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Background  The parasitic skin disease tungiasis (caused by the flea  Tunga penetrans ) affects resource-poor communities in Latin America, the Caribbean and sub-Saharan Africa. Prevalences in endemic areas are high, and severe pathology occurs commonly. However, risk factors for infestation have never been assessed in Africa.    Methods and Findings  A cross-sectional study was conducted in Erekiti, a rural community in Lagos State (Nigeria), where tungiasis is endemic. Individuals were examined clinically for the presence of tungiasis, and a questionnaire was applied. Data from 643 individuals (86.6% of the target population) were analyzed; 252 (42.5%) were infested with  T. penetrans . In the multivariate logistic regression analysis, presence of pigs on the compounds (adjusted odds ratio = 17.98; 95% confidence interval: 5.55–58.23), sand or clay floor inside houses (9.33; 5.06–17.19), and having the common resting place outside the house (7.14; 4.0–14.29) were the most important risk factors identified. The regular use of closed footwear (0.34; 0.18–0.62) and the use of insecticides indoors (0.2; 0.05–0.83) were protective against infestation. The population attributable fractions associated with tungiasis were: sand or clay floor inside the house (73.7%), resting usually outside the house (65.5%), no regular use of closed footwear (51.1%), and pigs on the compound (37.9%).    Conclusion  The presence of tungiasis in Erekiti is determined to an important extent by a limited number of modifiable variables. Effective and sustainable intervention measures addressing these factors need to be implemented in this and other West African communities with high disease burden.

Risk Factors for Tungiasis in Nigeria: Identification of Targets for Effective Intervention