Epidemiology of tungiasis at the animal–human interface in a vulnerable rural community

Introduction

Tungiasis is a parasitic skin disease caused by infestation with the female sand flea Tunga penetrans, commonly referred to as the jigger flea. Of the 14 described species within the genus Tunga, T. penetrans is the species most frequently associated with animal and human infections in sub-Saharan Africa (1). The parasite exhibits low host specificity and infects a wide variety of mammalian hosts, including humans as well as domestic and wild animals such as dogs, pigs, cats, cattle, small ruminants, non-human primates, and synanthropic rodents (2). Despite its substantial morbidity in endemic communities, tungiasis remains underrecognized within healthcare systems and receives limited public health attention, even though it may be considered as a neglected tropical disease (NTDs) (3). Clinical manifestations result from penetration and intraepidermal hypertrophy of the gravid female flea, eliciting a localized inflammatory response that may be exacerbated by bacterial superinfection. Lesions typically present as whitish papules or nodules with a central black dot corresponding to exposed posterior abdominal segments of the flea. They occur predominantly on the feet, toes, fingers, and interdigital spaces, while associated symptoms may include edema, erythema, pruritus, severe pain, and impaired mobility in cases of heavy infestation (4). In many endemic settings, embedded fleas are removed using non-sterile sharp instruments such as needles, pins, or thorns (5). These practices frequently result in severe complications, such as ulceration, suppuration, and gangrene, particularly among individuals with incomplete tetanus immunization (6).

Globally, more than one billion people are estimated to live in areas where environmental conditions are suitable for tungiasis transmission, predominantly in low- and middle-income countries (LMICs) (7). Reported prevalence in endemic settings varies widely, ranging from approximately 7% to over 63%, reflecting differences in ecological, seasonal, and socioeconomic factors (8). To date, tungiasis has been reported in approximately 88 countries, with the highest burden occurring in tropical and subtropical regions of Sub-Saharan Africa, Latin America, and the Caribbean (9, 10). In Sub-Saharan Africa, high prevalence rates have been documented in several endemic countries, including Kenya (up to 62.1%) (11, 12), Ethiopia (58%) (14), Cameroon (53.7%) (13), and Nigeria (28.4%), although substantial heterogeneity exist between Nigerian communities, where prevalence has been reported to range from 0% to 68.3% (15). Similar patterns have been observed in Latin America and the Caribbean. In Brazil, community-based studies have reported prevalence exceeding 50% in highly affected settlements (16). Likewise, a study conducted in Venezuela reported an overall prevalence of 44.27%, with infection associated with age, flooring type, farming and domestic occupation, lower educational attainment, and presence of accumulated waste around households (17). In the Caribbean, a prevalence of 31.1% was reported in Haiti (18), while a prevalence ranging from 15.7% to 31.4% was documented across five communities in south-western Trinidad, West Indies (19). Across both Caribbean nations, infection was consistently associated with poverty-related conditions, including inadequate housing, poor sanitation, environmental contaminations, and limited access to preventive measures.

In Nigeria, a substantial proportion of the population resides in rural and peri-urban settings characterized by poverty, inadequate housing, and limited access to sanitation, conditions that facilitate tungiasis transmission (20). Recognizing its public health importance, the World Health Organization (WHO) included tungiasis within the 2021–2030 NTD road map framework for intensified control and research attention (21). Nevertheless, in many endemic countries, limited systematic data on disease burden, spatial distribution, and animal reservoirs continue to hinder the implementation of locally tailored interventions.

Tungiasis transmission is disproportionately driven by interconnected environmental, socioeconomic, behavioral, and ecological factors. Poor housing conditions, particularly earthen and cracked or dusty floors, create suitable microhabitats for off-host flea development (10, 22). For instance, studies in Nigeria have demonstrated a significantly higher risk of infections in households with earthen floors (15). Inadequate hygiene and sanitation practices, limited access, use of footwear, and low awareness of preventive measures may further increase exposure risk. Behavioral factors such as walking barefoot or sleeping on floors may also heighten vulnerability. The presence of animal reservoirs, particularly dogs and pigs (23–25), but also cats, cattle, sheep, horses, mules, rats, and mice, around human residential areas may also contribute to environmental contamination with flea stages and sustain transmission cycles (26).

