CI c P d aOR 95% CI P Age 1618 0.88 0.83 0.94 < 0.001 0.89 0.83 0.95 < 0.001 Sex Female 880 1 1 Male 739 1.89 1.49 2.4 < 0.001 1.85 1.45 2.36 < 0.001 Had another skin infection No 1249 1 1 Yes 367 1.53 1.14 2.06 0.004 1.43 1.06 1.93 0.018 Wasted No 1174 1 1 Moderate 315 1.19 0.89 1.6 0.245 1.02 0.75 1.39 0.888 Severe 130 2.46 1.56 3.88 < 0.001 2.12 1.33 3.38 0.001 Stunted No 1136 1 Moderate 175 1.15 0.78 1.67 0.480 Severe 58 1.67 0.83 3.37 0.153 Live in a manyatta No 386 1 1 Yes 1232 4.26 1.95 9.3 < 0.001 3.51 1.57 7.83 0.002 a number, b odds ratio, c confidence interval, d p-value, e adjusted odds ratio Household risk factors (model 2) As a result of the men spending most of their time away from home herding livestock, most respondents were female and referred to themselves as the head of the household (515, 90.7%) and the primary caregiver. Only 6.5% of the households reported the primary caregiver for the children was a man (Table 4 ). While efforts have been made to supply water to the communities so that 73% had access to water at a shared borehole, no effort seems to have been made to improve sanitation, with 80.3% practicing open defecation and 66.4% discarded waste anywhere. Most (93.4%) of the households had only one sleeping room in the main house where adults and children slept together, and 74.7% (424) of the index children slept in that room. Only 11.6% of index children slept in a separate hut specifically for teenagers (girls or boys). Approximately one third (31.5%) of the households lived in a shared compound or homestead with other households and 64.8% were located within a manyatta. Compared to control households, a significantly higher proportion of case households were within a manyatta, lived in a shared homestead, had a male index child, a female head of household, used a borehole for water, and had only none or one meal in the previous day. The distribution of all explanatory variables by household infection status (case or control) is included in the Additional file 2 Table S3 . Table 4 Household characteristics Variable Category All (n) Controls (n) Cases (n, %) Chi 2 p-value All 568 358 210 (37.1) Median HH size (IQR) 5 (4−6) 5 (4−6) 5 (4−6) HH 1 in a manyatta No 200 190 10 (5.0) < 0.001 Yes 368 168 200 (54.4) HH in a shared homestead No 389 256 133 (34.2) 0.042 Yes 179 106 77 (43.0) Sex index child Male 230 127 103 (44.8) 0.002 Female 339 231 108 (31.9) Sex HH head Male 54 41 13 (24.1) 0.038 Female 515 317 198 (38.5) Sex caregiver Male 32 19 13 (40.6) 0.669 Female 537 339 198 (36.9) Adult over 60 years in HH No 502 325 177 (35.3) 0.020 Yes 66 33 33 (50.0) Land status Not owned 185 114 71 (38.4) 0.657 Owned 384 244 140 (36.5) Water source piped or own well 31 30 1 (3.2) < 0.001 shared borehole 415 216 199 (48.0) unimproved/open 119 110 9 (7.6) Toilet Latrine 111 71 40 (36.0) 0.808 Open defecation 456 286 170 (37.3) Waste disposal Discarded anywhere 377 236 141 (37.4) 0.471 In a pit 55 39 16 (29.1) Collected and burned 130 81 49 (37.7) Number of meals yesterday 0 or 1 383 219 164 (42.8) < 0.001 2 or 3 185 139 47 (24.9) Income source Employed, other 13 11 2 (15.4) 0.002 Casual labor 367 219 148 (40.3) Farming 32 25 7 (21.9) Selling goods 76 59 17 (22.4) None 74 40 34 (46.0) Brew their own alcohol No 366 225 141 (38.5) 0.302 Yes 202 133 69 (34.2) 1 household From the interview with the main caregiver and observations of the homesteads, 24 variables for the household were found to be associated with being an infected (case) household in the bivariable analysis (Additional file 2 Table S4 ). However, once combined in the multivariable model and backward elimination was conducted, only six factors remained significant (Table 5 ). Despite being rare (36 households), having an index child with a disability, meant the household had five times the odds of infection than households that did not have a disabled index child (aOR 5.38, 95% CI 1.92−15.03, p = 0.001). Table 5 Household risk factors for tungiasis (model 3). a full multivariable (n = 543) final multivariable (n = 559) Variables Categories N b aOR c 95% CI d P e aOR 95% CI P Index child sex Female 339 1 Male 230 0.45 0.24 0.84 0.012 HHH f age 0.99 0.95 1.03 0.648 Caregiver age 1.01 0.98 1.05 0.417 Index child relationship to caregiver Child 432 1 Other 136 1.00 0.35 2.92 0.994 Socioeconomic status 1.25 0.30 5.27 0.761 Brew alcohol at home No 366 1 1 Yes 202 0.75 0.37 1.53 0.435 0.52 0.29 0.93 0.028 Number of jerricans water used daily 0-1.5 154 1 1.5-3 327 0.88 0.39 1.98 0.760 > 3 87 1.05 0.38 2.91 0.924 Caregiver foot wash frequency Twice a day 344 1 1 Less often 224 2.59 1.23 5.44 0.012 2.39 1.29 4.42 0.006 Caregiver soap-use for foot washing Always 54 1 Not always 513 0.69 0.21 2.29 0.540 Number of meals eaten yesterday 0 or 1 383 1 2 or 3 185 0.84 0.43 1.65 0.616 Toilet used Latrine 111 1 Open defecation 456 1.46 0.67 3.17 0.342 Index child relationship to HH head Child 432 1 Grandchild 63 1.90 0.41 8.93 0.415 Other 73 3.06 0.87 10.79 0.082 Index child disability No 532 1 1 Yes 36 6.66 2.17 20.50 0.001 5.38 1.92 15.03 0.001 Frequency wash young children Twice a day 329 1 Once a day 121 1.42 0.58 3.51 0.442 Less often 64 2.12 0.70 6.42 0.184 Never 52 1.61 0.55 4.71 0.385 Index child frequency wash feet Twice a day 388 1 Less often 159 0.76 0.30 1.93 0.563 Don’t know 21 2.83 0.11 71.04 0.527 Index child soap use for foot washing Always 28 1 1 Less often 521 4.08 0.63 26.40 0.140 4.73 1.11 20.19 0.036 Don’t know 19 0.39 0.01 16.54 0.619 3.00 0.36 24.71 0.308 Caregiver hugged index child Yes 287 1 1 No 278 1.72 0.92 3.23 0.090 1.79 1.02 3.13 0.041 Caregiver education None 395 1 Some 164 0.93 0.45 1.92 0.851 Family income source Selling goods g 76 1 None 74 1.03 0.26 4.09 0.969 Casual labor 367 2.36 0.82 6.81 0.112 Farming h 32 1.46 0.23 9.10 0.688 Employed, other 13 0.52 0.04 6.22 0.698 State of repair main house Good 373 1 Poor 155 1.42 0.71 2.81 0.319 Very poor (holes in walls & roof) 33 2.38 0.58 9.78 0.229 Index child room sanitation Swept & tidy 277 1 Not swept, items scattered 266 1.79 0.90 3.56 0.097 2.09 1.22 3.60 0.007 Other 19 0.37 0.05 2.51 0.309 0.42 0.08 2.09 0.289 Floor in index child sleep room Hard clay 398 1 Loose clay/soil 155 1.33 0.61 2.94 0.474 Other 15 0.23 0.02 2.41 0.219 a Univariable model in Additional file Table S6 ; b Number of households; c adjusted odds ratio; d confidence interval; e p-value; f head of household; g includes selling food, alcohol etc.; h crops or livestock. The caregivers of most households (n = 521) reported that their index child did not always use soap to wash their own feet, and these households had nearly five times the odds of infection than the few households (n = 28) whose index child was reported to always used soap (aOR 4.73, 95% CI 1.11−20.19, p = 0.036). In addition, if the caregiver reported they washed their own feet less than twice a day, the household had twice the odds of having tungiasis than if the caregivers reported they washed twice a day (aOR 2.39, 95% CI 1.29−4.42, p = 0.006). Related to the hygiene factors was the cleanliness of the houses which could affect the development of the flea off-host stages on the house floor. In 63.6% of case households the sleeping room of the index child (which was the main house for most) was not swept and clean and items were scattered around the room compared to 37.7% of control households. The households with an un-swept room for the index child had twice the odds of infection than households where the index child’s room was clean and tidy (aOR 2.09, 95% CI 1.22−3.60, p = 0.007). There was no association with the number, age nor sex of people sharing the same sleeping room. As a possible indicator of parenting style and neglect, caregivers were asked if they hug their child. Nearly half of them (49%) said they do not hug their child, and these households had twice the odds of being infected than those where the caregiver said they do hug the child (aOR 1.79, 95% CI 1.02−3.13, p = 0.041). There was no association with the frequency of feet washing by the index child as reported by the caregiver, the caregiver’s soap use practices, the type of toilet used, the age and sex of the head of household and caregiver, living in a manyatta, their SES, nor their income source. The state of repair and sanitation of the main house was dropped from the model due to collinearity as it was usually also the same place that the index child slept. In bivariable linear regression analysis for factors associated with SES (Additional file 2 Table S5 ), we found households situated within a manyatta had a lower SES than those that were not (β -0.16, 95% CI -0.24− -0.09, p < 0.001). Households who brewed alcohol at home had a higher SES than those who did not (β 0.16, 95% CI 0.11− 0.20, p < 0.001) while those who reported having no income source (β -0.20, 95% CI -0.29− -0.11, p < 0.001) or who reported doing casual labor (β -0.15, 95% CI -0.21− -0.09, p < 0.001), had a lower SES than those who reported they sold various goods which included some who sold alcohol. The only variable that was correlated with economic status that was also associated with tungiasis was the brewing of alcohol at home. The 35% of households who brewed alcohol at home had half the odds of infection than those that did not brew alcohol (aOR 0.52, 95% CI 0.29−0.93, p = 0.029). The main income source of the household head was associated with tungiasis in the univariable model, those having none or only casual labor had three times the odds of infection than those who sold food, alcohol or other goods, (OR 3.0, 95% CI 1.01–9.07, p = 0.046 and OR 3.12, 95%CI 1.37–7.13, p = 0.007 respectively). However, the income source was not retained in the final multivariable model. Table 5 . Household risk factors for tungiasis (model 3). a Risk factors for adults examined in index households (model 3). The distribution of adults by their own infection status and each variable is detailed in Table 6 . Of all the adults examined, 71% reported they were the head of their household, 84% were female and half were between 25 and 44 years old. The level of education of adults was very low, with more than two thirds (68.4%) having had no education. Table 6 Demographic characteristics of adults examined at the households. Variable Category All (%) Uninfected Infected (%) p-value a All 693 488 205 (29.6) Live in a manyatta No 248 (35.8) 238 10 (4.0) < 0.001 Yes 440 (63.5) 247 193 (43.9) Sex Female 583 (84.1) 407 176 (30.2) 0.420 Male 110 (15.9) 81 29 (26.4) Age groups 18–24 95 (13.7) 83 12 (12.6) 60 86 (12.4) 46 40 (46.5) Education level None 474 (68.4) 309 165 (34.8) < 0.001 Some primary 151 (21.8) 124 27 (17.9) More 68 (9.8) 55 13 (19.1) Relationship to HH head Self 489 (71.0) 346 143 (29.2) 0.088 Spouse 81 (11.7) 59 22 (27.1) Child 48 (6.9) 38 10 (20.8) Sibling 18 12 6 (33.3) Parent 26 12 14 (53.9) Other 31 21 10 (32.3) Marital status Married 540 (77.9) 396 144 (26.7) 0.002 Other 153 (22.1) 92 61 (39.9) Occupation None 116 (16.7) 67 49 (42.2) < 0.001 Casual labor 423 (61.0) 289 134 (31.7) Farming 46 (6.6) 37 9 (19.6) Selling goods 90 (13.0) 79 11 (12.2) Other 18 (2.6) 16 2 (11.1) Disability No 633 (91.3) 460 173 (27.3) < 0.001 Yes 60 (8.7) 28 32 (53.3) Other illness No 397 (57.3) 303 111 (37.5) < 0.001 Yes 296 (42.7) 185 94 (23.7) Alcohol use No 106 (15.3) 82 24 (22.6) 0.089 Yes 587 (84.7) 406 181 (30.8) Building usually sleep in Main house 621 (89.6) 440 181 (29.2) 0.032 Kitchen 2 (0.3) 0 2 Separate hut 31 (4.5) 25 6 (19.4) Other 39 (5.6) 23 16 (43.9) a p-value from Chi 2 test The adult model was complicated by the fact that almost all variables were each independently associated with SES; age, education, marital status, occupation and living in a manyatta (Additional file 2, Table S5 ). As a result of this SES and manyatta were excluded from the final model but the others were still retained. Those who reported having no occupation had six times higher odds of infection (aOR 5.86, 95% CI 1.86−18.50, p = 0.003), and those doing casual labor had five times higher odds (aOR 4.89, 95% CI 1.82−12.67, p = 0.001) than those who reported selling various goods, which may have included selling alcohol (Table 7 ). There was an association of infection with an adult’s age, those over 45 years, who represented 35.5% of all adults examined, having nearly five times higher odds of infection than those aged 18 to 24 (45–60 years: aOR 4.88, 95% CI 1.93−12.32, p = 0.001, over 60 years: aOR 4.71, 95% CI 1.56−14.18, p = 0.006). The majority (85%) of adults reported they drank alcohol, and they had five times the odds of being infected than those (106) who reported they never drank alcohol (aOR 4.74, 95% CI 1.93−11.68, p = 0.001). Adults who reported having another illness had twice the odds of infection than those who reported having no other illness (aOR 2.30, 95% CI 1.35−3.92, p = 0.002). There was no association of adult infection with living in a manyatta, education level achieved, marital status nor disability. Table 7 Risk factors for tungiasis among adults in Napak (model 3). Discussion In this study we set out to determine what factors might be associated with tungiasis in Napak District of the Karamoja sub-region where there was an extremely high prevalence of tungiasis [22], and that could be used to inform the design of future intervention programs. Working in the same district but different villages, we confirmed the high prevalence and that this, and the intensity of infection, was highest among children under 15 years and adults over 60 years. This age distribution is common in all endemic areas [7, 23, 24], but it was unusual to see a lower prevalence and intensity of infection among adult men compared to women. Very few men were included in the study since they spend most of their lives away from the homes, attending to livestock in distant areas, to find better pasture and to avoid armed cattle raiding [32]. Those enrolled in the study were possibly only there for a short time and their prolonged absence likely protected them from tungiasis infection at home. In addition, according to cultural practices men can bathe openly in any water source while women must hide themselves which possibly makes it harder for them to bathe regularly (Mutebi unpublished observation). We identified three new factors which have not been reported before that were associated with tungiasis; for children this was living in a manyatta and for a household it was having a child with a disability and for adult infection it was drinking alcohol. Factors which have previously been identified and held true in this unique agro-pastoralist community included nutrition status, hygiene practices and sanitation of the child’s room, having another skin disease, age and sex of the child, and SES of their family. One of the new risk factors for children, which is unique to this part of the world, was living in the manyatta settlement structure. However, this was not significant at the household level nor for the adult’s infection status. This could be the result of the smaller sample size in the selected households, or the other household and adult factors were more important. There are two plausible reasons why living in manyattas may be associated with infection in children, one is the lower SES of households within manyattas compared to those not in manyattas which we present in Additional file 2, table S5 . Tungiasis has long been considered a disease of poverty and in this study and a previous study [4], it has been demonstrated using an asset score, that tungiasis infection in children is associated with low SES of their household. Another possible cause of the association could be that the population density is high in manyattas compared to other villages, as illustrated in Fig. 2 . High population density likely increases the odds of someone in the village having an infection and higher odds of other people coming into contact with free-living imago female fleas in the soil. People with disabilities in affected communities tend to have a high infection intensity and extremely severe pathology [45]. In the current study only 36 index children had a disability, and their infection intensity was not different to other cases, but their household had a higher odds of infection than those whose child was not disabled. This was not a formal clinical assessment of disability but reported by the caregivers responding to the household interviews and interviewer observations. People with disabilities (both physical