High prevalence of bed bug infestations and its associated public health concerns in residences in and around Makerere University

A pest control service provider in Uganda fumigates bedbugs

High prevalence of bed bug infestations and its associated public health concerns in residences in and around Makerere University

Tonny Abet and Patrick Vudriko

Pharmaceutical and Toxicology Research Laboratory, College of Veterinary Medicine, Animal Resources and Biosecurity, P. O Box 7062, Kampala (Uganda)

Abstract

Background: Bed bug explosion is attracting substantial public health attention across the globe, Uganda included. Besides their physical and psychological effects, bed bug infestation has direct impact of lowering residential and accommodation market. This study investigated the prevalence of bed bug infestations and its associated public health concerns in residences in and around Makerere University.

Methods: This was a cross sectional study in which structured questionnaires and key informant interviews were used as qualitative tools for data collection. The key variables assessed included level of bed bug infestation, perception of individual students on the effectiveness of control strategies, toxicity of chemicals used, specific impacts of bed bug infestations on student community and the extent to which facility managers are concerned about fighting and eradicating the bed bugs in the halls and hostels of residence in and around Makerere University.

Results: The prevalence of bed bug infestation was 100% (8/8) for the total number of residence facilities that participated. The prevalence of bed bug infestation across the residences in and around the university was 72% (58/80) basing on cases of infestation per total number of rooms reached; with the single sex (male) residences presenting with 100% (20/20) and the University owned residences contributing the major portion 57% of the total prevalence as enlightened in figure 1. Interestingly, 28.8 % (23/80) of the participants suffered from illusionary parasitosis, a form of psychological torture that result from chronic cimicosis. Up to 30% (24/80) of the correspondents said the efficacies of the insecticides used were poor with fake chemicals, incompetency of pest controllers and resistance of bugs as major reasons for low efficacies. The major effects of exposure to chemicals according to the respondents were itches on the skin, eye irritation and respiratory suppression. And, 63% (51/80) of correspondents were frustrated that the facility administrators were not doing enough to curb the infestation.

Conclusion: Bed bug infestation in halls of residence in and around Makerere University is high and appreciably impedes students’ psycho-social wellbeing through illusionary parasitosis, deterioration of the sleep quality, self-esteem and reduction in academic concentration. There is need for creating awareness on bed bug control and prevention in student residencies.

Key words: Bed bug, Cimex lectularius, residences, prevalence, illusionary parasitosis, toxicity

Introduction

Bed bugs are the emerging public health concern as the explosion thrives in all corners of the globe (Studdiford, 2012). Periurban settlements in low-income countries worldwide are characterized by inadequate environmental sanitation. Water, sanitation, and hygiene have been frequently addressed in these settings although risks associated with vectors and vermin are overlooked and not well integrated into public health policies. Specific urban risks and causes of low value of residential premises, mortality and morbidity have been associated with presence of pests.

The global explosion of bed bugs and shocking discoveries of the potential health impacts of bed bug bites have raised the public health concern (Kolb, 2009). The evolution of insecticide resistance could be a primary factor in explaining this resurgence of bedbugs in many areas, both rural and urban (Wang, 2011). Bed bugs are the hematophagus insects with over 40 parasitic microorganisms of public health concern detected (Doggett, 2012) remains an insect to treat with a little more care as scientific investigations steadily proceed. Health wise, in the laboratory, HBV has been detected up to 2 months after an infectious meal or after direct injection into the bedbug, it has been found in feces, and transstadial transmission has been demonstrated but possible human transmission is still being studied. HBV has frequently been detected in wild bedbugs (Blow JA et al., 2001). T. cruzi has been detected in wild bedbugs. Bedbugs can transmit deadly parasite like Trypanosoma cruzi of Chagas disease via feces (Salazar, 2015).

Bed bug infestations is said to be overwhelming the residents of Makerere area according to the information at hand. However, there had been no documentation of useful approaches and control steps either by the respective premises administrators or pest control service providers. The documentation is of utmost importance in pointing the general trend of infestations, evidence of insecticide field resistant of bed bugs for effective control and prevention. And it is in this breathe that this particular study serves to establish the baseline data as useful tool for better mitigation of the said heavy infestation in this community.