In Nigeria, surveillance systems, funding, and public health intervention programs have largely prioritized other NTDs such as schistosomiasis and onchocerciasis, as well as high-burden diseases like malaria (3, 27, 28). In contrast, tungiasis receives comparatively limited programmatic attention despite its substantial morbidity. The disease is associated with persistent pain, nail deformities, chronic ulceration, reduced mobility, social stigmatization, psychological distress, impaired school attendance, and reduced economic productivity, factors that may perpetuate cycles of poverty in affected communities (6). In Badagry, Lagos State, Nigeria, recurrent tungiasis transmission has been reported in vulnerable rural communities characterized by poor housing and environmental conditions (25, 29, 30). However, limited evidence exists regarding the role of domestic animals in sustaining household-level transmission or the extent to which animal infection correlates with human infection risk. To address this gap, this study aims to examine the epidemiological relationship between animal and human tungiasis in a vulnerable rural community in Badagry. Specifically, the study seeks to (i) determine the prevalence and determinants of tungiasis among domestic animals, and (ii) evaluate the household-level association between animal and human infection, to better understand the potential role of domestic animals in the epidemiology of human tungiasis. Findings from this study should inform integrated, locally adapted prevention and control strategies for tungiasis and other zoonotic NTDs in resource-limited settings.

Methods

Study area

This community-based study was conducted in a vulnerable rural community located in the periphery of Badagry (6.41622°N; 2.89077°E), within Badagry Local Government Area, Lagos State, Nigeria. Badagry is a coastal area with an estimated population of approximately 327,400 based on the 2016 projection (31). The area has a documented history of moderate to high tungiasis prevalence in both humans and domestic animals (20, 25, 32). The majority of residents belong to the Egun ethnic group, with primary occupations including fishing, farming, and trading, with only a small proportion engaged in formal employment.

The study setting is characterized by major socioeconomic and infrastructural challenges, including poor road networks, substandard housing, limited access to potable water, unreliable electricity supply, inadequate healthcare services, and poor sanitation infrastructure. Common sanitation conditions in this setting include open sewage systems, improper waste disposal, and irregular waste collection services, while behavioral practices include walking barefoot, open defecation, and rearing of domestic animals (25, 32).

Study population and sampling design

This cross-sectional study was conducted during the hot and dry season between September 2021 and June 2022. Prior to the commencement of the study, information meetings were conducted with community members. Subsequently, 208 households comprising 626 individuals were recruited to participate in this study across both seasons. Participants were enrolled at the household level using a non-probability sampling strategy, based on accessibility, willingness to participate, and the presence of domestic animals. This sampling strategy was adopted to ensure adequate representation of households with domestic animals, which are central to the study objective of examining human-animal interactions relevant to tungiasis.

Inclusion and exclusion criteria

Eligible households were approached, and all eligible members within these households were invited to participate in this study. Inclusion criteria comprised individuals who had resided in the community for at least three months prior to the study and spent at least four nights per week in the household. Only individuals who provided informed consent (written or verbal) were included in the study. Exclusion criteria included those. Exclusion criteria included visitors and individuals who had resided in the community for less than three months, those who spend less than four nights per week in the household, and individuals who did not provide informed consent.

Sample size

The sample size of total participants was determined using previously published estimates of tungiasis prevalence and established methodological approaches (15). Specifically, the single population proportion formula was applied:

n=Z2·p(1−p)d2

Where:

n is the required sample size,

Z is the standard normal deviate corresponding to a 95% confidence level (1.96),

P is the expected prevalence of the outcome, and.

d is the desired margin of error (precision).

An expected tungiasis prevalence of (p) of 28.4% based on the findings of Otubanjo et al., [15], a 95% CI (Z=1.96), and a margin of error (d) of 5% were used to calculate the sample size (n). This yielded a minimum required sample size of approximately 313 participants per sampling season.

Assessment of tungiasis in humans and domestic animals

Clinical examinations were conducted to determine tungiasis status among both human participants and domestic animals. Before the fieldwork, the team received training on standardized methods for lesions identification and clinical assessments. All examinations were performed by trained medical and veterinary practitioner using established diagnostic criteria, including the presence of embedded Tunga fleas, nodules, or white patches with a central black dot (Figure 1) (25, 33). Cases of diagnostic uncertainty were reviewed collectively to ensure accurate classification. The primary outcome variables were a) presence of tungiasis in human participants (infected or non-infected), and b) presence of tungiasis in domestic animals at the household level (also, infected or non-infected).