or mental) tend to sit or lie on the ground for extended periods every day, where they would be very vulnerable to host-seeking adult female sand fleas. For the household infection, the higher odds may be due to the infected disabled person increasing the density of off-host stages inside the house as well as increased stress of caring for the disabled person, the extra financial burden or a lower income for the family. It is also possible the disabled child was infected because other family members were and brought it into the home where the disabled child was very vulnerable to being infected. This factor needs to be investigated further where more people with disabilities are enrolled. Another risk factor for children aged 8 to 14 years was their nutritional status. Severe stunting and wasting were both associated with tungiasis, but since they were also associated with each other, only wasting was retained in the final model. This region experiences chronic food shortages and at the time of the survey the whole region was experiencing famine as a culmination of many factors [32, 51]. Our data shows 68% of households had only had one meal the previous day. A previous study in Kenya recently also demonstrated an association of tungiasis with malnutrition [11]. Whether there is any causal relationship requires further study, but it is possible that both co-occur because of extreme poverty. Several previous studies have identified poor hygiene practices to be a risk factor for tungiasis [4, 6, 7, 25, 30], both frequency of washing feet and use of soap when doing so. In the current study, households where the caregiver reported that the index child did not always use soap had a five times higher odds of infection, and households where the caregiver herself washed her feet less than twice a day also had higher odds of infection. The causal link with hygiene is unknown but it is conceivable that regular washing of feet could remove fecal residue from the embedded fleas and so reduce odors which are attractive to other host-seeking fleas. The physical rubbing action involved in feet-washing may also remove attached fleas before they fully penetrate the skin. Household tungiasis infection was also found to be associated with the state of cleanliness of the index child’s sleeping room, often the only room of the house shared with other family members, which has been reported to be a risk factor in a few previous studies [23, 26]. Dirty floors with items scattered over them likely provide appropriate conditions, such as organic matter and undisturbed loose soil, for the survival and development of flea larvae and pupae. Tungiasis in children and adults was associated with them having other skin conditions or other illnesses respectively. It is likely these would co-occur in the same households on account of their low SES and poor hygiene, but in the models where SES was available, these associations remained even when the models included SES. It is possible that people with tungiasis have an elevated stress level either as a result of the tungiasis or another stressor in their life which dysregulates their immune system and makes them more vulnerable to other diseases [52]. We have also shown an association with malnutrition which compromises the immune system [53]. In addition, tungiasis prevalence was higher in manyattas where the high population density may facilitate transmission of other infections. Alcohol use has never been reported as a risk factor for tungiasis before. Here we found it associated with infection of adults, but their consumption was not associated with the infection status of their household. In Karamoja alcohol use is widespread (85% of the adults examined for tungiasis), and is considered to be a cultural norm, with the drinks often being brewed by the household (36% of households in this study), from sorghum and millet. Mostly these are of low alcohol content, and are consumed as a food particularly in times of food insecurity, even by children [33]. Alcohol consumption is usually a social activity and leads people to sit for extended periods in communal areas, with at least their feet on the ground where they are exposed to host-seeking sand fleas. In addition, adults who consume alcohol may neglect their personal hygiene. In contrast, the brewing of alcohol at home was associated with lower odds of infection in a household, likely because they are selling it and had a higher SES, as we show in Additional file 2, table S5 . Study Limitations The main limitation of this study was that many variables had few observations in some categories, leading to rather wide confidence intervals and therefore limiting our ability to draw strong conclusions for some of the factors driving the high prevalence in this area, including child disability, caregiver and child soap-use for washing feet. Conclusions The very high prevalence seen in this region of northeastern Uganda may well be the result of the extremely high-density settlements. Once the parasite entered the community it was able to spread very quickly due to the population density, extreme poverty, parenting behavior and poor hygiene practices. Children with disabilities living in these conditions have high odds of becoming infected. Control programs in this area need to work with the community to integrate regular treatment of people and house floors with increased foot-washing and soap-use and improved childcare. Abbreviations aOR adjusted odds ratio AIC Akaike information coefficient CI confidence interval HH household IQR inter-quartile range N number OR odds ratio SES socioeconomic status Declarations Ethics approval and consent to participate This study was conducted in accordance with the Helsinki Declaration. Administrative clearance was obtained from Napak District Local Government (CR/205/1). Ethical review and clearance for the study was provided by the Vector Control Division-Research and Ethics Committee of the Ministry of Health (Reference VCDREC/101/UG-REC-018) and the Ethikkommission of the Charité Berlin (reference number EA2/100/16). The study was accredited with the Uganda National Council of Science and Technology (Reference SS 4815). Prior to any interview and foot examinations of household members, informed consent was sought from the household head or their representative. Adults (18 years and above) provided informed consent for themselves and their younger children. Children aged 12 to 17 years were also asked to provide informed assent before their examination. All data were collected on PIN protected electronic tablets, stored on password protected RedCap databases on the icipe servers. Data were analyzed after exporting to Excel without the inclusion of personal identifiers. All participants with tungiasis were treated with dimeticone oils (NYDA® PLUS). For those with secondary bacterial infection and other illnesses requiring treatment, a referral was made to the nearest health facility. Consent for publication Not applicable Availability of data and materials The datasets supporting the conclusions of this article are available in the Additional files associated with this manuscript. Competing interests All authors have no conflict of interest to declare. Funding Information Research funding for this work was provided by the German Research Foundation (DFG) through the project “Tungiasis in East-Africa - an interdisciplinary approach to understand the interactions between parasite and host” (project number 405027164; KR 2245/7-1) granted to Jürgen Krücken, Amina Abubakar, Ulrike Fillinger and Charles Waiswa. LE was supported by a Wellcome Trust Career Re-Entry Fellowship (grant number 213724/Z/18/Z). The views expressed herein do not necessarily reflect the official opinion of the donors. The funders had neither a role in the design of the study, nor in collection, analysis, interpretation of data nor in writing the manuscript. Author Contributions Conceptualization, LE, UF, HF, FM, CW, AA & JK; Methodology, LE, UF, FM, CW & JK; Formal Analysis, LE, UF, JK; Investigation, AM, FM, BO, Resources, UF, JK, CW.; Data Curation, LE, FM, AM, BO.; Writing – Original Draft Preparation, LE.; Writing – Review & Editing, AM, BO, FM, UF, JK, HF, CW; Visualization, LE, FM; Supervision, CW, AA, UF, JK; Project Administration, UF, JK, AA, FM; CW; Funding Acquisition, UF, JK, AA, CW. Acknowledgements We are grateful to the communities who participated, the sub-county technical teams and the District Health and Education Offices of Napak district Local Government who gave their approval for the study. We are grateful to Andrew Espira for the set up and maintenance of the RedCap data collection tools and database. We thank the field data collectors and the Village Health Teams (VHTs) for their long hard days of work. References World_Health_Organization. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. Geneva: World Health Organization 2020. World_Health_Organization. Ending the neglect to attain the Sustainable Development Goals: a strategic framework for integrated control and management of skin-related neglected tropical diseases. Geneva2022. World_Health_Assembly. Skin diseases as a global public health priority. 2025. Elson L, Kamau C, Koech S, Muthama C, Gachomba G, Sinoti E, et al. National prevalence and risk factors for tungiasis in Kenya. Infect Dis Poverty. 2023;12(1):85. doi: 0.1186/s40249-023-01131-x. Elson L, Matharu AK, Riithi N, Ouma P, Mutebi F, Feldmeier H, et al. Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures. Infectious Diseases of Poverty. 2023;12(1):24. doi: 10.1186/s40249-023-01080-5. Elson L, Wiese S, Feldmeier H, Fillinger U. Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya II: Results from a school-based observational study. PLoS Negl Trop Dis. 2019;13(5):e0007326. doi: 10.1371/journal.pntd.0007326. Wiese S, Elson L, Reichert F, Mambo B, Feldmeier H. Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya: I. Results from a community-based study. PLoS Negl Trop Dis. 2017;11(10):e0005925. doi: 10.1371/journal.pntd.0005925. Matharu AK, Ouma P, Njoroge MM, Amugune BL, Hyuga A, Mutebi F, et al. Identification of tungiasis infection hotspots with a low-cost, high-throughput method for extracting Tunga penetrans (Siphonaptera) off-host stages from soil samples-An observational study. PLoS Negl Trop Dis. 2024;18(2):e0011601. doi: 10.1371/journal.pntd.0011601. Amugune BL, Matharu AK, Ouma P, Mutebi F, Elson L, Fillinger U, et al. Cost-Effective PCR-Based Identification of Tunga penetrans (Siphonaptera) Larvae Extracted from Soil Samples Containing PCR Inhibitor-Rich Material. Insects. 2022;14(1). doi: 10.3390/insects14010005. PubMed PMID: 36661934. Elson L, Nyawa SM, Matharu A, Fillinger U. Developing low-cost house floors to control tungiasis in Kenya - a feasibility study. BMC Public Health. 2023;23(1):2483. Epub 20231212. doi: 10.1186/s12889-023-17427-4. PubMed PMID: 38087242; PubMed Central PMCID: PMCPMC10714545. Elson L, Kamau C, Koech S, Muthama C, Gachomba G, Sinoti E, et al. Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life. PLoS Negl Trop Dis. 2024;18(5):e0011800. doi: 10.1371/journal.pntd.0011800. Otieno B, Elson L, Matharu AK, Riithi N, Chongwo E, Katana K, et al. Neurocognitive and mental health outcomes in children with tungiasis: a cross-sectional study in rural Kenya and Uganda. Infectious Diseases of Poverty. 2023;12(1):100. doi: 10.1186/s40249-023-01154-4. Wiese S, Elson L, Feldmeier H. Tungiasis-related life quality impairment in children living in rural Kenya. PLoS Negl Trop Dis. 2018;12(1):e0005939. doi: 10.1371/journal.pntd.0005939. Heukelbach J, de Oliveira FA, Hesse G, Feldmeier H. Tungiasis: a neglected health problem of poor communities. Trop Med Int Health. 2001;6(4):267-72. doi: 10.1046/j.1365-3156.2001.00716.x. Eisele M, Heukelbach J, Van Marck E, Mehlhorn H, Meckes O, Franck S, et al. Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man. Parasitol Res. 2003;90(2):87-99. doi: 10.1007/s00436-002-0817-y. Nagy N, Abari E, D'Haese J, Calheiros C, Heukelbach J, Mencke N, et al. Investigations on the life cycle and morphology of Tunga penetrans in Brazil. Parasitol Res. 2007;101 Suppl 2:S233-42. doi: 10.1007/s00436-007-0683-8. Linardi PM, Calheiros CML, Campelo-Junior EB, Duarte EM, Heukelbach J, Feldmeier H. Occurrence of the off-host life stages of Tunga penetrans (Siphonaptera) in various environments in Brazil. Annals of Tropical Medicine & Parasitology. 2010;104(4):337-45. doi: 10.1179/136485910X12743554759902. Kimotho S, Neville_Miller A, Ngure P. Managing communication surrounding tungiasis stigma in Kenya. Communicatio. 2015;41(4):523-42. McNeilly H, Thielecke M, Mutebi F, Banalyaki M, Reichert F, Wiese S, et al. Tungiasis Stigma and Control Practices in a Hyperendemic Region in Northeastern Uganda. Trop Med Infect Dis. 2023;8(4). doi: 10.3390/tropicalmed8040206. Worth C, Heukelbach J Fau - Fengler G, Fengler G Fau - Walter B, Walter B Fau - Liesenfeld O, Liesenfeld O Fau - Feldmeier H, Feldmeier H. Impaired quality of life in adults and children with scabies from an impoverished community in Brazil. Int J Dermatol. 2012;51(3):275-82. doi: 10.1111/j.1365-4632.2011.05017.x. Girma M, Astatkie A, Asnake S. Prevalence and risk factors of tungiasis among children of Wensho district, southern Ethiopia. BMC Infect Dis. 2018;18(1):456. doi: 10.1186/s12879-018-3373-5. Mutebi F, McNeilly H, Thielecke M, Reichert F, Wiese S, Mukone G, et al. Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda. Trop Med Infect Dis. 2023;8(2). Epub 2023/02/25. doi: 10.3390/tropicalmed8020111. PubMed PMID: 36828527; PubMed Central PMCID: PMCPMC9963877. Muehlen M, Feldmeier H, Wilcke T, Winter B, Heukelbach J. Identifying risk factors for tungiasis and heavy infestation in a resource-poor community in northeast Brazil. Trans R Soc Trop Med Hyg. 2006;100(4):371-80. doi: 10.1016/j.trstmh.2005.06.033. Ugbomoiko US, Ariza L, Ofoezie IE, Heukelbach J. Risk factors for tungiasis in Nigeria: identification of targets for effective intervention. PLoS Negl Trop Dis. 2007;1(3):e87. doi: 10.1371/journal.pntd.0000087. Nsanzimana J, Karanja S, Kayongo M, Nyirimanzi N, Umuhoza H, Murangwa A, et al. Factors associated with tungiasis among primary school children: a cross-sectional study in a rural district in Rwanda. BMC Public Health. 2019;19(1):1192. doi: 10.1186/s12889-019-7481-y. Nyangacha RM, Odongo D, Oyieke F, Bii C, Muniu E, Chasia S, et al. Spatial distribution, prevalence and potential risk factors of Tungiasis in Vihiga County, Kenya. PLoS Negl Trop Dis. 2019;13(3):e0007244. Epub 2019/03/13. doi: 10.1371/journal.pntd.0007244. PubMed PMID: 30860992; PubMed Central PMCID: PMCPMC6413899. Mwangi J, Ozwara H, Gicheru M. Epidemiology of tunga penetrans infestation in selected areas in Kiharu constituency, Murang’a County, Kenya. Tropical Diseases, Travel Medicine and Vaccines. 2015;1:13. Pilger D, Schwalfenberg S, Heukelbach J, Witt L, Mehlhorn H, Mencke N, et al. Investigations on the biology, epidemiology, pathology, and control of Tunga penetrans in Brazil: VII. The importance of animal reservoirs for human infestation. Parasitol Res. 2008;102(5):875-80. Epub 2008/01/04. doi: 10.1007/s00436-007-0840-0. PubMed PMID: 18172688. Wafula ST, Ssemugabo C, Namuhani N, Musoke D, Ssempebwa J, Halage AA. Prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda. Pan Afr Med J. 2016;24:77. Epub 2016/09/20. doi: 10.11604/pamj.2016.24.77.8916. PubMed PMID: 27642416; PubMed Central PMCID: PMCPMC5012786. Ahirirwe SR, Migisha R, Mwine P, Bulage L, Kwesiga B, Kadobera D, et al. Investigation of human tungiasis cases, Sheema District, Uganda, November 2021-February 2022. Pan African Medical Journal. 2023;46(71). doi: doi: 10.11604/pamj.2023.46.71.41277. Powell J. Karamoja: A literature review. Saferworld, 2010. Cullis A, and R. L. Arasio. 2022. . The 2022 Humanitarian Crisis in Karamoja, Uganda: A real-time review. . Karamoja Resilience Support Unit, Feinstein International Center, Friedman School of Nutrition Science andPol icy, Tufts University, Kampala., 2022. Iyer P, Stites E. Trauma, loss and other psychosocial drivers of excessive alcohol consumption in Karamoja, Uganda. Pastoralism. 2021;11(1):30. doi: 10.1186/s13570-021-00199-0. Odhiambo MaA, R. L. 2024. . Privatization of Land and Its Impacts on Agro-pastoral Livelihoods in Karamoja, Uganda. Case studies of Moroto and Nakapiripirit Districts. Karamoja Resilience Support Unit, Feinstein International Center, Friedman School of Nutrition Science and Policy at Tufts University, Kampala., 2024. Uganda_Bureau_of_Statistics. The National Population and Housing Census 2024 – Final Report. Kampala, Uganda: 2024. Vittinghoff E, McCulloch C. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710-8. Mutebi F, Krücken J, Feldmeier H, Waiswa C, Mencke N, Sentongo E. Animal Reservoirs of Zoonotic Tungiasis in Endemic Rural Villages of Uganda. PLoS Negl Trop Dis. 2015;9(10):e0004126. doi: 10.1371/journal.pntd.0004126. Zaidman EA, Scott KM, Hahn D, Bennett P, Caldwell PH. Impact of parental health literacy on the health outcomes of children with chronic disease globally: A systematic review. J Paediatr Child Health. 2023;59(1):12-31. Epub 20221219. doi: 10.1111/jpc.16297. PubMed PMID: 36536542. Berry JO, Jones WH. The Parental Stress Scale: Initial Psychometric Evidence. Journal of Social and Personal Relationships. 1995;12(3):463-72. doi: 10.1177/0265407595123009. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine. 2001;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x. Ministry_of_Health_Kenya. Patient Health Questionnaire-9 (PHQ-9) for Depression Screening. Beal SJ, Greiner MV. Children in nonparental care: health and social risks. Pediatric Research. 2016;79(1):184-90. doi: 10.1038/pr.2015.198. PA Harris RT, R Thielke, J Payne, N Gonzalez, JG. Conde, . Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81. doi: 10.1016/j.jbi.2008.08.010. Vidmar SI, Cole T, Pan H. Standardizing Anthropometric Measures in Children and Adolescents with Functions for Egen: Update. Stata Journal 2013;13.2:366–78. doi: 10.1177/1536867x1301300211. Miller H, Ocampo J, Ayala A, Trujillo J, Feldmeier H. Very severe tungiasis in Amerindians in the Amazon lowland of Colombia: A case series. PLoS Negl Trop Dis. 2019;13(2):e0007068. Epub 2019/02/08. doi: 10.1371/journal.pntd.0007068. PubMed PMID: 30730885. Collins G, McLeod T, Konfor N, Lamnyam C, Ngarka L, Leo N. Tungiasis: A Neglected Health Problem in Rural Cameroun. International Journal of Collaborative Research on Internal Medicine & Public Health. 2009;1(1):2-10. Chopra M. Risk factors for undernutrition of young children in a rural area of South Africa. Public Health Nutr. 2003;6(7):645-52. doi: 10.1079/phn2003477. PubMed PMID: 14552665. Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, et al. Inequality in early childhood: risk and protective factors for early child development. The Lancet. 2011;378(9799):1325-38. doi: https://doi.org/10.1016/S0140-6736(11)60555-2. Walker SP, Wachs TD, Meeks Gardner J, Lozoff B, Wasserman GA, Pollitt E, et al. Child development: risk factors for adverse outcomes in developing countries. The Lancet. 2007;369(9556):145-57. doi: https://doi.org/10.1016/S0140-6736(07)60076-2. Do H, McCoy DC. The Relations Between Caregiver Education, Home Stimulation, and Children’s Developmental Outcomes: Research in Majority World Countries. International Journal of Early Childhood. 2024. doi: 10.1007/s13158-024-00398-x. Barrantes A, Caravani M. Situational Analysis of Food, Nutrition and Income Security in Karamoja: A normalising view of Karamoja. UK: Developmental Pathways, 2020. Seiler A, Fagundes CP, Christian LM. The Impact of Everyday Stressors on the Immune System and Health. In: Choukèr A, editor. Stress Challenges and Immunity in Space: From Mechanisms to Monitoring and Preventive Strategies. Cham: Springer International Publishing; 2020. p. 71-92. Morales F, Montserrat-de la Paz S, Leon MJ, Rivero-Pino F. Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children's Health Status: A Literature Review. Nutrients. 2023;16(1). Epub 20231219. doi: 10.3390/nu16010001. PubMed PMID: 38201831; PubMed Central PMCID: PMCPMC10780435. Additional Declarations No competing interests reported. Supplementary Files ElsonKaramojatungiasisHHQuestionnaire.docx Additional file 1: a zipped folder with the study questionnaires. ElsonKaramojatungiasisAdditionalfile218072025.docx Additional file 2: an MS word document with multiple sections: S1: Stata output results for the polychoric factor analysis for Socioeconomic status Table S2: Infection intensity score of all cases by age groups and sex Table S3: Household characteristics Table S4: Univariable logistic regression for household risk factors for tungiasis Table S5: Adult and Household factors associated with socioeconomic status ElsonKaramojachildren814footexamdataset.xlsx Additional file 3. Elson Karamoja children 8-14 foot exam dataset.xlsx Description: Microsoft excel workbook containing data and associated codebook for data collected January and March 2022 during examination of children in Karamoja, northeastern Uganda. Contains 62 variables for 1619 observations, 476 Kb ElsonKaramojaHHRiskFactordataset.xlsx Additional file 4. Elson Karamoja HH Risk Factor dataset.xlsx Description: Microsoft excel workbook containing data and associated codebook for data collected January and March 2022 during interviews of caregivers in Karamoja, northeastern Uganda. Contains 162 variables for 568 observations, 488 Kb. ElsonKaramojaadultfootexamdataset.xlsx Additional file 5. Elson Karamoja adult foot exam dataset.xlsx Description: Microsoft excel workbook containing data and associated codebook for data collected January and March 2022 during examination of adults in Karamoja, northeastern Uganda. Contains 67 variables for 673 observations, 213 Kb. ElsonKaramojatungiasisadultfootexam.pdf ElsonKaramojatungiasischildfootexam.pdf Cite Share Download PDF Status: Published Journal Publication published 03 Mar, 2026 Read the published version in Tropical Medicine and Health → Version 1 posted Editorial decision: Revision requested 16 Sep, 2025 Reviews received at journal 16 Sep, 2025 Reviews received at journal 01 Sep, 2025 Reviewers agreed at journal 21 Aug, 2025 Reviewers agreed at journal 19 Aug, 2025 Reviewers invited by journal 12 Aug, 2025 Editor assigned by journal 12 Aug, 2025 Submission checks completed at journal 12 Aug, 2025 First submitted to journal 04 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7288997","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":501458007,"identity":"417b95f0-b11e-4e96-91c3-4ad81ecb21bf","order_by":0,"name":"Lynne Elson","email":"","orcid":"","institution":"University of Oxford","correspondingAuthor":false,"prefix":"","firstName":"Lynne","middleName":"","lastName":"Elson","suffix":""},{"id":501458008,"identity":"6c4bd66f-ab85-444a-b981-294da1db3fc8","order_by":1,"name":"Abneel K. Matharu","email":"","orcid":"","institution":"Freie Universität Berlin","correspondingAuthor":false,"prefix":"","firstName":"Abneel","middleName":"K.","lastName":"Matharu","suffix":""},{"id":501458009,"identity":"7731001b-1bbf-4c93-9416-41eecc43818d","order_by":2,"name":"Berrick Otieno","email":"","orcid":"","institution":"Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Berrick","middleName":"","lastName":"Otieno","suffix":""},{"id":501458010,"identity":"4105417f-5fda-4b5b-b71e-336d7ab7d5e5","order_by":3,"name":"Herman Feldmeier","email":"","orcid":"","institution":"Charité University Medicine","correspondingAuthor":false,"prefix":"","firstName":"Herman","middleName":"","lastName":"Feldmeier","suffix":""},{"id":501458011,"identity":"c4061307-e0fc-4deb-a502-f5b29a119015","order_by":4,"name":"Charles Waiswa","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"","lastName":"Waiswa","suffix":""},{"id":501458013,"identity":"e8530580-b234-4716-bdab-722ad8794508","order_by":5,"name":"Amina Abubakar","email":"","orcid":"","institution":"Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Amina","middleName":"","lastName":"Abubakar","suffix":""},{"id":501458017,"identity":"242a60f0-4e7b-47c8-84cd-0c82e054f9ab","order_by":6,"name":"Jürgen Krücken","email":"","orcid":"","institution":"Freie Universität Berlin","correspondingAuthor":false,"prefix":"","firstName":"Jürgen","middleName":"","lastName":"Krücken","suffix":""},{"id":501458018,"identity":"6ece51ca-dfb9-4bfc-a6fc-7c1f52f89eb2","order_by":7,"name":"Ulrike Fillinger","email":"","orcid":"","institution":"International Centre of Insect Physiology and Ecology (ICIPE)","correspondingAuthor":false,"prefix":"","firstName":"Ulrike","middleName":"","lastName":"Fillinger","suffix":""},{"id":501458020,"identity":"45a704ff-2bfb-498b-99d3-fbe5a499447f","order_by":8,"name":"Francis Mutebi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYBAC9gYQaQDhMDMY2DAw8BDQwnMAroUZpCWNWC0MMC0Mh4nQIn342YMfBXUMujPyDz4uKDgfzd9zgPHDD4bDdg24tPClmRv2GBxmMLuRzGw8w+B27oyzDcySPQyHk3FpsedhMJNmMDgA0sImzQPU0nCegUEa6MJknA7jYf8G1FIH0sL+m8fgXO788wzMv/Fr4QHZwgy2hZnH4EDuhrMNbCBb7PBoKZME+oXH7MxjY+kZBsm5G88cbLPsMUhPwOOwbRI//tTJmR1PfPi54I9d7rwzyYdv/KiwtselBa4Vic3YAIrcxAZCejAAQVtGwSgYBaNgxAAAO2xOujJSesgAAAAASUVORK5CYII=","orcid":"","institution":"Makerere University","correspondingAuthor":true,"prefix":"","firstName":"Francis","middleName":"","lastName":"Mutebi","suffix":""}],"badges":[],"createdAt":"2025-08-04 08:53:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7288997/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7288997/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s41182-025-00841-2","type":"published","date":"2026-03-03T15:58:45+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89456290,"identity":"b55f4752-aea8-47ed-a377-8c65858566f2","added_by":"auto","created_at":"2025-08-20 07:02:36","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78347,"visible":true,"origin":"","legend":"\u003cp\u003eMaps of A) Africa, B) Uganda and C) Napak district in the Karamoja sub-region to show the study sites. B) adapted from a map extracted from Mutebi 2023 [22] (cc by 4.0), C) based on a map extracted from Powell 2010 [31] (permission for use obtained).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/42c6fae87a6d6b564cfddbe3.jpg"},{"id":89454383,"identity":"4a304a5f-d41c-4575-b89b-bcce4e5fd567","added_by":"auto","created_at":"2025-08-20 06:46:36","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":192992,"visible":true,"origin":"","legend":"\u003cp\u003eA) Aerial image of a manyatta taken from Google Earth. B) Aerial image of homesteads not in a manyatta, taken from Google Earth, C) a typical manyatta (credit Mutebi), D) households in an open homestead (credit Mutebi).\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/99c3beff4602a8a8c14da25d.jpg"},{"id":89457199,"identity":"02ed5f03-4e53-4ecd-a0d0-fc7279c561ac","added_by":"auto","created_at":"2025-08-20 07:10:36","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":72610,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow chart. HH, household.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/b5fec20d478a62d5d57a9ee9.jpg"},{"id":104250850,"identity":"d1f7d755-0516-45e1-a87c-9d3981142433","added_by":"auto","created_at":"2026-03-09 16:10:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2101022,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/cbabcfd6-250b-42a0-b7b3-41c1284b9d41.pdf"},{"id":89454386,"identity":"ce82dfde-d322-4433-ada6-09ee4f70994a","added_by":"auto","created_at":"2025-08-20 06:46:36","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":466177,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 1: a zipped folder with the study questionnaires.\u003c/p\u003e","description":"","filename":"ElsonKaramojatungiasisHHQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/585974785708873f959e59c5.docx"},{"id":89454389,"identity":"72b2df05-5bdb-42f2-860f-25b5557834f0","added_by":"auto","created_at":"2025-08-20 06:46:36","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":137220,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 2: an MS word document with multiple sections:\u003c/p\u003e\n\u003cp\u003eS1: Stata output results for the polychoric factor analysis for Socioeconomic status\u003c/p\u003e\n\u003cp\u003eTable S2: Infection intensity score of all cases by age groups and sex\u003c/p\u003e\n\u003cp\u003eTable S3: Household characteristics\u003c/p\u003e\n\u003cp\u003eTable S4: Univariable logistic regression for household risk factors for tungiasis\u003c/p\u003e\n\u003cp\u003eTable S5: Adult and Household factors associated with socioeconomic status\u003c/p\u003e","description":"","filename":"ElsonKaramojatungiasisAdditionalfile218072025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/04c06e8efc5f58fe1e71b424.docx"},{"id":89455711,"identity":"34dd6154-74e4-4811-a02e-d8a3a49a92d5","added_by":"auto","created_at":"2025-08-20 06:54:36","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":477631,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 3. Elson Karamoja children 8-14 foot exam dataset.xlsx\u003c/p\u003e\n\u003cp\u003eDescription: Microsoft excel workbook containing data and associated codebook for data collected January and March 2022 during examination of children in Karamoja, northeastern Uganda. Contains 62 variables for 1619 observations, 476 Kb\u003c/p\u003e","description":"","filename":"ElsonKaramojachildren814footexamdataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/3b24c3340a8f7d260ad638ce.xlsx"},{"id":89456291,"identity":"3057f0fc-34ed-43be-b333-da44bbea723d","added_by":"auto","created_at":"2025-08-20 07:02:36","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":490559,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 4. Elson Karamoja HH Risk Factor dataset.xlsx\u003c/p\u003e\n\u003cp\u003eDescription: Microsoft excel workbook containing data and associated codebook for data collected January and March 2022 during interviews of caregivers in Karamoja, northeastern Uganda. \u0026nbsp;Contains 162 variables for 568 observations, 488 Kb.\u003c/p\u003e","description":"","filename":"ElsonKaramojaHHRiskFactordataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/c4b2fda7152ca04331c61a1b.xlsx"},{"id":89457200,"identity":"0794f2e4-4031-4920-a3f2-44e8ef14a683","added_by":"auto","created_at":"2025-08-20 07:10:36","extension":"xlsx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":216346,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional file 5. Elson Karamoja adult foot exam dataset.xlsx\u003c/p\u003e\n\u003cp\u003eDescription: Microsoft excel workbook containing data and associated codebook for data collected January and March 2022 during examination of adults in Karamoja, northeastern Uganda. Contains 67 variables for 673 observations, 213 Kb.\u003c/p\u003e","description":"","filename":"ElsonKaramojaadultfootexamdataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/5fc1894f58d4309509d017ab.xlsx"},{"id":89455719,"identity":"347707e3-3dfd-400a-a0a3-8ec95ce35ea4","added_by":"auto","created_at":"2025-08-20 06:54:37","extension":"pdf","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":74889,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"ElsonKaramojatungiasisadultfootexam.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/8e44ab138420a0a38c4d0a7e.pdf"},{"id":89454404,"identity":"74a48f2c-1a0a-4236-aca0-4ecbb86281b5","added_by":"auto","created_at":"2025-08-20 06:46:37","extension":"pdf","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":73130,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"ElsonKaramojatungiasischildfootexam.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7288997/v1/2db304d3545ce0957c4e4bf0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"High density rural settlements, parenting behavior and child disability are significant factors associated with tungiasis in Karamoja, northeastern Uganda: a case control study","fulltext":[{"header":"Background","content":"\u003cp\u003eTungiasis has recently received renewed attention due to its addition to the World Health Organization’s list of Neglected Tropical Diseases[1], as a Neglected Tropical Skin Disease targeted for control [2] and now the adoption of a resolution by the 78th World Health Assembly of “Skin Diseases as a Global Public Health Priority”[3]. In the past few years epidemiological [4–7], entomological [8], genomic [9] and intervention studies [10] have been conducted to better understand the ecology and impact [11–13] of the parasite and how it might be controlled.