Methods

The study was conducted to establish the prevalence of bed bug infestations and its associated public health concerns in halls of residence in and around Makerere University. The study participants were the resident students and university stakeholders who served as key informant.

This was a cross sectional study in which structured questionnaires and key informant interviews were used as qualitative tools for data collection. The key variables assessed included level of bed bug infestation, perception of individual students on the effectiveness, toxicity of chemicals, the specific impacts of bed bug infestations on student community and the extent to which university administration is concerned about fighting and eradicating the bed bugs in the halls and hostels of residence in and around Makerere University.

Semi structured questionnaires were used to collect data from participants on the knowledge and attitude on burden of bed bug infestation in their halls/hostels of residence. The questionnaire also assessed perception of individual students on the effectiveness, toxicity of chemicals, the specific impacts of bedbug infestations on student community and the extent to which university administration is concerned about fighting and eradicating the bedbugs in the halls and hostels of residence in and around Makerere University. Interviews were also conducted with wardens and custodians. Knowledge, attitude and perspective on the history and burden of bedbug infestation and more so on how other hostel administrators are scooping success stories in effective management of this infestation.

Data were entered in MS-Excel for validation. Analysis was performed with SPSS for Windows.

Results

Demographic characteristics of participants

The study involved 118 rooms of students from halls and hostels in and around the institution and out of whom, 57% (45/80) were for females and 43% were for males. Ten (10) premise administrators served as key informants. Eight (8) residences participated. Eighty 80 correspondents were randomly considered in the statistical analysis with questionnaire data from 10 individuals per residence used as shown in Table 1 in the appendix:

Knowledge on bed bug infestation and prevalence of the bed bug infestation in this community

Of the total participants, those who had heard about cases of bed bugs and the infestation anywhere either in or outside Makerere area were 92.5% (74/80). At least 72.5% (58/80) had primarily encountered bed bugs for the first time in Makerere areaas shown inTable 2 in the appendix:

Impact of bed bug infestations on students’ wellbeing and health

Surprisingly, 28.8 % (23/80) of the participants suffered from illusionary parasitosis, a form of psychological torture that result from chronic bed bug bites. Other effects included the deterioration on the concentration in academics 27.5% (22/80), sleep quality 42.5% (34/80) and general self-esteem 31% (25/80) of the victims. On the health concern, 66% (53/80) of participants were afraid the bed bugs harbour harmful parasitesthat may cause disease to them as shown in the Table 3 in the appendix:

Chemical control: perceived effectiveness and effect on health

The use of chemicals 94% (75/80) and use of hot water 6% (5/80) were the two major methods employed in the bed bug control. Up to 33.8% (27/80) of correspondents said the efficacies of the chemicals are poor, the other 33.8% (27/80) were sure the insecticides are effective whilst the rest of the participants declined to respond. 68.8% (55/80) were afraid the chemicals used present toxic side effects to humans but the rest of the correspondents had no clue about the health concerns surrounding the pesticides often applied indoor. Among the direct effects the chemicals present to the correspondents were; the hostile smell, irritation to the eye and skin and then causation of sneezing as shown in Table 4 in the appendix:

Collaborative Involvement in the control and eradication fight

At least 63% (51/80) were astonished that the university administrators were not doing enough to curb the burdening infestation amidst leaving the entire control costs on the shoulders of students who were directed into the already infested rooms by the same administrators.

The useful views from residence facility administrators can be seen in Table 5 in the appendix:

Discussion

Excavating from the extensive interviews, observational studies conducted and the results above, the major escalating factors for the high infestation levels of bedbugs in this community included; the low levels of hygiene, poor coordination  between the residents and facility administrators, overcrowding of residents in rooms, poor facility design, the broken-down state of internal facility and furniture that advanced multiple cracks and crevices that bedbugs gleeto breed and proliferate, the unprofessional response to bed bug control, and finally the resistance factor of the bed bugs to the chemicals used  to spray them . The other escalating factors included the involvement of non-professionals and untrained individuals in the control process for this sophisticated pest especially in the use of chemical control attempt, unregulated fake and expired chemicals in the consumer market and finally, the uncontrolled property shifts among residences.