Data collection and questionnaire design

Data were collected through face-to-face interviews using a structured questionnaire adapted from previously validated instruments (32), with minor context-specific modifications. Prior to the main survey, the questionnaire was pretested among 30 randomly selected participants from the study community to assess clarity and feasibility. Data obtained during the pretest were excluded from the final analysis, and minor revisions were made to the questionnaire based on the pilot findings. The survey was conducted between September 2021 and June 2022, covering both rainy and dry seasons. We ensured that an equal number of participants were surveyed across the two seasons to capture potential seasonal variation in tungiasis occurrence. The questionnaire contained variables such as sociodemographic characteristics, household environmental conditions, behavioral risk factors, domestic animal ownership, rat sightings, and hygiene-related practices.

Ethical considerations

All study procedures were conducted in accordance with relevant ethical guidelines and regulations and are reported in line with the ARRIVE guidelines. Ethical approval for the clinical examination of reservoir hosts of T. penetrans (human participants and domestic animals), was obtained from the Nigerian Institute of Medical Research Ethics Committee (approval number IRB/21/053). Additionally, authorization was obtained from the Badagry Local Government Area Public Health Board, and permission to conduct the study was obtained from community leadership in the study area.

Oral/written informed consent was obtained from all adult participants prior to enrollment. For minors, oral/written informed consent was obtained from parents or legal guardians, and oral assent was obtained from the participating minors. Household heads provided oral/written consent after receiving a detailed explanation of the study objectives and procedures. Only individuals who consented were included in the study. All individual-level data were pseudo-anonymized during the data cleaning process to ensure participant confidentiality and anonymity. Access to data was restricted to authorized research personnel.

Statistical data analysis

Descriptive analyses were conducted to summarize study variables, including the prevalence of tungiasis among both humans and domestic animals. The variables (categorical) were expressed as frequencies and percentages.

To identify factors associated with tungiasis in domestic animals, we first performed univariable logistic regression analyses to assess associations between animal infection status and candidate explanatory variables, including household characteristics, environmental conditions, hygiene-related factors, and daily rat sightings (a known and validated proxy for poor household hygiene, including waste accumulation (34, 35). Variables with p< 0.15 in the univariable analyses were considered for inclusion in multivariable models, given opting for the conventional level of 0.05 at this stage may fail to identify all important variables (36). Multicollinearity among predictors was assessed using the variance inflation factor (VIF), with VIF values of > 5 considered indicative of problematic collinearity. The final multivariable model was selected based on Akaike’s Information Criterion (AIC), retaining the most parsimonious model. Model fit was evaluated using Hosmer-Lemeshow goodness-of-fit test and inspection of residual observations. Results were reported as odds ratios (ORs) with 95% confidence intervals (CIs).

To examine the animal- human interface, a household-level exposure variable was constructed by classifying households as positive if at least one domestic animal was infected. The association between household animal infection status and human tungiasis was initially evaluated using contingency tables and Fisher’s exact tests. To further evaluate this relationship, we fitted multilevel logistic regression models with human infection status as the outcome and household animal infection status as the main primary exposure. A random intercept for household was included to account for clustering of individuals within households.

Potential confounders were evaluated using a change-in-estimate approach, whereby variables that altered the regression coefficient of the primary exposure by ≥10% were retained in the adjusted model. Model assumptions were assessed by examining multicollinearity and overall model fit. Adjusted odds ratios (aORs) with 95% CIs were reported.

Missing data were assessed prior to analysis. Because the proportion of missing observations was significantly low (approximately 0.3%), a complete-case analysis was performed. Finally, the intraclass correlation coefficient (ICC) was estimated to quantify the degree of clustering of infection within households. Statistical significance was defined as p< 0.05. All analyses were performed using R software version 4.5.2 (R Core Team. (2019).

Results

Study population characteristics and overall prevalence of tungiasis

As shown in Table 1, a total of 626 participants were interviewed across two seasons during the study period. The prevalence of tungiasis was 7.2% (45/626) among domestic animals and 5.4% (34/626) among human participants. Most participants were female (60.2%) and belonged to the 20 to 39 age group (43%). Regarding educational attainment, 44.7% had completed at least secondary education, while 22.0% had no formal education. Farming was the predominant occupation (62.0%). The majority of participants were assessed as having satisfactory body and clothing cleanliness. Exposure-related behaviors were common: 49.2% of participants reported irregular shoe use, and another 30.8% reported never wearing shoes. More than half (57.8%) reported usually sleeping on a mattress placed directly on the floor, and 16.6% of households had earthen flooring. Chickens were the most commonly raised domestic animals (66.3%), whereas pigs were the least commonly raised (5.8%). Frequent daily rat sightings were reported by 64.5% households.