\u003c/p\u003e\u003cp\u003eTungiasis, also known as sand flea disease or “jiggers” in Africa, is caused by female adult \u003cem\u003eTunga penetrans\u003c/em\u003e [14]. The disease is widespread in South America, the Caribbean, and Sub-Saharan Africa, mostly affecting extremely resource poor, marginalized families in rural and peri-urban communities [14]. The adult female flea (imago) burrows into the skin, usually of the feet, and grows 2000-fold in size as the eggs develop in its abdomen [15]. Eggs are deposited into the environment where they hatch and if conditions are suitable, the larvae will feed and develop into pupae and the adults will emerge approximately three weeks later [16]. The main location for off-host development is on the earthen floors of people’s sleeping rooms [8, 17]. The growing female flea induces a strong inflammatory response which causes considerable pain and itching which in turn cause difficulty in walking, sleeping and concentration in class [11, 13]. Children with tungiasis have been shown to have poor cognitive function [12], lower academic achievement [11], and to experience stigma and discrimination [18–20].\u003c/p\u003e\u003cp\u003eAlthough it is widespread, the distribution of tungiasis is extremely heterogeneous. In Kenya for example, the national prevalence in 2021 was estimated to be 1.35% through randomized school-based surveys, but prevalence in individual schools ranged from less than 1–22.5% among affected schools [4]. Multiple surveys conducted in different countries that targeted communities known to have tungiasis, have reported prevalences from 7% in a Kenyan village [7] to 58.7% in southern Ethiopia [21] and 62.8% in north-eastern Uganda [22].\u003c/p\u003e\u003cp\u003eTo date, several risk factor studies have been conducted in affected communities in different countries in Africa and in Brazil in South America. After age (under 15 years and over 60) and sex (male), most factors identified are related to poverty including living in low standard housing with earthen floors [23–26], not wearing closed shoes [21, 26, 27], presence of domestic animals [23, 28, 29], practicing open defecation [23, 26], and not washing feet daily with soap [7, 25, 30].\u003c/p\u003e\u003cp\u003eIn this study we aimed to determine what factors might be associated with tungiasis in Napak district of the Karamoja subregion where the prevalence was extremely high [22].\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was an exploratory case-control study of children aged 8 to 14 years and their households. The surveys were carried out between January and March 2022, the main dry season for the area.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy area and population\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study was conducted in 25 villages in three sub-counties (Lotome, Matany, Lokiteded) of Napak District in northeastern Uganda (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The area is inhabited mostly by the Karamojong people who have traditionally been pastoralists practicing transhumance in which the men and adolescent boys migrate with their livestock to find pasture and recently also to avoid violent stock theft [31]. The women, children and elderly people mostly live in permanent high-density house groupings enclosed in a barrier of thorny hedges or aggregates of sticks, known as manyattas. Within the manyatta, crude stick fencing separates homesteads and households as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Those that do not live in a manyatta live in open homestead clusters of households as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC. In this study a household was considered to be a family unit of people who usually sleep in one or two structures and usually eat together. Manyattas comprise multiple households who may or may not be related to each other.\u003c/p\u003e\u003cp\u003eHistorically the Karamojong have suffered multiple affronts to their livelihoods from marginalization, loss of traditional communal land for pastoralism to private developers, livestock diseases, desert locust swarms, crop diseases, drought, famine and armed conflicts [32–34]. Consequently, this area has the highest poverty rate of the country, the lowest literacy rate among people over 10 years (25% v 74% nationally) [35] and at the time of the study was in the midst of a famine with 80% of the population had limited access to, or no food [32].\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSince the study was conducted as part of a larger project conducted in Uganda and in two counties in Kenya, the sample size calculation was the same. Our sample size was based on the assumption that any factor that may put families at risk of infection might be present in the same proportion of the population as have the disease. Since at the time of planning there was no prior data on the disease prevalence in each of the target districts/counties, we assumed a prevalence of 20%. For an un-matched case-control study with a ratio of two for uninfected children (controls) to infected children (cases), assuming that 20% of the controls were exposed, and a least extreme odds ratio of 2 to be detected, we would require 126 cases and 252 controls to have 80% power at a 95% confidence level (based on OpenEpi Version 3). However, based on the lack of sufficient baseline data to inform our assumptions and since we planned to implement a multivariable analysis to identify risk factors, we increased the sample size by 30% guided by rules of thumb [36] and practical considerations. Consequently, our target sample size was at least 160 case households and 320 control households in Napak.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNapak district was purposively selected as an area known to have a high prevalence of tungiasis [22]. Recruitment was conducted in Lotome sub-county, but when insufficient control households (no family member infected) were found, the study then moved to recruit households in villages in the sub-counties of Matany and Lokiteded, some distance from the Lotome villages. In these villages the population was of the same tribe, but they lived in lower density house structures as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB and D.\u003c/p\u003e\u003cp\u003eWithin each village the Village Health Teams (VHTs) were asked to invite all children aged 8 to 14 years to a central location where they could be examined by the study team. Each child washed their feet under supervision. Trained field officers examined children’s hands and feet as described below. During the enrollment and examination of children, basic demographic information was collected regarding their age, sex, whether their house was in a manyatta and the material of their house floor (Additional file 1).\u003c/p\u003e\u003cp\u003eAfter all children had been examined in each village only those sleeping in a house with an earthen floor were selected since this factor has been well-established as a major risk factor for tungiasis [5, 23, 24] and we sought to identify other possible factors among this population. This group of children (living in houses with earthen floors) was then stratified into those infected (“cases”) and uninfected (“controls”). When possible, in each village, a total of 10 index cases and 20 controls were randomly selected using the paper lottery method. If too few cases or controls were present in a village, all were selected.\u003c/p\u003e\u003cp\u003eThe households of the selected children were visited to enroll them in the study. Prior to enrollment of control households, the uninfected status of all household members was first verified. Any potential control households found to have any infected members were provided with treatment and not enrolled in the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eClinical assessment procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll children aged 8 to 14 years had their height and weight measured. The foot examinations were conducted systematically by observing their hands and nine zones on each foot in order from the largest toe to the smallest toe, the medial side, lateral side, the sole and the heel as described previously [5]. The tools used to record the examinations are included in Additional File 1. Those children found to have sand fleas embedded in the feet were assessed for intensity of infection by counting the number of fleas that were alive (round white lesion with dark spot at center or a hyperemic itchy and painful zone with a dark spot in the center); dead (black, irregular-shaped lesion); manipulated (lesion from where a flea had clearly been removed) or large clusters of embedded fleas in which individual fleas could not be counted as they were too close together. All participants were also examined for signs of other skin infections which could have included fungal infections, scabies, podoconiosis, cutaneous larva migrans, myiasis and warts.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCaregiver interviews\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCaregiver interviews were conducted at the home, in a location which afforded privacy, following which observations were made of the homestead structures accompanied by the caregiver. All family members who were present at the time of the visit were systematically examined for tungiasis as described above. During the examination, simple demographic information was collected for all participants: age, sex, relationship to the household head, disabilities, other illnesses and the building they slept in. All adults were also asked about their level of education completed, marital status, alcohol use, religion and occupation.\u003c/p\u003e\u003cp\u003eAll interviews and observations were conducted using structured questionnaires (available in Additional File 1) which had been translated into Karamojong and were pre-tested in villages neighboring the study villages. Interviews were conducted by trained field officers from the community.\u003c/p\u003e\u003cp\u003eExplanatory variables\u003c/p\u003e\u003cp\u003eWe aimed to explore details of a child’s life and the circumstances of their household. Since the fleas spend a considerable part of their life in the environment [8, 16] and transmission depends on contact between hosts and imagoes (adult fleas), we investigated factors relating to the physical structures of the houses, the state of repair and sanitation (cleanliness) of the various buildings they owned and who slept in which building and room. Since past studies had indicated a role for hygiene [7], we included access to water, soap and sanitation as well as foot washing behavior of both the caregiver and the index child, and the caregiver’s assistance to children younger than 8 to 14 years. Since animals can be infected [37] and contaminate the environment with flea eggs and organic matter would provide feed for off-host stages, we explored ownership of domestic animals and where they were kept. The level of education of adults was included since this has been shown to impact child health [38]. Based on previous personal observations in affected villages we included whether the index child or other family members had any mental or physical disability (not related to tungiasis) and also other skin diseases or long-term illness which could increase the vulnerability of families.\u003c/p\u003e\u003cp\u003eSince tungiasis is a disease of neglect we wished to explore if this extended to parenting styles which had never been explored before. To this end we included variables which were conceptually related to neglect such as whether the parent knew the friends of their child and those friends’ parents. We asked how much time the caregiver spent with the child and whether they hugged their child and if this had been different when they were younger.\u003c/p\u003e\u003cp\u003e Sometimes children who do not live with their biological parents may be neglected and treated differently to other family members which could make them more vulnerable to poor health outcomes including diseases such as tungiasis [42]. Consequently, we explored the family structure, how the index child was related to the head of household and the caregiver, who they would prefer to talk to when they felt unwell and whether they felt they received the same amount of food as other family members.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eStudy data were collected and managed using electronic data capture tools using the REDCap application [43] on handheld devices and data uploaded daily to a password protected server. All analyses were conducted in Stata/BE 18.\u003c/p\u003e\u003cp\u003eFor all children and adults examined, the number and proportion (%) infected were calculated. Correlation of infection with variables was first tested with a chi\u003csup\u003e2\u003c/sup\u003e test.\u003c/p\u003e\u003cp\u003eThe infection intensity for each infected individual was calculated as the sum of all fleas (of any stage live, dead and manipulated) on both feet, plus the number of flea clusters multiplied by 5 (as an estimate for an average number of fleas/cluster). All cases were classified as mild if they had 10 fleas or less and severe if they had more than 10 fleas, as described previously [5]. Since infection intensities for cases were not normally distributed, medians and interquartile ranges (IQR) were calculated and differences between age groups tested using a Kruskall-Wallis test and differences between sexes using the Wilcoxon rank sum test.\u003c/p\u003e\u003cp\u003eHeight-for-age and weight-for-age z scores were calculated using the “zanthro” extension for Stata with the UK-WHO Term Growth Charts for adolescents provided [44]. The proportion of children considered to be moderately or severely wasted or stunted was calculated based on the standard thresholds of z-scores of -2.0 for moderate and − 3.0 for severe.\u003c/p\u003e\u003cp\u003eTo determine if there was an association with socioeconomic status (SES), ownership of assets such as phone, radio, bicycle, motorbike, solar power system and land was included. In addition, the source of income (occupation) for the family was included. A SES variable for households was generated using polychoric principal component analysis incorporating ownership of a radio, mobile phone, bicycle, motorcycle, solar and livestock as detailed in Additional file 2, section S1. The association of SES with other explanatory variables was assessed using bivariable linear mixed effect models with village ID as a random effect and outcomes are presented in Additional file 2, Table \u003cspan refid=\"MOESM5\" class=\"InternalRef\"\u003eS5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe difference in distribution of participants by infection status and all categorical variables was tested using Chi\u003csup\u003e2\u003c/sup\u003e and is expressed as a p-value in the population characteristics tables.\u003c/p\u003e\u003cp\u003eTo assess the association of tungiasis with possible risk factors (independent explanatory variables), three different sets of bivariable and corresponding multivariable multilevel, maximum likelihood, mixed effects logistic models were used as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In the results section we refer to these models by these numbers. The unique village identifier numbers were included as random effects to adjust for bias related to clustering. The dependent variable for each of the three models is described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Initially, bivariable analyses were run for each independent variable and then any variable with a p-value less than 0.2 was included in the full multivariable model. Backward elimination was used to develop the final model using Akaike information criteria (AIC) to compare quality of the models. Wald tests were used to confirm the role of variables in the final models. Univariable outcomes are presented as odds ratios (OR) and multivariable outcomes as adjusted odds ratios (aOR) with 95% confidence intervals (CI) and p-values. When suitable, some of the original explanatory variables with multiple categories were collapsed into fewer categories to have sufficient observations to include in the models.