Filaria presentation 2012 on MDA

It is very useful for Govt. public health officials

Thanks to Dr. D. Roy fromer Dy Cmoh-II Bankura

1. Elimination of Lymphatic Filariasis Presented By Dr. Debashis Roy Dy.Chief Medical Officer of Health - II, Bankura

2. FILARIA : A Public Health Problem It leads to elephantiasis & large Hydroceles causing economic loss and severe physical disability to the affected individuals. LF is usually acquired in childhood & the lymphatic system is gradually damaged.

3. Magnitude of The Disease In India 400 million live in 250 Filaria prone Districts in 15 states & 5 UTs. Affected States are – Orissa, W.B., A.P., T.N., Kerala, Bihar, U.P., Jharkhand , M.P., Gujrat & Maharashtra.

4. Objectives To reduce and eliminate transmission of LF by MDA of DEC To reduce & prevent MORBIDITY in affected persons of lymphoedema . To strengthen the existing health care services. Achieved through the existing health services with improved health care delivery system and enhanced activities by involving the NGOs, private & public sectors . Enhanced IEC for integrated VBD controlled involving the PRI.

5. Back ground of Elimination of Lymphatic Filariasis National Filaria Control Programme was Launched during 1955 with the Strategy of Delimitation of Filaria Endemic Areas Detection & Treatment with DEC Vector Control Activities

6. Elimination of Lymphatic Filariasis Strategy Classically LF treatment with DEC has been a 12 days regimen It is still being followed in NFCP units Studies showed that a single dose of DEC can suppress Mf level in blood for a period as long as one year This single dose with DEC came as an effective PROGRAMME TOOL It helped for a POLICY SHIFT towards giving simultaneous annual single dose of DEC to whole population of endemic areas Objective is to cut down the transmission

7. Elimination of Lymphatic Filariasis Strategy (Continued) Thus we entered in to the age of MDA During 2007 , ALBENDAZOLE was added with DEC. 11 TH November was fixed for observing National Filaria Day with MAD as major activity. Subsequently, due to different reasons the states started doing MDA on different dates in different years IDEAL COVERAGE TO ACHIEVE FOR ELF 85 per cent of population should take prescribed dose on the day of MDA for 5 successive years. Mf rate should be <1 % at community level after 5 years of MDA. DO THEY ????

8. Elimination of Lymphatic Filariasis Strategy (Continued) ADDITIONAL COMPONENT OF ELF For ethical reason and giving visibility to the Programme , disability prevention & management were included in the strategy Home-based morbidity care. Hospital-based hydrocele operation

9. MDA : Planning MAJOR ACTIVITIES Updating line list of Lymphedema & Hydrodele cases. Up scaling of hydrocele operation. Pre-MDA Mf Survey. Micro action plan- HSC, PHC/Town, District. T raining of Dist./PHC/HSC level officials. Training of Drug Distributors, Drug Supervisors & handing over of drug stock. IEC, BCC & Social mobilization. Distribution & ensuring consumption of drugs on the day of MDA. Supervision of MDA & positioning RR Teams. MOPPING-UP in next 2 days. Report compilation (coverage, compliance) Expenditure accounting, Submission of REPORT, UC & SOE.

10. MDA : Planning Drug Distributors 1 per 100 houses or 500 People Drug Supervisors 1 per 15 Drug Distributors Rapid Response Teams Training/Orientation of Health Officials at District / BPHC & PHC Mos’ / Paramedical Staffs / ASHA / VHW

11. MDA : Implementation Implementation is OPERATIONAL aspect of TRANSLATING plan in to actions FACTORS RESPONSIBLE FOR IMPLAMENTATION Political commitment Administrative support Advocacy Community participation (including Rogi Kalyan Samitee & VHSC) Quality of planning Timely availability of resources Motivation, Supervision, Leadership Inter- sectoral co-operation (Education, Youth Affairs, Social Welfare, Rural Development, Panchyat , Municipality, I & B etc.)

12. Causes of Lymphatic Filariasis Due to lymphatic dwelling nematode parasites ( Wuchereria Bancrofti & Brugia Malayi ) in India . Bancroftian filariasis transmitted by Culex Quinquefasciatus mainly, prefer to breed in dirty & polluted water . Brugian filariasis transmitted by Mansonia mosquitoes which breed in water bodies with aquatic vegetation.

13. Lymphatic Filariasis Transmission Adult parasites usually found in lymphatic system of human being giving birth to as many as 50,000 microfilariae (mf) per day, which find their way into blood circulation. While feeding, mf are picked up by female vectors from mf-carriers. Mf in vectors develops in 3 stages in 10-14 days. Infected vectors when bite another person deposited mf-larvae at the site & enter into the lymphatic system. These larvae develop into adult (M & F) in humans. Adult worms survive for 5-8 yrs or more & go on releasing mf into human blood circulation.

14. Prevention & Treatment In endemic are – single dose of DEC Tabs (100 mg / Tab.) are administered once in a year for five or more consecutive years. Following Doses are recommended < 2 years : Nil Tabs. 2 – 5 Yrs. : 1 Tab. 6 – 14 Yrs : 2 Tabs. > 15 Yrs. : 3 Tabs .

15. Remember Pregnant Woman Children Below 2 Years of Age & Seriously Ill Persons Are Excluded from Treatment

16. HOW TO ACCESS MEDICINE DEC can be obtained from all Government Health Centers / Hospital free of cost. On National Filaria Day drug distribution is done by door-to-door campaign.

17. Goal National Health Policy (2002) Goal To eliminate lymphatic Filariasis from INDIA by the year 2015

18. Advantages of Mass Drug Administration It avoids the cost of mass blood exam. All members of community receive treatment, nobody feels left out. It is as effective as 12 days DEC therapy. Lesser side effects enhancing public compliance. It involves decreased delivery cost. It does not require complex management infrastructure.

19. Side Effects of DEC DEC is a safe drug being used in India for more than 50 yrs However, the drug reactions may occur & are of TWO kinds Those due to drug itself Headache, Anorexia, Nausea, Vomiting, Abdominal Pain, Dizziness Weakness or Lethargy. Symptoms appear within 1 – 2 hrs. & persist for a few hours Those due to allergic reactions Destruction of mf & adult worms Fever, local inflammation around dead worms & pruritus . These reactions are transitory and Subside within 2 days.

20. Salient Points to Remember for MDA Exclude children below 2 years, pregnant woman, chronically ill persons and infirm old persons from MDA. Administer DEC to all eligible persons by door- to-door visits. Ascertain correct age from the individual or the mother so that the recommended does is given. DO NOT ADMINISTER THE DRUG ON EMPTY STOMACH Ensure that the drug is swallowed in your presence Discreetly caution that some people may experience temporary side effects and drugs are available free of cost at Sub Centre and PHCs for management. Conduct mopping up operation in the subsequent days recover the inmates of locked households and also refusal cases through intensified IEC. Reports serious cases immediately to PHC Medical Officer.

21. National Filaria Day Mass Drug Administration is being Observed on a single day as NATIONAL FILARIA DAY (NFD) The following are action points for successful implementation of MDA Free Drug distribution. IEC Training Monitoring & Evaluation

22. THE ELF IS COMPLEX AND DEEP, WE HAVE TO WORK HUNDREDS OF HOURS BEFORE WE SLEEP

23. THANKS