 The laxity of the relevant health agencies and civil society organizations to putting in place clear public policies and developing the enforcement means for coordinated management of domestic pests especially the dreadful bed bug, could have offered this fertile ground for the bed bug infestation to thrive ruthlessly in this community. The wide communication gap between the residents and facility administrators complicates timely reporting of the incidence of infestation allowing bed bugs to flourish before the information can reach useful ears.

Conclusion

The prevalence of bedbug infestations was generally very high in students’ residences of Makerere University with the major proportion contributed by the university owned premises of residence. The bed bug infestation has advanced substantial impediment to the psycho-social wellbeing of residents through illusionary parasitosis, stigma and lowering of self-esteem, deterioration of the sleep quality and reduction in academic concentration. The financial loss and time wastage associated with failed control attempts were also echoed by residents.

There is strong need for setting up and enforcing clear public policy on management of domestic pests especially the monstrous bed bug. The raising of public awareness on bed bug and the integrated management approach for bed bug and other domestic pests needs to be invested upon by the state. The firms manufacturing and selling pesticides for public health usage should be better regulated. The current body of Pest Control Service providers should ensure quality service from members to clients and more importantly check on unqualified players.

Competing interests

There was no conflict of interest in this study.

Ethics approval and consent to participate

The research approval was obtained from the school of Biosecurity, Biotechnology and Laboratory sciences with a clearance from the office of the Dean of Makerere University. Only those individuals who consented to the study were involved.

Funding

This study was funded by the authors.

Authors' contribution

TA –designed the study, collected the data and carried out experiments.

PV –designed experiment, data analysis and drafted the manuscript.

Both authors read and approved the final manuscripts.

Acknowledgements

The authors acknowledge the contributions of the staff of Pharmaceutical and Toxicology Research Laboratory. Appreciations also go to the students, residence facility managers and pest control service providers who participated in the study.

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APPENDIX:

Table 1: Demographic characters of participants

Variable	Response	Frequency	Percentage
Sex	Male	35	43.2
	Female	45	56.8
	Total	80	100
Age groups	18-24	73	90.7
	25-35	6	8.5
	>35	1	0.8
	Total	80	100
Residence Hall	CCE hall	10	12.5
	Mitchell hall	10	12.5
	Lumumba hall	10	12.5
	Mary Stuart hall	10	12.5
	Africa hall	10	12.5
	MISH hostel	10	12.5
	Garden courts Hostel	10	12.5
	DAG/postgraduate hall	10	12.5
	Total	80	100
Sponsor	Government	30	36.4
	Private	49	61.9
	Others	1	1.7
	Total	100	100

Table 2: Knowledge and perception about bed bug infestation

Variable	Response	Frequency	Percentage	P- value
Ever heard of bedbugs anywhere?	Yes	73	90.7	0.011
	No	7	9.3
	Total	80	100
Are there Bedbugs in Makerere?	Yes	58	72	0.0001
	No	22	28
	Total	80	100
Bedbugs harbor disease causings parasites?	Yes	53	66.8	0.399
	No	27	33.2
	Total	80	100
Is your hall/hostel infested?	Yes	43	51.7	0.0001
	No	28	48.3
1.    Lumumba hall	Yes	9	87
2.    Mitchell hall.	Yes	9	87
3.    Complex hall	Yes	9	83
4.    MISH hostel	Yes	5	47
5.    Mary Stuart hall	Yes	5	44
6.    Postgraduate hall	Yes	2	30
7.    G. Courts hostel	Yes	2	20
8.    Africa hall	Yes	2	19
Have you seen a live bedbug in your room?	Yes	58	72	0.0001
	No	22	28
1.    Lumumba hall.	Yes	10	100
2.    Mitchell hall.	Yes	10	100
3.    Complex hall	Yes	10	100
4.    MISH hostel	Yes	6	60
5.    Mary Stuart hall	Yes	6	60
6.    Postgraduate hall	Yes	5	50
7.    G. Courts hostel	Yes	6	60
8.    Africa hall	Yes	5	50

Figure 1: The comparison of the prevalence of bed bug infestation distribution between residences in Makerere area.

Figure 2: The comparison of the prevalence of bed bug infestation in respect to sex of the occupants in Makerere area.