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDetails of the three mixed effect logistic models run to assess factors associated with tungiasis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel number\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParticipants\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eData collection tool\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDependent variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChildren aged 8 to 14 years examined in the villages\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDemographics collected during examination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChild had at least one flea vs. no infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1619\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHouseholds of selected case and control index children aged 8 to 14 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCaregiver questionnaire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHousehold had at least one case vs. no cases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e568\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll adults examined at the households of selected case and control index children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDemographics collected during examination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdults had at least one flea vs. no infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e693\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea\u003c/sup\u003e number of observations included in the final multivariable model\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eStudy population characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 1,619 children aged 8 to 14 years from 25 villages were examined and just over a half (54.1%, n\u0026thinsp;=\u0026thinsp;876) were found to have tungiasis (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) of whom 210 were selected as index cases. Of the uninfected children, 358 were selected as index controls for the household observations and caregiver interviews. Although we aimed for a ratio of 2 controls for every case, due to the very high prevalence we only managed a ratio of 1.7 controls for each case. In the households of index cases, a total of 265 adults and 287 children were examined, of whom 201 (75.8%) adults and 216 (75.3%) children were found to be infected (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eInfection intensity of all identified cases\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong all the 1298 cases, the selected index children and their household members, the median infection intensity was 8 fleas (IQR 3\u0026minus;21). There was no difference in infection intensity between male and female cases, except in the 8 to 14 years age group where boys had a higher median infection intensity than girls (9 v. 6, Wilcoxon test p\u0026thinsp;=\u0026thinsp;0.004, Additional File Table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e). There was a significant difference in infection intensity between the age groups, (Kruskall-Wallis test p\u0026thinsp;=\u0026thinsp;0.008) with adults over 60 years having the highest (median 18 fleas (IQR 5\u0026minus;38) and the 15- to 24-years age group had the lowest (median 4, IQR 3\u0026minus;6) (Additional File 2 Table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eDemographic factors associated with tungiasis among children aged 8 to 14 years (model 1)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOf the 1619 children examined, 45.7% (739) were boys, 76% (1232) lived in a manyatta, 27.5% (445) were either moderately or severely wasted and 14.4% (233) were moderately or severely stunted (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Almost a quarter (22.7%, n\u0026thinsp;=\u0026thinsp;367) of all the children examined had another skin condition other than tungiasis, half (51.5%, n\u0026thinsp;=\u0026thinsp;189) of which were identified as dermatophytosis. Compared to uninfected children, significantly more infected children were male, lived in a manyatta, and were severely wasted or stunted (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of children aged 8 to 14, by infection status\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAll (n\u003csup\u003ea\u003c/sup\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUninfected (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eInfected\u003c/p\u003e\u003cp\u003en (%\u003csup\u003eb\u003c/sup\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChi\u003csup\u003e2\u003c/sup\u003e p-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1619\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e743\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e876 (54.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e880\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e430 (48.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e739\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e446 (60.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive in a manyatta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e63 (16.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e420\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e812 (65.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther skin disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e589\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e660 (52.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e213 (58.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDermatophytosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e110 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.196\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e103 (54.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFloor of room sleep in\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMud/soil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1607\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e870 (54.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.774\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConcrete\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWasted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e556\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e618 (52.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e169 (53.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e89 (68.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStunted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e743 (53.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e92 (52.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e41 (70.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e Number, \u003csup\u003eb\u003c/sup\u003e Percent infected\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAll these variables were significantly associated with tungiasis infection in the bivariable model and were included in the full multivariable model (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). During backward elimination stunting was removed. Children who lived in a manyatta had more than three times the odds of being infected (aOR3.51, 95% CI 1.57\u0026ndash;7.83, p\u0026thinsp;=\u0026thinsp;0.002). The odds of boys being infected was nearly twice as high than for girls (aOR 1.85, 95% CI 1.45\u0026minus;2.36, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and age was negatively associated with infection. Children who had another skin condition had higher odds of also having tungiasis (aOR 1.43, 95% CI 1.06\u0026minus;1.93, p\u0026thinsp;=\u0026thinsp;0.018). Children who were severely wasted (more than 3.0 standard deviations below the mean) had twice the odds of being infected (aOR 2.12, 95% CI 1.33\u0026ndash;3.38, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRisk factors for tungiasis among children aged 8 to 14 years (Model 1)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e\u003cp\u003eBivariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e\u003cp\u003eFinal multivariable (n\u0026thinsp;=\u0026thinsp;1614)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e95% CI\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eaOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1618\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e880\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e739\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHad another skin infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWasted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e0.888\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStunted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive in a manyatta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e7.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"12\"\u003e\u003csup\u003ea\u003c/sup\u003e number, \u003csup\u003eb\u003c/sup\u003e odds ratio, \u003csup\u003ec\u003c/sup\u003e confidence interval, \u003csup\u003ed\u003c/sup\u003e p-value, \u003csup\u003ee\u003c/sup\u003e adjusted odds ratio\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eHousehold risk factors (model 2)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAs a result of the men spending most of their time away from home herding livestock, most respondents were female and referred to themselves as the head of the household (515, 90.7%) and the primary caregiver. Only 6.5% of the households reported the primary caregiver for the children was a man (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). While efforts have been made to supply water to the communities so that 73% had access to water at a shared borehole, no effort seems to have been made to improve sanitation, with 80.3% practicing open defecation and 66.4% discarded waste anywhere. Most (93.4%) of the households had only one sleeping room in the main house where adults and children slept together, and 74.7% (424) of the index children slept in that room. Only 11.6% of index children slept in a separate hut specifically for teenagers (girls or boys). Approximately one third (31.5%) of the households lived in a shared compound or homestead with other households and 64.8% were located within a manyatta.\u003c/p\u003e\u003cp\u003eCompared to control households, a significantly higher proportion of case households were within a manyatta, lived in a shared homestead, had a male index child, a female head of household, used a borehole for water, and had only none or one meal in the previous day. The distribution of all explanatory variables by household infection status (case or control) is included in the Additional file 2 Table \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003eS3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHousehold characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControls (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCases\u003c/p\u003e\u003cp\u003e(n, %)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eChi\u003csup\u003e2\u003c/sup\u003e p-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e568\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e210 (37.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian HH size (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (4\u0026minus;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (4\u0026minus;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (4\u0026minus;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHH\u003csup\u003e1\u003c/sup\u003e in a manyatta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e200 (54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHH in a shared homestead\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e389\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e133 (34.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77 (43.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex index child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e103 (44.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e108 (31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex HH head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (24.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e515\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e317\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e198 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (40.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.669\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e537\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e198 (36.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdult over 60 years in HH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e177 (35.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLand status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot owned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e71 (38.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.657\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOwned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e384\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e140 (36.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWater source\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003epiped or own well\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (3.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eshared borehole\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e415\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e199 (48.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eunimproved/open\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToilet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLatrine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40 (36.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.808\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpen defecation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e456\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e170 (37.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWaste disposal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiscarded anywhere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e377\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e141 (37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.471\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn a pit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 (29.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollected and burned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49 (37.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of meals yesterday\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 or 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e164 (42.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 or 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47 (24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncome source\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed, other\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCasual labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e148 (40.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelling goods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 (22.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 (46.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBrew their own alcohol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e366\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e141 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.302\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e69 (34.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e1\u003c/sup\u003e household\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFrom the interview with the main caregiver and observations of the homesteads, 24 variables for the household were found to be associated with being an infected (case) household in the bivariable analysis (Additional file 2 Table \u003cspan refid=\"MOESM4\" class=\"InternalRef\"\u003eS4\u003c/span\u003e). However, once combined in the multivariable model and backward elimination was conducted, only six factors remained significant (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Despite being rare (36 households), having an index child with a disability, meant the household had five times the odds of infection than households that did not have a disabled index child (aOR 5.38, 95% CI 1.92\u0026minus;15.03, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHousehold risk factors for tungiasis (model 3).