national filariasis control programme ppt

national filariasis control programme

1. SEMINAR ON NATIONAL FILARIA CONTROL PROGRAMME Presented By- Pinki Barman

2. INTRODUCTION Lymphatic Filariasis is distributed in economically challenged countries. Bancroftian filariasis caused by Wuchereria banccrofti which is transmitted to man by the bites of infected mosquitoes- Culex , Anopheles, Mansonia and Ades . National Filaria Control Programme (NFCP) was launched in the country in 1955 with the objective of delimiting the problem, to undertake control measures in endemic areas and to train personnel.

3. FILARIASIS Filariasis is caused by several round, coiled and thread-like parasitic worms belonging to the family filaridea The disease is caused by the nematode worm, either Wuchereria bancrofti or Brugia malayi and transmitted by Culex quinquefasciatus and Mansonia annulifera / M.uniformis respectively. The disease manifests often in bizarre swelling of legs, and hydrocele

4. LYMPHATIC FILARIASIS (LF) Lymphatic Filariasis (LF), commonly known as elephantiasis is a disfiguring and disabling disease Lymphatic filariasis is estimated to be one of the leading causes of disability worldwide In the early stages, there are either no symptoms or non-specific symptoms. The long term physical consequences are painful swollen limbs ( lymphoedema or elephantiasis)

5. EPIDEMIOLOGY The WHO has estimated that 600 million people are at risk of infection in South-East Asia and 60 million are actually infected in the region. There are about 553 million people at the risk of infection with 48 million (80% i.e., 48 out of 60 million) infected with parasite in India. Lymphatic filaria is prevalent in 250 districts in 20 states and union territories . Bancroftian filariasis is widely distributed while brugian filariasis caused by Brugia malayi is restricted to states-UP, Bihar, Andhra Pradesh, Orissa, Tamil Nadu, Kerala, and Gujarat.

6. FILARIA VECTORS C.quinque fasciatus

7. LIFE CYCLE OF FILARIA PARASITE

8. CLINICAL PRESENTATION OF LF There are bouts of fever accompanied by pain, tenderness and erythema . Inflammation of the spermatic cord, epididymitis and orchitis . Progressive enlargement, coarsening corrugation and fissuring of skin and subcutaneous tissue with warty superficial excrescences develop gradually causing elephantiasis.

9. DIFFERENCE BETWEEN BANCROFTIAN FILARIASIS AND BRUGIA FILARIASIS

10. Bancroftian Filariasis The lymphatic vessels of the male genitalia are most commonly affected in bancroftian filariasis . Hydrocele is the most common sign of chronic bancroftian filariasis , followed by lymphoedema , elephantiasis and chyluria . Adenolymphangitis of the extremities is less common.

11. Brugia Filariasis CATEGORIES SYMPTOMS Mf carrier Asymptomatic but Mf circulate in blood ADL Fever with adenolymphangitis Lymphedema I Reversal edema limbs overnight, skin normal, damage to the lymphatic system Lymphedema II Irreversible edema in the limbs even with elevation, skin normal, repeated attacks of ADL Lymphedema III Irreversible edema in the limbs, skin thickened, repeated attacks of ADL

12. Lymphedema IV Irreversible edema in the limbs, skin fold thickening, pigmentary changes, chronic ulceration and epidermal and subepidermal nodules. Hydrocele <15 cm Swelling of scrotum ( Tunica) Hydrocele ≥15cm Swelling of scrotum( Tunica) Chyluria Milky urine due to obstruction of lymphatic system

13. NATIONAL FILARIA CONTROL PROGRAMME After pilot project in Orissa from 1949 to 1954, the National Filaria Control Programme (NFCP) was launched in the country in 1955 with the objective of delimiting the problem, to undertake control measures in endemic areas and to train personnel to run the programme .

14. OBJECTIVES Reduction of the problem in un-surveyed areas. Control in urban areas through recurrent anti larval and anti-parasitic measures.