Table 1. Sociodemographic, behavioral, household environmental, and animal exposure characteristics of study participants (n = 626¹).

n (%); Mean (SD).

*****Represents variable with missing values.

Determinants of tungiasis in domestic animals

In the univariable analyses, nine variables met the inclusion threshold (p ≤ 0.15) and were considered for multivariable modeling (Supplementary Material 1). Among competing models, the final multivariable logistic regression model was selected based on the lowest AIC and parsimony, retaining four variables (AIC = 292.0) (Supplementary Material 2).

In the final model, the presence of dogs in the household was the most significantly associated factor with animal tungiasis, presenting nearly fourfold higher odds of infection (OR=3.90; 95% CI: 2.03-7.88; p< 0.001). Similarly, animals from households with earthen flooring had approximately threefold higher odds of tungiasis infection than those from households without earthen floors (OR=2.72; 95% CI: 1.31-5.49; p< 0.006). The presence of at least one infected human household member was also associated with higher odds of animal infection (OR=2.95; 95% CI: 1.07-7.55; p< 0.029) compared to those without infected human household members. Additionally, frequent daily rat sightings in or around households were associated with increased odds of animal tungiasis, particularly increasing the odds of infection by more than twofold (OR=2.49; 95% CI: 1.13-6.30; p< 0.0034) (Table 2).

Table 2. Multivariable logistic regression analysis of factors associated with tungiasis in domestic animals.

Significant values are in bold.

Human tungiasis and the animal-human interface

To examine the association between household animal and human tungiasis, fifteen candidate covariates were evaluated, of which six met the inclusion criterion based on a ≥10 change-in-estimate for the primary exposure.

In the adjusted multilevel logistic regression model, the presence of at least one infected animal in the household was associated with higher odds of human tungiasis. However, this association did not reach statistical significance (OR = 2.29; 95% CI: 0.74-7.12; p< 0.151) (Table 3). Descriptive comparisons further supported this pattern, with approximately 36% of individuals residing in households with at least one infected animals had tungiasis infection, compared with only about 5% of those living in households without infected animals (Figure 2). While this marked difference suggests a potential household-level association between animal and human tungiasis infection, the cross-sectional nature of the study does not allow conclusions regarding the direction of transmission or causality.

Table 3. Multivariable logistic regression of factors associated with human tungiasis, including household-level animal infection status as the primary exposure, with random intercepts for household.

CI, Confidence Interval; OR, Odds Ratio.

Other variables in the final model were also associated with human tungiasis. Compared with participants aged 10 years or younger, increasing age group showed a somewhat lower infection rate, particularly those aged 20-39 years (OR=0.13; 95% CI: 0.01-1.27; p< 0.078) and 40-59 years (OR=0.11; 95% CI: 0.01-1.24; p< 0.074). Household environmental factors were also important predictors. Living in a household with a cement floor was associated with significantly lower odds of infection (OR=0.25; 95% CI: 0.08-0.76; p< 0.015). Seasonality was also observed, with participants surveyed during the dry season having significantly lower odds of infection compared with those surveyed during the rainy season (OR=0.14; 95% CI: 0.05-0.42; p< 0.001). Other variables, including type of sleeping surface and daily rat sightings, were retained in the model but were not statistically significant, suggesting potential residual or contextual contributions to infection risk (Table 3).

The ICC analysis indicated that approximately 77% of the variance in human tungiasis risk was attributable to between-household differences after adjusting for covariates. This finding suggests substantial household-level clustering, indicating that individuals within the same household may share similar risk profiles compared with individuals from different households.

