|STRATEGY FOR ELIMINCATION OF LYMPHATIC FILARIASIS
Progress and Achievement
- 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.
Validation through Transmission Assessment Survey (TAS)
- In pursuit of the goals, the Government of India launched nationwide MDA in 2004 in endemic areas as well as home based morbidity management, scaling up hydrocelectomies in hospitals and CHCs. During the year 2004, only 202 districts could be covered with coverage rate of 72.6%. The number of districts was upscaled and in 2007 all the 250 (now 255 due to bifurcation) known LF endemic districts were brought under MDA. The policy decision to implement global strategy of co-administration of DEC with Albendazole during MDA was approved by National Task Force on Elimination of Lymphatic Filariasis under the Chairmanship of DGHS in 2006. The population coverage during MDA has improved from 73% in 2004 to 86% in 2014 (Prov.) which has resulted in the overall reduction of microfilaria rate from 1.2% in 2004 to 0.4% in 2014 (Prov.).
- Capacity building has improved the performance of various functionaries. The initiative was also taken to involve senior faculties from various medical colleges for assessment of actual drug compliance. Approximately about 1.5 million health personnel incl uding Medical Officers, Paramedicals, Drug Administrators, Lab. Technicians, etc are trained annually on MDA and Morbidity management.
- Intensive social mobilization during MDA, have been carried out by various states/ UTs involving political/ opinion leaders, decision makers, local leaders and community.
- Assessment of Mass Drug Administration is regularly done through Medical colleges to take corrective measures. Such assessments revealed that there is gap between coverage and actual compliance of drug. However, the compliance has improved over a period of time, but intensive social mobilization would still be required to bridge the gap between coverage and actual consumption so that the actual consumption rate of above 90% is achieved.
- Independent Appraisal of LF elimination programme in the country through Indian Council of Medical Research was undertaken during July, 2014 in 6 states namely Bihar, Gujarat, Madhya Pradesh, Odisha, Telangana and West Bengal. The Independent appraisal observed a strong commitment and leadership at national level in achieving the goal of LF elimination. Adequate funds were ensured to states. Guidelines were made available for programme implementation. Technical and scientific collaboration with research institutes and WHO was also observed. Directorate NVBDCP is receptive to inputs and innovations based on critical reviews, independent assessment and operational research. The independent appraisal recommended that:
- Districts reporting mf rate more than 1% will have to continue MDA with additional supervision to ensure enhanced drug compliance. Bihar needs special attention.
- Assessment of coverage and compliance for each round of MDA to be ensured.
- Districts reporting mf rate less than 1% should be subjected for transmission assessment survey for MDA stoppage.
- More trainings to be conducted for district level officials to strengthen documentation and reporting.
- Status of MDA districts to be assessed on the basis of site-wise mf prevalence and not on based on district average.
- Site specific social mobilization should be taken to enhance compliance.
- Integrated vector management should be supplemented in urban and semi-urban areas.
- LF status in unsurveyed/non-endemic districts should be assessed by line listing of filaria cases and screening children for antigenemia.
- Morbidity management services at PHC/CHC level should be reviewed regularly at district level to ensure bringing patients under morbidity management. Awareness also need to be generated.
- Considering the prediction based on simulation model, additional rounds of MDA with a consumption of above 65% would be required in those districts where mf prevalence is much higher than 1%. Programme may align with the global goal of elimination accordingly.
- As per WHO guidelines-2011, the districts having observed minimum five rounds of MDA with more than 65% coverage against total population at risk in implementation unit (population of district covered under MDA) are to be subjected to Transmission Assessment Survey (TAS) using Immuno-chromatographic test (ICT) for presence of circulating antigenemia in children born after initiation of MDA to know the current infection. This is required to take a decision for MDA stoppage. NVBDCP with the support of WHO and ICMR has trained about 290 officials for conducting TAS. Achievement is significant as till May, 2016, 72 districts with 110 evaluation units (approx. 164 million population each) have successfully completed TAS and qualified for MDA stoppage. Thirty five more districts will observe after July when schools reopen. Goa has cleared 2nd successive TAS and maintaining post MDA surveillance in both the districts.
Morbidity Management and Disability Alleviation
- Morbidity Management is another pillar of strategy for ELF and states/UTs were advised on up-scaling home based morbidity management of Lymphoedema cases and Hydrocele operations. The process involved updating the line-listing of Lymphoedema & Hydrocele cases in the districts. Training and education materials detailing these strategies were provided to public health facilities at state and district levels and to 79 medical colleges in endemic areas. Motivate for surgical intervention to hydrocele cases. The updated report from LF endemic states/UTs indicated 8.63 lakh Lymphoedema and 3.86 lakh hydrocele cases.
- Since 2004, the states/UTs have reported 141902 hydrocele operations. Different states have initiated management of Lymphodema cases through demonstrating home based foot hygiene method to patients at local levels.