Figure 2: Why people continue residing in bed bug infested premises

Table 3: Effects of bed bug infestation on residents

Variable	Response	Frequency	Percentage	P-value
Why continue residing in infested room.	Security Near college	10 23	8.5 28.8	0.001					0.0001
	Sponsor	06	7.5
	Costs	24	30
	Others	20	25
Magnitude of effects on academics.	Strongly – Very strongly	14	17.5
	Weakly –Moderately	8	10
	Others	58	72.5
	Total	80	100
Negative impact on your self-esteem.	Strongly – Very strongly	16	20	0.001
	Weakly – Moderately	9	11
	Others	55	69
	Total	80	100
Magnitude of effect on skin and bodily health.	Strongly – Very strongly	14	17.5	0.021
	Weakly – Moderately	11	13.8
	Others	55	68.7
	Total	80	100
Experienced illusionary parasitosis.	Yes	23	28.8	0.0001
	No	44	55
	N/ A	13	16.2

Table 4: Health concern and perception of participants on the effectiveness of chemicals currently used

variable	Response	Frequency	Percentage	P- value
Room fumigated for bedbugs?	Yes	56	70	0.0001
	No	24	30
Frequency of fumigation.	Per semester	37	46.3	0.0001
	Others	19	23.8
	N/A	24	30
Level of insecticide effectiveness.	Effective – Very Effective	27	33.8
	Poorly effective – Ineffective	27	33.8
	N/A	36	45
Cause of low effectiveness.	Fake chemical and poor techniques  of application	25	31.3
	Resistance of bedbugs	21	26.3	0.003
	Others	8	10
	N/A	36	45
Discomfort caused by chemical is more than that of bedbug bites.	Yes	23	28.8	0.0001
	No	44	29.9
	N/A	13	16.3
Level of university commitment in fighting bedbug infestations.	Committal – Strongly Committal	18	22.5
	Weakly committal-Not committal	51	63.8
	N/A	11	13.7

Table 5: Views from residence facilities administrators

Residence/position/sex	Level of infestation, if any?	Control strategy	Way forward
Waterleau/custodian/F	Very low	Fumigating every new student’s property especially those coming from halls. Fast response when our students report cases of bedbug and ensuring general hygiene at hostel and student rooms’ levels.	The hall/hostel and university administration should get more involved in fighting the bedbug infestation. Students should maintain good personal hygiene.
Nsibirwa hall/ass. Custodian/M	High	We fumigate at the beginning of every semester. The chemicals are not effective. The fumigation service provider here is a fraud.	A professional company should be hired to do the work more effectively.
Mary Stuart hall/custodian/F	Medium	We fumigate during the recess otherwise students do it themselves. Some rooms are so infested and I always wonder how some students sleep in them like that, I think most of them are used to bedbugs. The students organize and we support the cleaning festival.	The students should work on their personal hygiene. The university administrators should accord more funds to fight the bedbugs.
Lumumba hall/ass. Warden/M	Medium	We fumigate at the end of every semester. Some insecticides especially those bought by students along the streets are fake. We are very committal in fighting bedbugs.	Fumigation should be adjusted to twice a semester. The university should reconsider providing mattresses for students. Hostels and halls should coordinate since students are ever visiting one another. Student property should be fumigated before entering rooms. More research should be done to find more effective chemicals especially those that can kill the eggs.
MISH/custodian/F	Very Low	We do general fumigation once a semester and or fumigate when students call for.	Students should report the infestation early. Fumigation should be done twice a semester. Students should stop shying away from reporting infestation in their rooms.
Garden courts	Low	We do general fumigation at the end of every semester. We prioritize and have groomed good hygiene facilitated by a committed effective team of cleaners. We also provide our students with mattresses and so effective monitoring and management of fumigation is possible. We have an internal body specialized in managing residual insects.	Fumigate at the beginning and end of every semester. Good level of hygiene in the general hostel and rooms should be maintained.
Post graduate hall/chief custodian/F	Low	We fumigate when demanded.	University should buy new furniture for the hall and fumigate more frequently.
Mitchell hall/chief custodian/M	Medium	We fumigate at the end of semester and when called for.	Effective chemicals and integrated control methods should be used.
Complex hall/chief custodian/M	Medium	We fumigate at end of semester and when students ask for.	Fumigation should be done 3 to 4 times every semester. The professional competency of pest control service providers should be checked.
Chairperson of hall chairperson council/M	High	Fumigation	Students should get more involved.