\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e\u003cp\u003efull multivariable (n\u0026thinsp;=\u0026thinsp;543)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e\u003cp\u003efinal multivariable (n\u0026thinsp;=\u0026thinsp;559)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eaOR\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e95% CI\u003csup\u003ed\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eaOR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex child sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHHH\u003csup\u003ef\u003c/sup\u003e age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.648\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex child relationship to caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.994\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocioeconomic status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.761\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBrew alcohol at home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e366\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.435\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of jerricans water used daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0-1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.5-3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e327\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.760\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.924\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver foot wash frequency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwice a day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e344\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess often\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e4.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver soap-use for foot washing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot always\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of meals eaten yesterday\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 or 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 or 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToilet used\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLatrine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpen defecation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e456\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex child relationship to HH head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGrandchild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.415\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex child disability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e15.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrequency wash young children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwice a day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e329\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOnce a day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.442\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess often\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.385\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex child frequency wash feet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwice a day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess often\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e71.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.527\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex child soap use for foot washing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAlways\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess often\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e20.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.619\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e24.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.308\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver hugged index child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.090\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e395\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.851\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily income source\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelling goods\u003csup\u003eg\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.969\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCasual labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarming\u003csup\u003eh\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployed, other\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eState of repair main house\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery poor (holes in walls \u0026amp; roof)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndex child room sanitation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSwept \u0026amp; tidy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot swept, items scattered\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e266\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e2.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.289\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFloor in index child sleep room\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHard clay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e398\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLoose clay/soil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003ea\u003c/sup\u003e Univariable model in Additional file Table \u003cspan refid=\"MOESM6\" class=\"InternalRef\"\u003eS6\u003c/span\u003e; \u003csup\u003eb\u003c/sup\u003eNumber of households; \u003csup\u003ec\u003c/sup\u003e adjusted odds ratio; \u003csup\u003ed\u003c/sup\u003e confidence interval; \u003csup\u003ee\u003c/sup\u003e p-value; \u003csup\u003ef\u003c/sup\u003e head of household; \u003csup\u003eg\u003c/sup\u003e includes selling food, alcohol etc.; \u003csup\u003eh\u003c/sup\u003e crops or livestock.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe caregivers of most households (n\u0026thinsp;=\u0026thinsp;521) reported that their index child did not always use soap to wash their own feet, and these households had nearly five times the odds of infection than the few households (n\u0026thinsp;=\u0026thinsp;28) whose index child was reported to always used soap (aOR 4.73, 95% CI 1.11\u0026minus;20.19, p\u0026thinsp;=\u0026thinsp;0.036). In addition, if the caregiver reported they washed their own feet less than twice a day, the household had twice the odds of having tungiasis than if the caregivers reported they washed twice a day (aOR 2.39, 95% CI 1.29\u0026minus;4.42, p\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e\u003cp\u003eRelated to the hygiene factors was the cleanliness of the houses which could affect the development of the flea off-host stages on the house floor. In 63.6% of case households the sleeping room of the index child (which was the main house for most) was not swept and clean and items were scattered around the room compared to 37.7% of control households. The households with an un-swept room for the index child had twice the odds of infection than households where the index child\u0026rsquo;s room was clean and tidy (aOR 2.09, 95% CI 1.22\u0026minus;3.60, p\u0026thinsp;=\u0026thinsp;0.007). There was no association with the number, age nor sex of people sharing the same sleeping room.\u003c/p\u003e\u003cp\u003e As a possible indicator of parenting style and neglect, caregivers were asked if they hug their child. Nearly half of them (49%) said they do not hug their child, and these households had twice the odds of being infected than those where the caregiver said they do hug the child (aOR 1.79, 95% CI 1.02\u0026minus;3.13, p\u0026thinsp;=\u0026thinsp;0.041).\u003c/p\u003e\u003cp\u003eThere was no association with the frequency of feet washing by the index child as reported by the caregiver, the caregiver\u0026rsquo;s soap use practices, the type of toilet used, the age and sex of the head of household and caregiver, living in a manyatta, their SES, nor their income source. The state of repair and sanitation of the main house was dropped from the model due to collinearity as it was usually also the same place that the index child slept.\u003c/p\u003e\u003cp\u003eIn bivariable linear regression analysis for factors associated with SES (Additional file 2 Table \u003cspan refid=\"MOESM5\" class=\"InternalRef\"\u003eS5\u003c/span\u003e), we found households situated within a manyatta had a lower SES than those that were not (β -0.16, 95% CI -0.24\u0026minus; -0.09, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Households who brewed alcohol at home had a higher SES than those who did not (β 0.16, 95% CI 0.11\u0026minus; 0.20, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) while those who reported having no income source (β -0.20, 95% CI -0.29\u0026minus; -0.11, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) or who reported doing casual labor (β -0.15, 95% CI -0.21\u0026minus; -0.09, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), had a lower SES than those who reported they sold various goods which included some who sold alcohol. The only variable that was correlated with economic status that was also associated with tungiasis was the brewing of alcohol at home. The 35% of households who brewed alcohol at home had half the odds of infection than those that did not brew alcohol (aOR 0.52, 95% CI 0.29\u0026minus;0.93, p\u0026thinsp;=\u0026thinsp;0.029). The main income source of the household head was associated with tungiasis in the univariable model, those having none or only casual labor had three times the odds of infection than those who sold food, alcohol or other goods, (OR 3.0, 95% CI 1.01\u0026ndash;9.07, p\u0026thinsp;=\u0026thinsp;0.046 and OR 3.12, 95%CI 1.37\u0026ndash;7.13, p\u0026thinsp;=\u0026thinsp;0.007 respectively). However, the income source was not retained in the final multivariable model.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Household risk factors for tungiasis (model 3).\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eRisk factors for adults examined in index households (model 3).\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe distribution of adults by their own infection status and each variable is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Of all the adults examined, 71% reported they were the head of their household, 84% were female and half were between 25 and 44 years old. The level of education of adults was very low, with more than two thirds (68.4%) having had no education.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of adults examined at the households.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAll (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUninfected\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eInfected (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e488\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e205 (29.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLive in a manyatta\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e248 (35.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e238\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e440 (63.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e247\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e193 (43.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e583 (84.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e407\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e176 (30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.420\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e110 (15.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29 (26.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95 (13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12 (12.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e352 (50.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84 (23.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e160 (23.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e69 (43.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86 (12.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40 (46.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e474 (68.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e309\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e165 (34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSome primary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e151 (21.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27 (17.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13 (19.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRelationship to HH head\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e489 (71.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e143 (29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81 (11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 (27.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSibling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14 (53.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10 (32.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e540 (77.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e396\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e144 (26.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153 (22.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e61 (39.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e116 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49 (42.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCasual labor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e423 (61.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e134 (31.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46 (6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9 (19.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelling goods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90 (13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11 (12.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e633 (91.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e173 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32 (53.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e397 (57.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e111 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e296 (42.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e94 (23.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlcohol use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e106 (15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24 (22.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e587 (84.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e181 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBuilding usually sleep in\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMain house\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e621 (89.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e181 (29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKitchen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (0.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSeparate hut\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31 (4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39 (5.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16 (43.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003ea\u003c/sup\u003e p-value from Chi\u003csup\u003e2\u003c/sup\u003e test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe adult model was complicated by the fact that almost all variables were each independently associated with SES; age, education, marital status, occupation and living in a manyatta (Additional file 2, Table \u003cspan refid=\"MOESM5\" class=\"InternalRef\"\u003eS5\u003c/span\u003e). As a result of this SES and manyatta were excluded from the final model but the others were still retained. Those who reported having no occupation had six times higher odds of infection (aOR 5.86, 95% CI 1.86\u0026minus;18.50, p\u0026thinsp;=\u0026thinsp;0.003), and those doing casual labor had five times higher odds (aOR 4.89, 95% CI 1.82\u0026minus;12.67, p\u0026thinsp;=\u0026thinsp;0.001) than those who reported selling various goods, which may have included selling alcohol (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere was an association of infection with an adult\u0026rsquo;s age, those over 45 years, who represented 35.5% of all adults examined, having nearly five times higher odds of infection than those aged 18 to 24 (45\u0026ndash;60 years: aOR 4.88, 95% CI 1.93\u0026minus;12.32, p\u0026thinsp;=\u0026thinsp;0.001, over 60 years: aOR 4.71, 95% CI 1.56\u0026minus;14.18, p\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e\u003cp\u003eThe majority (85%) of adults reported they drank alcohol, and they had five times the odds of being infected than those (106) who reported they never drank alcohol (aOR 4.74, 95% CI 1.93\u0026minus;11.68, p\u0026thinsp;=\u0026thinsp;0.001). Adults who reported having another illness had twice the odds of infection than those who reported having no other illness (aOR 2.30, 95% CI 1.35\u0026minus;3.92, p\u0026thinsp;=\u0026thinsp;0.002). There was no association of adult infection with living in a manyatta, education level achieved, marital status nor disability.