Discussion

The study describes evidence on the epidemiology of tungiasis at the human-animal interface in a vulnerable rural community, highlighting the potential importance of household environmental conditions, domestic animals, and shared living environments in shaping observed infection patterns. The prevalence of tungiasis observed among domestic animals (7.2%) and humans (5.4%) underscores the continued public health relevance of the disease, particularly in vulnerable settings in LMICs. Our results highlighted a higher proportion of human tungiasis infection among individuals living in households with at least one infected animal compared with those residing in households without infected animals. In addition, the interclass correlation coefficient (ICC=0.77) indicated substantial clustering of infection at the household level. Together, these results suggest that household-level factors may be important in understanding the distribution of tungiasis within the study community. Such factors may include housing conditions, sanitation, animal husbandry practices, and broader poverty gradients, although the present study was not designed to determine their relative contributions. These observations are consistent with previous studies reporting that tungiasis is frequently concentrated in resource- limited settings characterized by inadequate and impoverished housing and environmental conditions (10, 37). Beyond poverty deprivation, studies from Kenya have also identified caregiver characteristics, psychosocial stress, and parenting practices as factors associated with tungiasis occurrence in endemic areas (38). Similarly, Heukelbach and Feldmeier reported associations between poor housing characteristics, limited sanitation management, and proximity to soil and animal reservoirs and the occurrence of tungiasis in endemic communities (7). Collectively, the available evidence suggests that tungiasis may be closely associated with poverty-related environmental and structural determinants, although the relative importance of specific factors may vary across settings.

The observed prevalence in human (5.4%) and animal (7.2%) was lower than that reported in highly endemic settings, such as Uganda (39), where prevalence remains substantial, particularly among children and in settings with limited access to adequate housing and sanitation (33, 40). Similarly, markedly higher prevalence has been documented in Ethiopia (29), with estimates reaching (52%) among children, and in Brazil, where prevalence has been reported at (59%) in animals and (39%) in humans (41). Nonetheless, the persistence of infection in both humans and animals in this study suggests ongoing exposure to environmental conditions that likely sustain the life cycle of T. penetrans. Behavioral and household-level factors such as irregular or absent shoe use, sleeping on a mat placed directly on the floor, and the presence of earthen flooring, may contribute to continued exposure to infested environments. These potential risk factors have been reported to contribute to both animal and human tungiasis infection risk (39). In particular, earthen flooring has been strongly linked to higher infection risk, whereas replacement with cemented flooring has been shown to be protective (42). Similarly, the reported association between daily rat sightings and tungiasis infection may reflect broader environmental conditions (29), such as poor waste management or accumulation of organic debris, that create favorable habitats for multiple synanthropic pests, including flea vectors (34, 43).

The presence of dogs in households emerged as a key factor associated with tungiasis in domestic animals. Dogs have been documented to contribute to tungiasis infection. Our findings are consistent with previous studies demonstrating that infections in dogs may contribute to maintaining transmission cycles within affected communities (41, 44). In contrast, one study from Uganda identified pigs as the prominent reservoirs of T. penetrans, although dogs also exhibited notable prevalence among domestic animals (2). Additionally, a systematic review from Sub-Saharan Africa reported that children living with domestic animals, particularly cats and dogs, were approximately three times more likely to be infected than those without such exposure (10). These suggest that dogs may be key determinant in the persistence and transmission of tungiasis infection among humans and animals, emphasizing the importance of animal management in control strategies.

Age-related patterns in human infection were also observed, with lower odds of tungiasis observed with increasing age. Although not statistically significant, this trend is consistent with previous studies indicating that children are usually disproportionately affected, likely due to increased exposure through play behaviors, reduced use of protective footwear, and greater contact with potentially infested areas (45), potentially accounting for the elevated exposure risk among the younger age group compared with their older counterparts.

The observed seasonal variation, with significantly lower odds of tungiasis during the dry season, suggests that local environmental conditions play an important role in shaping transmission dynamics. In the study area, prolonged periods of rainfall likely maintain elevated soil moisture levels, potentially creating favorable conditions for the survival, development, and reproduction of T. penetrans, given the off-host stages of the flea depend on suitable microenvironmental conditions, especially humidity and temperature for successful maturation in the soil. This interpretation aligns with the findings from settings characterized by perennial rainfall. Where no marked seasonal variation in prevalence has been observed (46). However, this finding is different from those reported from other settings with seasonally variability, where higher prevalence have been reported during dry season (3, 47), potentially reflecting differences environmental factors such as reduced rainfall leading to optimal conditions for flea development.