15. NFCP STRATEGY Recurrent anti-larval measures at weekly intervals. Environmental methods including source reduction by filling ditches, pits, low lying areas etc. Biological control of mosquito breeding through larvivorous fish. Anti-parasitic measures through 'detection' and 'treatment' of microfilaria carriers and disease person with DEC by Filaria Clinics in towns covered under the programme

16. INDICATORS Percentage of population actually consumed Drug. Microfilaria rate in sentinel sites of the districts Member Hospitals/CHCs equipped for hydrocelectomy . Number of hydrocele operations conducted out of total enlisted . Number of complications after hydrocelectomy to assess quality of service per 1000 operations Percentage of Lymphedema cases practicing Home based management

17. CONTROL STRATEGY Vector Control Anti-Mosquito and Anti-larval Measures Biological Control through larvivorous fishes. Environmental engineering through source reduction and water management; Antiparasitic measures For the individual case treatment: Diethyl Carbamazine (DEC) is given for Bancroftifilariasis in the dose of 6 mg/kg body weight orally daily for 12 days in divided doses after meal (a total of 72 mg per kg of DEC). For the Brugianfilariasis , DEC is given 3-6 mg/kg body weight per day up to total dose of 18-72 mg per kg.

18. DEC tablets should be taken once in a year on the identified day of MDA (National Filaria Day). The tablets should be taken after food. If the tablets are taken on empty stomach, it may cause stomach discomfort. There is a report of successful treatment of elephantiasis with doxycycline given for 14 days Mass treatment Revised Strategy- Single dose mass treatment of Diethylcarbamazine (DEC) alone or combined with Albendazole repeated at six months or one year

19. Pre MDA activities- First visit: (Household enumeration) Visit every house in assigned area within 15 days prior to the day of MDA . Enquire about the details of the household and record Inform the family members about the MDA programme and clarify their doubts

20. Second visit: (Interpersonal contact) Make house to house visit Meet all the available members Select the correct dose of DEC based on the age of the person Co-administer DEC with albendazole Ensure that the individual is consuming the drugs in your presence (supervised administration) Record the absentees and their time of availability Advise to approach the Subcentre /PHC if any inconvenience is faced

21. Mopping-up: Make daily visits to your assigned area for two days following MDA to cover the absentees If any case with side effects are come across, provide them with symptomatic treatment If any case requires hospital admission, report to the VHN/rapid response team

22. Age (in years) DEC Albendazole (400 mg) Dose No of Tablets (100 mg) <2 Nil Nil Nil 2-5 100 mg 1 tablet 1 tablet 6-14 200 mg 2 tablets 1 tablet 15 & above 300 mg 3 tablets 1 tablet

23. Single dose of Ivermectin (20-400 ug /kg of body weight) has been found to be effective, but it is associated with high recurrence rates (5-40%) after 6 months of treatment in bancroftian infections. Triple drug therapy: Ivermectin , DEC and Albedazole to eliminate Lf by 2020 (coverage endemic districts of Maharashtra, 1 district each in Bihar, UP, Jharkhand. Behavior Change Communication Capacity building for home based management.

24. Infrastructure District Health Officer Medical officer (PHC) Village health guide or health workers

25. ELIMINATION OF LYMPHATIC FILARIASIS In 1997, WHO and its Member States made a commitment to eliminate Lymphatic Filariasis (LF) as public health problem by 2020 through World Health Assembly Resolution WHA 50.29. The National Health Policy (2002) has set the goal of Elimination of Lymphatic Filariasis in India by 2015. Later extended to 2021. Subsequent to that Global Alliance to Eliminate Lymphatic Filariasis (GAELF) has been formed in 2000.

26. Twin Pillar Strategy for Elimination of Lymphatic Filariasis Annual Mass Drug Administration (MDA) of single dose of DEC ( Diethylcarbamazine citrate) and Albendazole for 5 years or more to the eligible population (except pregnant women, children below 2 years of age and seriously ill persons) to interrupt transmission of the disease. Home based management of lymphoedema cases and up-scaling of hydrocele operations in identified CHCs/ District hospitals /medical colleges

27. Milestones of ELF In 1997-Elimination of Lymphatic Filariasis as a global public health problem In 2002- National Health Policy set a goal for ELF in India by 2015 In 2004-Elimination of Lymphatic Filariasis (ELF) programme In 2013- validation started through Transmission Assessment Survey (TAS) On 13th June, 2018-Accelerated Plan for Elimination of Lymphatic Filariasis 2018

28. Triple Drug Therapy (IDA) has been successfully implemented in 5 districts namely Arwal (Bihar) and Simdega (Jharkhand), Nagpur (Maharashtra), Varanasi (Uttar Pradesh), Yadgiri (Karnataka) on 20 th  December 2018, 10 th  January 2019, 20 th  January, 2019, 20 th  February, 2019 and 13 th  November, 2019 respectively. Government of India has revised the financial norms for Morbidity Management Kits from Rs. 150/- to Rs. 500/- per kit in February 2019.