\u003c/p\u003e\u003cp\u003eTable 7 Risk factors for tungiasis among adults in Napak (model 3).\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" width=\"695\" height=\"597\"\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study we set out to determine what factors might be associated with tungiasis in Napak District of the Karamoja sub-region where there was an extremely high prevalence of tungiasis [22], and that could be used to inform the design of future intervention programs. Working in the same district but different villages, we confirmed the high prevalence and that this, and the intensity of infection, was highest among children under 15 years and adults over 60 years. This age distribution is common in all endemic areas [7, 23, 24], but it was unusual to see a lower prevalence and intensity of infection among adult men compared to women. Very few men were included in the study since they spend most of their lives away from the homes, attending to livestock in distant areas, to find better pasture and to avoid armed cattle raiding [32]. Those enrolled in the study were possibly only there for a short time and their prolonged absence likely protected them from tungiasis infection at home. In addition, according to cultural practices men can bathe openly in any water source while women must hide themselves which possibly makes it harder for them to bathe regularly (Mutebi unpublished observation).\u003c/p\u003e\u003cp\u003eWe identified three new factors which have not been reported before that were associated with tungiasis; for children this was living in a manyatta and for a household it was having a child with a disability and for adult infection it was drinking alcohol. Factors which have previously been identified and held true in this unique agro-pastoralist community included nutrition status, hygiene practices and sanitation of the child\u0026rsquo;s room, having another skin disease, age and sex of the child, and SES of their family.\u003c/p\u003e\u003cp\u003eOne of the new risk factors for children, which is unique to this part of the world, was living in the manyatta settlement structure. However, this was not significant at the household level nor for the adult\u0026rsquo;s infection status. This could be the result of the smaller sample size in the selected households, or the other household and adult factors were more important. There are two plausible reasons why living in manyattas may be associated with infection in children, one is the lower SES of households within manyattas compared to those not in manyattas which we present in Additional file 2, table \u003cspan refid=\"MOESM5\" class=\"InternalRef\"\u003eS5\u003c/span\u003e. Tungiasis has long been considered a disease of poverty and in this study and a previous study [4], it has been demonstrated using an asset score, that tungiasis infection in children is associated with low SES of their household. Another possible cause of the association could be that the population density is high in manyattas compared to other villages, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. High population density likely increases the odds of someone in the village having an infection and higher odds of other people coming into contact with free-living imago female fleas in the soil.\u003c/p\u003e\u003cp\u003ePeople with disabilities in affected communities tend to have a high infection intensity and extremely severe pathology [45]. In the current study only 36 index children had a disability, and their infection intensity was not different to other cases, but their household had a higher odds of infection than those whose child was not disabled. This was not a formal clinical assessment of disability but reported by the caregivers responding to the household interviews and interviewer observations. People with disabilities (both physical or mental) tend to sit or lie on the ground for extended periods every day, where they would be very vulnerable to host-seeking adult female sand fleas. For the household infection, the higher odds may be due to the infected disabled person increasing the density of off-host stages inside the house as well as increased stress of caring for the disabled person, the extra financial burden or a lower income for the family. It is also possible the disabled child was infected because other family members were and brought it into the home where the disabled child was very vulnerable to being infected. This factor needs to be investigated further where more people with disabilities are enrolled.\u003c/p\u003e\u003cp\u003eAnother risk factor for children aged 8 to 14 years was their nutritional status. Severe stunting and wasting were both associated with tungiasis, but since they were also associated with each other, only wasting was retained in the final model. This region experiences chronic food shortages and at the time of the survey the whole region was experiencing famine as a culmination of many factors [32, 51]. Our data shows 68% of households had only had one meal the previous day. A previous study in Kenya recently also demonstrated an association of tungiasis with malnutrition [11]. Whether there is any causal relationship requires further study, but it is possible that both co-occur because of extreme poverty.\u003c/p\u003e\u003cp\u003eSeveral previous studies have identified poor hygiene practices to be a risk factor for tungiasis [4, 6, 7, 25, 30], both frequency of washing feet and use of soap when doing so. In the current study, households where the caregiver reported that the index child did not always use soap had a five times higher odds of infection, and households where the caregiver herself washed her feet less than twice a day also had higher odds of infection. The causal link with hygiene is unknown but it is conceivable that regular washing of feet could remove fecal residue from the embedded fleas and so reduce odors which are attractive to other host-seeking fleas. The physical rubbing action involved in feet-washing may also remove attached fleas before they fully penetrate the skin. Household tungiasis infection was also found to be associated with the state of cleanliness of the index child\u0026rsquo;s sleeping room, often the only room of the house shared with other family members, which has been reported to be a risk factor in a few previous studies [23, 26]. Dirty floors with items scattered over them likely provide appropriate conditions, such as organic matter and undisturbed loose soil, for the survival and development of flea larvae and pupae.\u003c/p\u003e\u003cp\u003eTungiasis in children and adults was associated with them having other skin conditions or other illnesses respectively. It is likely these would co-occur in the same households on account of their low SES and poor hygiene, but in the models where SES was available, these associations remained even when the models included SES. It is possible that people with tungiasis have an elevated stress level either as a result of the tungiasis or another stressor in their life which dysregulates their immune system and makes them more vulnerable to other diseases [52]. We have also shown an association with malnutrition which compromises the immune system [53]. In addition, tungiasis prevalence was higher in manyattas where the high population density may facilitate transmission of other infections.\u003c/p\u003e\u003cp\u003eAlcohol use has never been reported as a risk factor for tungiasis before. Here we found it associated with infection of adults, but their consumption was not associated with the infection status of their household. In Karamoja alcohol use is widespread (85% of the adults examined for tungiasis), and is considered to be a cultural norm, with the drinks often being brewed by the household (36% of households in this study), from sorghum and millet. Mostly these are of low alcohol content, and are consumed as a food particularly in times of food insecurity, even by children [33]. Alcohol consumption is usually a social activity and leads people to sit for extended periods in communal areas, with at least their feet on the ground where they are exposed to host-seeking sand fleas. In addition, adults who consume alcohol may neglect their personal hygiene. In contrast, the brewing of alcohol at home was associated with lower odds of infection in a household, likely because they are selling it and had a higher SES, as we show in Additional file 2, table \u003cspan refid=\"MOESM5\" class=\"InternalRef\"\u003eS5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe main limitation of this study was that many variables had few observations in some categories, leading to rather wide confidence intervals and therefore limiting our ability to draw strong conclusions for some of the factors driving the high prevalence in this area, including child disability, caregiver and child soap-use for washing feet.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe very high prevalence seen in this region of northeastern Uganda may well be the result of the extremely high-density settlements. Once the parasite entered the community it was able to spread very quickly due to the population density, extreme poverty, parenting behavior and poor hygiene practices. Children with disabilities living in these conditions have high odds of becoming infected. Control programs in this area need to work with the community to integrate regular treatment of people and house floors with increased foot-washing and soap-use and improved childcare.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eaOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;adjusted odds ratio\u003c/p\u003e\n\u003cp\u003eAIC\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Akaike information coefficient\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;confidence interval\u003c/p\u003e\n\u003cp\u003eHH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;household\u003c/p\u003e\n\u003cp\u003eIQR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;inter-quartile range\u003c/p\u003e\n\u003cp\u003eN\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;number\u003c/p\u003e\n\u003cp\u003eOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;odds ratio\u003c/p\u003e\n\u003cp\u003eSES \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;socioeconomic status\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in accordance with the Helsinki Declaration. Administrative clearance was obtained from Napak District Local Government (CR/205/1). Ethical review and clearance for the study was provided by the Vector Control Division-Research and Ethics Committee of the Ministry of Health (Reference VCDREC/101/UG-REC-018) and the Ethikkommission of the Charit\u0026eacute; Berlin (reference number EA2/100/16). The study was accredited with the Uganda National Council of Science and Technology (Reference SS 4815). Prior to any interview and foot examinations of household members, informed consent was sought from the household head or their representative. Adults (18 years and above) provided informed consent for themselves and their younger children. Children aged 12 to 17 years were also asked to provide informed assent before their examination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll data were collected on PIN protected electronic tablets, stored on password protected RedCap databases on the icipe servers. Data were analyzed after exporting to Excel without the inclusion of personal identifiers.\u003c/p\u003e\n\u003cp\u003eAll participants with tungiasis were treated with dimeticone oils (NYDA\u0026reg;\u0026nbsp;PLUS). For those with secondary bacterial infection and other illnesses requiring treatment, a referral was made to the nearest health facility.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets supporting the conclusions of this article are available in the Additional files associated with this manuscript.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eAll authors have no conflict of interest to declare.\u003c/p\u003e\n\u003ch2\u003eFunding Information\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eResearch funding for this work was provided by the German Research Foundation (DFG) through the project \u0026ldquo;Tungiasis in East-Africa - an interdisciplinary approach to understand the interactions between parasite and host\u0026rdquo; (project number 405027164; KR 2245/7-1) granted to J\u0026uuml;rgen Kr\u0026uuml;cken, Amina Abubakar, Ulrike Fillinger and Charles Waiswa. LE was supported by a Wellcome Trust Career Re-Entry Fellowship (grant number 213724/Z/18/Z). The views expressed herein do not necessarily reflect the official opinion of the donors. The funders had neither a role in the design of the study, nor in collection, analysis, interpretation of data nor in writing the manuscript.\u003c/p\u003e\n\u003ch2\u003eAuthor Contributions\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eConceptualization,\u0026nbsp;LE, UF, HF, FM, CW, AA \u0026amp; JK; Methodology,\u0026nbsp;LE, UF, FM, CW \u0026amp; JK; Formal Analysis, LE, UF, JK; Investigation, AM, FM, BO, Resources, UF, JK, CW.; Data Curation, LE, FM, AM, BO.; Writing \u0026ndash; Original Draft Preparation, LE.; Writing \u0026ndash; Review \u0026amp; Editing, AM, BO, FM, UF, JK, HF, CW; Visualization, LE, FM; Supervision, CW, AA, UF, JK; Project Administration, UF, JK, AA, FM; CW; Funding Acquisition, UF, JK, AA, CW.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe are grateful to the communities who participated, the sub-county technical teams and the District Health and Education Offices of Napak district Local Government who gave their approval for the study. We are grateful to Andrew Espira for the set up and maintenance of the RedCap data collection tools and database. We thank the field data collectors and the Village Health Teams (VHTs) for their long hard days of work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld_Health_Organization. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021\u0026ndash;2030. Geneva: World Health Organization 2020.\u003c/li\u003e\n\u003cli\u003eWorld_Health_Organization. Ending the neglect to attain the Sustainable Development Goals: a strategic framework for integrated control and management of skin-related neglected tropical diseases. Geneva2022.\u003c/li\u003e\n\u003cli\u003eWorld_Health_Assembly. Skin diseases as a global public health priority. 2025.\u003c/li\u003e\n\u003cli\u003eElson L, Kamau C, Koech S, Muthama C, Gachomba G, Sinoti E, et al. National prevalence and risk factors for tungiasis in Kenya. Infect Dis Poverty. 2023;12(1):85. doi: 0.1186/s40249-023-01131-x.\u003c/li\u003e\n\u003cli\u003eElson L, Matharu AK, Riithi N, Ouma P, Mutebi F, Feldmeier H, et al. Characterization of tungiasis infection and morbidity using thermography in Kenya revealed higher disease burden during COVID-19 school closures. Infectious Diseases of Poverty. 2023;12(1):24. doi: 10.1186/s40249-023-01080-5.\u003c/li\u003e\n\u003cli\u003eElson L, Wiese S, Feldmeier H, Fillinger U. Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya II: Results from a school-based observational study. PLoS Negl Trop Dis. 2019;13(5):e0007326. doi: 10.1371/journal.pntd.0007326.\u003c/li\u003e\n\u003cli\u003eWiese S, Elson L, Reichert F, Mambo B, Feldmeier H. Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya: I. Results from a community-based study. PLoS Negl Trop Dis. 2017;11(10):e0005925. doi: 10.1371/journal.pntd.0005925.\u003c/li\u003e\n\u003cli\u003eMatharu AK, Ouma P, Njoroge MM, Amugune BL, Hyuga A, Mutebi F, et al. Identification of tungiasis infection hotspots with a low-cost, high-throughput method for extracting Tunga penetrans (Siphonaptera) off-host stages from soil samples-An observational study. PLoS Negl Trop Dis. 2024;18(2):e0011601. doi: 10.1371/journal.pntd.0011601.\u003c/li\u003e\n\u003cli\u003eAmugune BL, Matharu AK, Ouma P, Mutebi F, Elson L, Fillinger U, et al. Cost-Effective PCR-Based Identification of Tunga penetrans (Siphonaptera) Larvae Extracted from Soil Samples Containing PCR Inhibitor-Rich Material. Insects. 2022;14(1). doi: 10.3390/insects14010005. PubMed PMID: 36661934.