My name's Lynne Elson, I'm a research fellow with Oxford University
and KEMRI Wellcome Trust in Kenya.
I work on tungiasis which is a neglected tropical skin disease,
it's caused by a sand flea which is known scientifically at Tunga penetrans,
and the adult female burrows into the skin of mostly people's feet but also the hands,
it affects mostly children of school age, the elderly and disabled people, and it's found
very widely across well throughout sub-Saharan Africa, as well as Central and South America.
There has been some research on looking at how we can prevent the disease although there have not
been any formal systematic studies done, but we think that we can prevent it by sealing the floors
because mostly it's people who live in a house that does not have a hard floor, many people in
Africa and South America live on a floor that is just soil and the fleas develop within that soil.
So we think we can prevent it by trying to help people to have a hard floor,
but also by assisting people to wash their feet every day with soap; many of these communities
lack access to water and soap, or as you see these people are disabled or they're
elderly they cannot do that themselves and so they need people to help them.
For treatment there is no well-known and well effective treatment available in
these communities, and in their desperation people will cut the fleas out of their feet
using non sterile instruments like thorns which they just pull off bushes,
and of course that causes more problems and more pain for them.
And so in Kenya there is a product which is being used widely it's actually a disinfectant
it's potassium permanganate, which is actually a hazardous chemical;
it causes a lot of irritation and pain when the children are being treated,
and in fact there has been one clinical trial using it for tungiasis
and it only killed about 40 percent of the fleas, so there's still no good treatment available.
Last year I was working on a clinical trial myself which was using a herbal medicine that I found
being used very successfully in a community of people living along the coast in Kenya,
the product is mostly using neem and coconut oils, both of which come from trees which grow
widely along the coast of Kenya, and in that study what we found is that although within the one week
trial period, it didn't kill any more fleas than the potassium permanganate
but it actually caused the fleas to rapidly age; we saw a change in their development
so we feel that had the study been able to go on for a little bit longer we would have seen
all of those fleas were dead and the product would look much better than the potassium permanganate.
But even as it is, it caused less pathology - it improved
pathology - and it caused a reduction in pain that the children were feeling,
so we feel it's a much better product people can use it themselves because it's not toxic we can
give it to families and they can keep using it regularly whenever they get re-infected.
Well there's very few people working on tungiasis it is a very neglected tropical disease
and less than 20 people probably work on the disease, so within the last five to ten years
there's only been a few small studies but I think the most important study that's been done was
again a couple of clinical trials actually based using a silicon oil, there's a product which is
sold in the developed world for treating headlice, which is based on silicon oils; it's called nyda,
and that product has been shown in these two trials to be very very effective to kill the
fleas, so we're very excited about that as well and it's being pursued with the manufacturer to
get it registered in endemic countries now and then to build up into a very large-scale trial.
This is a very important disease because it causes so much pain and suffering for the people who are
affected and there are very many people infected: within Kenya alone the government estimates that
there are two million people with tungiasis at the moment, but there are still such gaps in the
knowledge of what we know about the disease and how to control it and so we need funding to be
able to do large-scale surveys to map it, find out how many people are affected, where they live, why
some people in one village compared to the next door village have jiggers and those ones do not,
and also to find out what are the conditions which enable those fleas to develop within the soil.
The research that I do is very applied, it's all targeted on developing and
understanding the ways to control the disease and developing interventions to control it, so
we work very closely with communities right from the start,
and working with policy makers so that as we design our studies
they can be very quickly translated into policy to control the disease at the national level.