29. Mass Drug Administration (MDA) MDA started as mass campaign from 2004. Initially with single dose of DEC only. In the year of 2007 with DEC + Albendazole co-administration Form 2018 Triple Drug Therapy (IDA) i.e. DEC + Albendazole + Ivermectin is launched initially in five selected districts.

30. ACCELERATED PLAN TO ELIMINATE LF 2018 Starting from 2018, the national programme plans to implement an accelerated plan to give a new impetus to the ongoing activities and achieve the goal of LF elimination by 2020, in accordance with the World Health Organization (WHO) regional strategic frame work for control/elimination of Neglected Tropical Diseases (NTDs) and WHO NTD goals and timeline. The plan is built upon the national guidelines for elimination of LF (2009) and seeks to introduce newer intervention strategies and improve implementation of MDA and Monitoring& Evaluation and surveillance strategies

31. Goal Elimination of lymphatic filariasis (LF) as a public health problem by 2020, as envisaged by WHO-SEAR’s strategic framework. General objectives To accelerate interruption of transmission in all endemic districts using enhanced and innovative preventive chemotherapy strategies To provide a minimum package of care to all people affected with chronic disease to alleviate suffering To augment the programme activities towards preparation of LF elimination validation dossier

32. Specific objectives To strengthen advocacy and ownership of the program at all levels To implement confirmatory mapping of uncertain areas To strengthen communication and social mobilization To ensure enhanced MDA in all endemic districts To introduce new and innovative preventive chemotherapy strategies and strengthen supplementary intervention measures To strengthen monitoring and surveillance system To assess burden of chronic disease

33. To strengthen the health system capacity to provide quality care for people affected with chronic disease To ensure quality data management at all levels To address the gender equity and disability related issues (no one should be left behind as per the theme of SDGs) To build stronger and sustainable partnerships To support operational research To initiate steps for preparation of dossier for validation of elimination of LF

34. Action Action 1: To enhance advocacy and ownership of the programme at all levels Action 2: To implement confirmatory mapping in uncertain areas Action 3: To strengthen communication and social mobilization Action 4: Ensure enhanced MDA in all districts Action 5: To introduce innovative preventive chemotherapy strategies and strengthen supplementary measures. Action 6: To strengthen monitoring and surveillance system Action 7: To identify all people affected with chronic disease to facilitate treatment

35. Action 8: To strengthen the health system capacity to provide quality care for people affected with chronic disease Action 9: To ensure quality data management at all levels Action 10: To build stronger and sustainable partnerships Action 11: To support operational research 12: Preparation of dossier for validation of elimination of LF

36. Morbidity management and disability prevention (MMDP)

37. Goal To alleviate suffering in people with ADLA, lymphedema , and hydrocele . To provide access to the recommended basic care for every person with these manifestations in areas endemic for lymphatic filariasis .

38. Measures for managing lymphedema Responsibility Activities required Person(s) responsible and skills required Care delivery level Disease condition- Acute dermatolymphangioadenitis (ADLA) Identify patients and treat ADLA and manage complications Visit patients regularly to identify attacks, treat ADLA with appropriate antibiotics, follow up patients Doctors and nurse Knowledge of basic principles of management doctors and nurses Primary health care level, sub-divisional or district hospital Prevent injuries and entry lesions Washing limbs, distribution of footwear, prompt treatment of injuries and rest during attacks Patients with ADLA, ASHA, Doctors and nurse- Knowledge of predisposing factors for ADLA and facilities available for treatment Community and family home-based, Primary health care level, sub-divisional or district hospital

39. Disease condition: Lymphoedema and elephantiasis Manage lymphedema and its complications Washing limbs, foot care, exercise and prevention of ADLA Patients with lymphoedema , ASHA, Doctors and nurse- Knowledge of predisposing factors for ADLA and facilities available for treatment Knowledge of basic principles of treatment and management of lymphedema and complications Disease condition: Hydrocele Identify and perform safe hydrocoelectomy Treat ADLA and its complications with appropriate antibiotics Motivate patients and refer for surgery ASHA, Doctor, Nurse- Manage, refer and counsel Basic principles of management as appropriate

40. ROLE OF COMMUNITY HEALTH NURSE Administration Communication Nursing Teaching

41. Summary And Conclusion