\u003c/li\u003e\n\u003cli\u003eElson L, Nyawa SM, Matharu A, Fillinger U. Developing low-cost house floors to control tungiasis in Kenya - a feasibility study. BMC Public Health. 2023;23(1):2483. Epub 20231212. doi: 10.1186/s12889-023-17427-4. PubMed PMID: 38087242; PubMed Central PMCID: PMCPMC10714545.\u003c/li\u003e\n\u003cli\u003eElson L, Kamau C, Koech S, Muthama C, Gachomba G, Sinoti E, et al. Tungiasis among children in Kenya is associated with poor nutrition status, absenteeism, poor school performance and high impact on quality of life. PLoS Negl Trop Dis. 2024;18(5):e0011800. doi: 10.1371/journal.pntd.0011800.\u003c/li\u003e\n\u003cli\u003eOtieno B, Elson L, Matharu AK, Riithi N, Chongwo E, Katana K, et al. Neurocognitive and mental health outcomes in children with tungiasis: a cross-sectional study in rural Kenya and Uganda. Infectious Diseases of Poverty. 2023;12(1):100. doi: 10.1186/s40249-023-01154-4.\u003c/li\u003e\n\u003cli\u003eWiese S, Elson L, Feldmeier H. Tungiasis-related life quality impairment in children living in rural Kenya. PLoS Negl Trop Dis. 2018;12(1):e0005939. doi: 10.1371/journal.pntd.0005939.\u003c/li\u003e\n\u003cli\u003eHeukelbach J, de Oliveira FA, Hesse G, Feldmeier H. Tungiasis: a neglected health problem of poor communities. Trop Med Int Health. 2001;6(4):267-72. doi: 10.1046/j.1365-3156.2001.00716.x.\u003c/li\u003e\n\u003cli\u003eEisele M, Heukelbach J, Van Marck E, Mehlhorn H, Meckes O, Franck S, et al. Investigations on the biology, epidemiology, pathology and control of Tunga penetrans in Brazil: I. Natural history of tungiasis in man. Parasitol Res. 2003;90(2):87-99. doi: 10.1007/s00436-002-0817-y.\u003c/li\u003e\n\u003cli\u003eNagy N, Abari E, D\u0026apos;Haese J, Calheiros C, Heukelbach J, Mencke N, et al. Investigations on the life cycle and morphology of Tunga penetrans in Brazil. Parasitol Res. 2007;101 Suppl 2:S233-42. doi: 10.1007/s00436-007-0683-8.\u003c/li\u003e\n\u003cli\u003eLinardi PM, Calheiros CML, Campelo-Junior EB, Duarte EM, Heukelbach J, Feldmeier H. Occurrence of the off-host life stages of Tunga penetrans (Siphonaptera) in various environments in Brazil. Annals of Tropical Medicine \u0026amp; Parasitology. 2010;104(4):337-45. doi: 10.1179/136485910X12743554759902.\u003c/li\u003e\n\u003cli\u003eKimotho S, Neville_Miller A, Ngure P. Managing communication surrounding tungiasis stigma in Kenya. Communicatio. 2015;41(4):523-42.\u003c/li\u003e\n\u003cli\u003eMcNeilly H, Thielecke M, Mutebi F, Banalyaki M, Reichert F, Wiese S, et al. Tungiasis Stigma and Control Practices in a Hyperendemic Region in Northeastern Uganda. Trop Med Infect Dis. 2023;8(4). doi: 10.3390/tropicalmed8040206.\u003c/li\u003e\n\u003cli\u003eWorth C, Heukelbach J Fau - Fengler G, Fengler G Fau - Walter B, Walter B Fau - Liesenfeld O, Liesenfeld O Fau - Feldmeier H, Feldmeier H. Impaired quality of life in adults and children with scabies from an impoverished community in Brazil. Int J Dermatol. 2012;51(3):275-82. doi: 10.1111/j.1365-4632.2011.05017.x.\u003c/li\u003e\n\u003cli\u003eGirma M, Astatkie A, Asnake S. Prevalence and risk factors of tungiasis among children of Wensho district, southern Ethiopia. BMC Infect Dis. 2018;18(1):456. doi: 10.1186/s12879-018-3373-5.\u003c/li\u003e\n\u003cli\u003eMutebi F, McNeilly H, Thielecke M, Reichert F, Wiese S, Mukone G, et al. Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda. Trop Med Infect Dis. 2023;8(2). Epub 2023/02/25. doi: 10.3390/tropicalmed8020111. PubMed PMID: 36828527; PubMed Central PMCID: PMCPMC9963877.\u003c/li\u003e\n\u003cli\u003eMuehlen M, Feldmeier H, Wilcke T, Winter B, Heukelbach J. Identifying risk factors for tungiasis and heavy infestation in a resource-poor community in northeast Brazil. Trans R Soc Trop Med Hyg. 2006;100(4):371-80. doi: 10.1016/j.trstmh.2005.06.033.\u003c/li\u003e\n\u003cli\u003eUgbomoiko US, Ariza L, Ofoezie IE, Heukelbach J. Risk factors for tungiasis in Nigeria: identification of targets for effective intervention. PLoS Negl Trop Dis. 2007;1(3):e87. doi: 10.1371/journal.pntd.0000087.\u003c/li\u003e\n\u003cli\u003eNsanzimana J, Karanja S, Kayongo M, Nyirimanzi N, Umuhoza H, Murangwa A, et al. Factors associated with tungiasis among primary school children: a cross-sectional study in a rural district in Rwanda. BMC Public Health. 2019;19(1):1192. doi: 10.1186/s12889-019-7481-y.\u003c/li\u003e\n\u003cli\u003eNyangacha RM, Odongo D, Oyieke F, Bii C, Muniu E, Chasia S, et al. Spatial distribution, prevalence and potential risk factors of Tungiasis in Vihiga County, Kenya. PLoS Negl Trop Dis. 2019;13(3):e0007244. Epub 2019/03/13. doi: 10.1371/journal.pntd.0007244. PubMed PMID: 30860992; PubMed Central PMCID: PMCPMC6413899.\u003c/li\u003e\n\u003cli\u003eMwangi J, Ozwara H, Gicheru M. Epidemiology of tunga penetrans infestation in selected areas in Kiharu constituency, Murang\u0026rsquo;a County, Kenya. Tropical Diseases, Travel Medicine and Vaccines. 2015;1:13.\u003c/li\u003e\n\u003cli\u003ePilger D, Schwalfenberg S, Heukelbach J, Witt L, Mehlhorn H, Mencke N, et al. Investigations on the biology, epidemiology, pathology, and control of Tunga penetrans in Brazil: VII. The importance of animal reservoirs for human infestation. Parasitol Res. 2008;102(5):875-80. Epub 2008/01/04. doi: 10.1007/s00436-007-0840-0. PubMed PMID: 18172688.\u003c/li\u003e\n\u003cli\u003eWafula ST, Ssemugabo C, Namuhani N, Musoke D, Ssempebwa J, Halage AA. Prevalence and risk factors associated with tungiasis in Mayuge district, Eastern Uganda. Pan Afr Med J. 2016;24:77. Epub 2016/09/20. doi: 10.11604/pamj.2016.24.77.8916. PubMed PMID: 27642416; PubMed Central PMCID: PMCPMC5012786.\u003c/li\u003e\n\u003cli\u003eAhirirwe SR, Migisha R, Mwine P, Bulage L, Kwesiga B, Kadobera D, et al. Investigation of human tungiasis cases, Sheema District, Uganda, November 2021-February 2022. Pan African Medical Journal. 2023;46(71). doi: doi: 10.11604/pamj.2023.46.71.41277.\u003c/li\u003e\n\u003cli\u003ePowell J. Karamoja: A literature review. Saferworld, 2010.\u003c/li\u003e\n\u003cli\u003eCullis A, and R. L. Arasio. 2022. . The 2022 Humanitarian Crisis in Karamoja, Uganda: A real-time review. . Karamoja Resilience Support Unit, Feinstein International Center, Friedman School of Nutrition Science andPol icy, Tufts University, Kampala., 2022.\u003c/li\u003e\n\u003cli\u003eIyer P, Stites E. Trauma, loss and other psychosocial drivers of excessive alcohol consumption in Karamoja, Uganda. Pastoralism. 2021;11(1):30. doi: 10.1186/s13570-021-00199-0.\u003c/li\u003e\n\u003cli\u003eOdhiambo MaA, R. L. 2024. . Privatization of Land and Its Impacts on Agro-pastoral Livelihoods in Karamoja, Uganda. Case studies of Moroto and Nakapiripirit Districts. Karamoja Resilience Support Unit, Feinstein International Center, Friedman School of Nutrition Science and Policy at Tufts University, Kampala., 2024.\u003c/li\u003e\n\u003cli\u003eUganda_Bureau_of_Statistics. The National Population and Housing Census 2024 \u0026ndash; Final Report. Kampala, Uganda: 2024.\u003c/li\u003e\n\u003cli\u003eVittinghoff E, McCulloch C. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol. 2007;165:710-8.\u003c/li\u003e\n\u003cli\u003eMutebi F, Kr\u0026uuml;cken J, Feldmeier H, Waiswa C, Mencke N, Sentongo E. Animal Reservoirs of Zoonotic Tungiasis in Endemic Rural Villages of Uganda. PLoS Negl Trop Dis. 2015;9(10):e0004126. doi: 10.1371/journal.pntd.0004126.\u003c/li\u003e\n\u003cli\u003eZaidman EA, Scott KM, Hahn D, Bennett P, Caldwell PH. Impact of parental health literacy on the health outcomes of children with chronic disease globally: A systematic review. J Paediatr Child Health. 2023;59(1):12-31. Epub 20221219. doi: 10.1111/jpc.16297. PubMed PMID: 36536542.\u003c/li\u003e\n\u003cli\u003eBerry JO, Jones WH. The Parental Stress Scale: Initial Psychometric Evidence. Journal of Social and Personal Relationships. 1995;12(3):463-72. doi: 10.1177/0265407595123009.\u003c/li\u003e\n\u003cli\u003eKroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine. 2001;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.\u003c/li\u003e\n\u003cli\u003eMinistry_of_Health_Kenya. Patient Health Questionnaire-9 (PHQ-9) for Depression Screening.\u003c/li\u003e\n\u003cli\u003eBeal SJ, Greiner MV. Children in nonparental care: health and social risks. Pediatric Research. 2016;79(1):184-90. doi: 10.1038/pr.2015.198.\u003c/li\u003e\n\u003cli\u003ePA Harris RT, R Thielke, J Payne, N Gonzalez, JG. Conde, . Research electronic data capture (REDCap) \u0026ndash; A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81. doi: 10.1016/j.jbi.2008.08.010.\u003c/li\u003e\n\u003cli\u003eVidmar SI, Cole T, Pan H. Standardizing Anthropometric Measures in Children and Adolescents with Functions for Egen: Update. Stata Journal 2013;13.2:366\u0026ndash;78. doi: 10.1177/1536867x1301300211.\u003c/li\u003e\n\u003cli\u003eMiller H, Ocampo J, Ayala A, Trujillo J, Feldmeier H. Very severe tungiasis in Amerindians in the Amazon lowland of Colombia: A case series. PLoS Negl Trop Dis. 2019;13(2):e0007068. Epub 2019/02/08. doi: 10.1371/journal.pntd.0007068. PubMed PMID: 30730885.\u003c/li\u003e\n\u003cli\u003eCollins G, McLeod T, Konfor N, Lamnyam C, Ngarka L, Leo N. Tungiasis: A Neglected Health Problem in Rural Cameroun. International Journal of Collaborative Research on Internal Medicine \u0026amp; Public Health. 2009;1(1):2-10.\u003c/li\u003e\n\u003cli\u003eChopra M. Risk factors for undernutrition of young children in a rural area of South Africa. Public Health Nutr. 2003;6(7):645-52. doi: 10.1079/phn2003477. PubMed PMID: 14552665.\u003c/li\u003e\n\u003cli\u003eWalker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, et al. Inequality in early childhood: risk and protective factors for early child development. The Lancet. 2011;378(9799):1325-38. doi: https://doi.org/10.1016/S0140-6736(11)60555-2.\u003c/li\u003e\n\u003cli\u003eWalker SP, Wachs TD, Meeks Gardner J, Lozoff B, Wasserman GA, Pollitt E, et al. Child development: risk factors for adverse outcomes in developing countries. The Lancet. 2007;369(9556):145-57. doi: https://doi.org/10.1016/S0140-6736(07)60076-2.\u003c/li\u003e\n\u003cli\u003eDo H, McCoy DC. The Relations Between Caregiver Education, Home Stimulation, and Children\u0026rsquo;s Developmental Outcomes: Research in Majority World Countries. International Journal of Early Childhood. 2024. doi: 10.1007/s13158-024-00398-x.\u003c/li\u003e\n\u003cli\u003eBarrantes A, Caravani M. Situational Analysis of Food, Nutrition and Income Security in Karamoja: A normalising view of Karamoja. UK: Developmental Pathways, 2020.\u003c/li\u003e\n\u003cli\u003eSeiler A, Fagundes CP, Christian LM. The Impact of Everyday Stressors on the Immune System and Health. In: Chouk\u0026egrave;r A, editor. Stress Challenges and Immunity in Space: From Mechanisms to Monitoring and Preventive Strategies. Cham: Springer International Publishing; 2020. p. 71-92.\u003c/li\u003e\n\u003cli\u003eMorales F, Montserrat-de la Paz S, Leon MJ, Rivero-Pino F. Effects of Malnutrition on the Immune System and Infection and the Role of Nutritional Strategies Regarding Improvements in Children\u0026apos;s Health Status: A Literature Review. Nutrients. 2023;16(1). Epub 20231219. doi: 10.3390/nu16010001. PubMed PMID: 38201831; PubMed Central PMCID: PMCPMC10780435.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"tropical-medicine-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tmah","sideBox":"Learn more about [Tropical Medicine and Health](https://tropmedhealth.biomedcentral.com/)","snPcode":"41182","submissionUrl":"https://submission.springernature.com/new-submission/41182/3","title":"Tropical Medicine and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tungiasis, Neglected tropical diseases, risk factors, WASH, disability, Karamoja","lastPublishedDoi":"10.21203/rs.3.rs-7288997/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7288997/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTungiasis is a neglected tropical skin disease caused by adult female fleas which burrow into the skin of people and animals, causing considerable pain and itching. The distribution of the disease is heterogenous, with Napak district, Karamoja sub-region of northeastern Uganda having the highest disease burden recorded globally. We aimed to determine the factors associated with this high prevalence to inform future intervention strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a case: control study to identify factors associated with infection of individual children, adults and with the whole household. Infected children were identified through mass-screening of 1619 children aged 8 to 14 years between January and March 2022 in 25 villages. Infected (210) and uninfected (358) children were randomly selected, and their households were enrolled into the study. Observations were made of the homesteads, and structured interviews were conducted with the caregivers. All adults and children in the households were examined. Mixed effect logistic regression analysis was used to identify factors associated with infection of individuals or households.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWe found children who lived in high-density settlements (manyattas) had more than three times the odds of being infected than those in more open, low-density settlements (adjusted odds ratio aOR 3.51, 95% CI 1.57\u0026minus;7.83, p\u0026thinsp;=\u0026thinsp;0.002). For the first time we demonstrate the association of household infection with having a child with a disability (aOR 5.38, 95% CI 1.92\u0026minus;15.03, p\u0026thinsp;=\u0026thinsp;0.001) and a caregiver who did not show affection to their child (aOR 1.79, 95% CI 1.02\u0026minus;3.13, p\u0026thinsp;=\u0026thinsp;0.041). For individual adults, those who reported drinking alcohol had four times the odds of infection than those who did not (aOR 4.74, 95% CI 1.93\u0026minus;11.68, p\u0026thinsp;=\u0026thinsp;0.001). Frequency of washing feet, soap use and house cleanliness were also associated with household infection.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eControl programs should be developed together with the caregivers to enable them to reduce alcohol use, improve their childcare, hygiene and sanitation practices.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003enot applicable\u003c/p\u003e","manuscriptTitle":"High density rural settlements, parenting behavior and child disability are significant factors associated with tungiasis in Karamoja, northeastern Uganda: a case control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-20 06:46:31","doi":"10.21203/rs.3.rs-7288997/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-16T08:28:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-16T07:06:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-01T11:59:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245767282515984988174196992059543773262","date":"2025-08-21T20:13:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325278494632584676590620100135655932457","date":"2025-08-19T11:34:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-12T04:59:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-12T04:52:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-12T04:52:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Tropical Medicine and Health","date":"2025-08-04T08:51:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"tropical-medicine-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tmah","sideBox":"Learn more about [Tropical Medicine and Health](https://tropmedhealth.biomedcentral.com/)","snPcode":"41182","submissionUrl":"https://submission.springernature.com/new-submission/41182/3","title":"Tropical Medicine and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ac8c3947-2888-430d-b0a2-1a215a97a0bb","owner":[],"postedDate":"August 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:05:42+00:00","versionOfRecord":{"articleIdentity":"rs-7288997","link":"https://doi.org/10.1186/s41182-025-00841-2","journal":{"identity":"tropical-medicine-and-health","isVorOnly":false,"title":"Tropical Medicine and Health"},"publishedOn":"2026-03-03 15:58:45","publishedOnDateReadable":"March 3rd, 2026"},"versionCreatedAt":"2025-08-20 06:46:31","video":"","vorDoi":"10.1186/s41182-025-00841-2","vorDoiUrl":"https://doi.org/10.1186/s41182-025-00841-2","workflowStages":[]},"version":"v1","identity":"rs-7288997","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7288997","identity":"rs-7288997","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}