Although the association between household animal and human tungiasis did not reach statistical significance, the observed effect estimate and descriptive patterns may warrant further investigation in larger studies. The higher prevalence of human tungiasis observed among individuals living in households with infected animals may reflect shared environmental, behavioral, or socioeconomic factors that influence exposure risk within households. This interpretation is consistent with previous studies that have identified associations between the presence of domestic animals and tungiasis risk, particularly in socioeconomically vulnerable populations residing in settings with inadequate housing conditions (10, 41, 44). However, the present findings do not provide sufficient evidence to draw conclusions regarding animal-to-human transmission or the directionality of any observed relationship. Rather, they suggest that household environments may represent important contexts in which human and animal infections co-occur. Consequently, interventions aimed at reducing tungiasis burden may benefit from addressing broader household and environmental conditions, including housing improvements (i.e. flooring improvements), enhanced sanitation, appropriate domestic animal management, and community-based health education to promote preventive behavior among at-risk populations.

This study is not without flaws, as a number of limitations need to be considered when interpreting the findings. First, participant recruitment was based on accessibility, willingness to participate, and the presence of domestic animals within the households. This non-probability sampling approach may have introduced selection bias and limited the representativeness of the study population. For example, households that were more accessible, more willing to participate, or more engaged in animal ownership may differ systematically from non-participating households with respect to socioeconomic status, environmental conditions, health-seeking behavior, or even exposure to tungiasis risk factor. As a result, the results reported here may not fully reflect the true burden of tungiasis infection in the wider community. The observed associations between household characteristics and tungiasis may have been influenced by differential participation patterns, and therefore should be interpreted with caution. Second, the cross-sectional design of the study precludes causal inference and limits the ability to establish temporal relationships between exposures and outcomes. As a result, it was impossible to determine whether animal infection precedes human infection or vice versa, or whether both occurred concurrently because of the shared environmental conditions. Thus, the observed associations should be interpreted as reflecting co-occurrence and potential shared risks factors rather than direct transmission pathways. Third, some variables such as the frequency of rodent sightings relied on self-reported information and may therefore be subject to recall, social desirability bias, or reporting bias. Additionally, although multivariable analyses were employed to account for measured confounders, residual confounding from unmeasured or incompletely measured factors cannot be ruled out. Finally, given the study’s sampling strategy and its focus on a rural community, the findings should be generalized cautiously to other populations and settings.

Despite these limitations, the study provides valuable insights into tungiasis epidemiology at human-animal interface in an under-researched area and generates hypotheses that can be evaluated through larger, longitudinal, and population-based studies. The somewhat observed clustering of infections within households, alongside the convergence of key environmental and animal-related risk factors, strengthens the plausibility and relevance of the findings.

From a public health perspective, these results support the need for integrated control strategies that combine improvements in housing infrastructure (e.g., replacing earthen floors), promotion of protective behaviors (e.g., consistent shoe use), and adequate management of domestic animal infections. Targeting households, rather than individuals alone, may be particularly useful. Future longitudinal studies are needed to better understand the temporal dynamics of transmission and to clarify the role of domestic animals in sustaining human tungiasis. Such evidence will be critical for informing context-specific and sustainable interventions to reduce the burden of this neglected tropical disease, especially in vulnerable communities in LMICs, where competing socioeconomic challenges may further constrain disease prevention efforts.

Conclusion

This study provides novel insights into the epidemiology of tungiasis at the human-animal interface in a rural community in Badagry, Nigeria. Although the overall prevalence of tungiasis was relatively low, the observed household-level, clustering and co-occurrence of infection suggest that shared environmental, behavioral, and socioeconomic factors may be important in influencing infection patterns within the community. Several household characteristics, including the presence of dogs, earthen flooring, and recurrent rat sightings, were associated with tungiasis prevalence, suggesting the multifactorial nature of the disease in endemic settings. These results support the view that tungiasis may be closely linked to household- and environment-mediated conditions rather than solely to individual-level factors. While the observed patterns involving human and animal infections warrant further investigation, nevertheless, the findings suggest that interventions aimed at improving housing conditions, environmental sanitation, use of protective footwear, and better animal management may be relevant components of broader tungiasis control efforts in endemic communities. Further longitudinal studies are needed to better understand transmission dynamics, clarify the relationship between human and animal infection, and inform context-specific One Health approaches in resource-limited settings.

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Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fitd.2026.1880383/full#supplementary-material

Supplementary material Supplementary material at the source

Supplementary material Supplementary material at the source

Footnotes

Edited by: Dushyant Dudhagara, Bhakta Kavi Narsinh Mehta University, India

Reviewed by: Juan Pablo Escalera-Antezana, CIES Salud Sexual y Salud Reproducitva, Bolivia

Karina Cáceres-Fernández, Universidad Autonoma de Encarnacion, Paraguay