Aim: To describe the impact and sustainability of an evidence-based intervention against tungiasis in a severely affected community in Lagos State, Nigeria.

Methods: We performed an intervention targeted at the control of tungiasis, and a cross-sectional follow-up study after one year. After 14 years, the community was revisited, and a rapid assessment was performed. Risk factors identified before the intervention included sandy floors inside houses, irregular use of footwear, and free-roaming pigs on the compound. In collaboration with community members and traditional leaders, the floors of the primary school and houses without concreted floor were sealed with concrete, free-roaming pigs were banned/confined to pigpens, and regular use of footwear and environmental hygiene, particularly consisting of cleaning the compound and streets from waste, were encouraged. We examined the participants for the presence of tungiasis on legs, feet, hands, and arms. Signs and symptoms were documented.

Results: In the baseline survey before intervention, 557 participants were included in the follow-up study after one year, 540 participants were included. The prevalence of tungiasis decreased from 45.2% to 21.3%, and the total number of lesions from 3,111 to 617 (both P < 0.0001). Severe symptoms and pathology (e.g., difficulty walking, deformation of toenails, loss of toenails, and bacterial superinfection) were reduced from high to negligible levels. After 14 years, there was no case with vital tungiasis lesions.

Conclusion: Long-term control of tungiasis is possible in heavily affected communities by considering an evidence-based One Health approach. Urbanization may have contributed to elimination of tungiasis after 14 years.

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