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SEMINAR ON
NATIONAL FILARIA CONTROL
PROGRAMME
(NFCP)
PRESENTED BY
ARUN.JV
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INTRODUCTION
Filariasis has been a major public health
problem in India next only to malaria. The
disease was recorded in India as early as 6th
century B.C. by the famous Indian physician,
Susruta in his book Susruta Samhita. In
7thcentury A.D., Madhavakara described signs
and symptoms of the disease in his treatiseMadhava Nidhana which hold good even
today.
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INTRODUCTION cont
In 1709, Clarke called elephantoid legs in Cochin as
Malabar legs.
The discovery of microfilariae (MF) in the peripheral
blood was made first by Lewis in 1872 in Calcutta(Kolkata).
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FILARIASIS
Filariasis is caused by several round, coiled and thread-
like parasitic worms belonging to the family filaridea.
These parasites after getting deposited on skin penetrate
on their own or through the opening created by mosquitobites to reach the lymphatic system. The disease is caused
by the nematode worm, either Wuchereria
bancrofti orBrugia malayi and transmitted by ubiquitous
mosquito species Culexquinquefasciatus and Mansonia annulifera/M.uniformisrespectively.
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FILARIASIS
Brugian filariasis
Bancroftian filariasis
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FILARIA VECTORS
Culex quinquefasciatus transmits filariasis in
India. Culex breeds in polluted water. Common
breeding sites are wet pit latrines, septic tanks,barrow pits, cess pools, drains, disused wells,
paddy fields, etc.
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TRANSMISSION OF LYMPHATIC
FILARIASIS
The adult produces millions of very small
immature larvae known as microfilariae, which
circulate in the peripheral blood with markednocturnal periodicity. The worms usually live
and produce microfilariae for 5-8 years.
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In India, 99.4% of the cases are caused by the
species - Wuchereria bancrofti whereas Brugia
malayi is responsible for 0.6% of the problem.
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Wuchereria bancrofti Brugia malayi
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MAGNITUDE OF DISEASE
Indigenous cases have been reported from about250 districts in 20 states/Union Territories.
Cases of filariasis have been recorded from
Andhra Pradesh, Assam, Bihar, Chhattisgarh, Goa,Jharkhand, Karnataka, Gujarat, Kerala, Madhya
Pradesh, Maharashtra, Orissa, Tamil Nadu, Uttar
Pradesh, West Bengal, Pondicherry, Andaman &
Nicobar Islands, Daman & Diu, Dadra & NagarHaveli and Lakshadweep.
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B. malayi is prevalent in the states of Kerala, Tamil Nadu, AndhraPradesh, Orissa, Madhya Pradesh, Assam and West Bengal.
The single largest tract of this infection lies along the west coast of
Kerala, comprising the districts of Trichur, Ernakulum, Alleppey,
Quilon and Trivandrum, stretching over an area of 1800 sq km. Theinfection in the other six states is confined to a few villages. Surveys
undertaken recently in Kerala and a few villages in other states revealed
either a reduction of foci or complete elimination of the parasite as well
as the vector(s) in many villages which were known to be endemic
forB. malayi infection four decades back
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ECONOMIC LOSS :
About 1.2 billion man-days are lost due to
filariasis every year leading to an economicloss of Rs. 3500 crore
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NATIONAL FILARIA CONTROL
PROGRAMME
National filarial control programme was
started in 1955.
After pilot project in Orissa from 1949 to1954, 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 manage the programme.
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Pilot project in Orissa:
mass drug administration with
diethylcarbamazine (DEC)
recurrent antilarval measures Residual insecticidal spray as anti-adult
measure.
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Recommendations of assessment
committee.
(a) proper environmental sanitation
(b) antilarval measures by the application of oil.
U d h NFCP h f ll i i i i b i
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Under the NFCP the following avtivities are being
undertaken
Delimitation of the programme in unsurveyed
areas.
Adoption of antilarval and anti-mosquitomeasures.
Detect and treat positive cases of filariasis.
Install underground drainage system to preventmosquito breeding.
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4 rural research cum training centres were
established,one each in Andhra
Pradesh,Maharashtra,Madhya Pradesh ,and in uttar
Pradesh3 regional research cum training centres situated at
Calicut ,Rajahamudry(AP) and Varanasi(UP) under the
National Institute of communicable diseases ,Delhi.
At the state level 12 headquarters bureaux arefunctioning.
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National filarial control programme is being
implemented through 206 filaria control units
,199 filaria clinics and 27 survey units primarilyin filarial endemic urban towns.In rural areas
anti filarial medicines and morbidity
management through primary health care system.
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NATIONAL GOAL
The National Health Policy 2002 aims
at Elimination of LymphaticFilariasis by 2015.
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The elimination is defined aslymphatic
filariasis ceases to be public health problem,
when the number of microfilaria carriers is lessthan 1 percent and the children born after
initiation of ELF are free from circulating
antigenaemia(presence of adult filarial worm inhuman body)
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Central Assistance
During Fourth Five Year Plan the NFCP was 100 per centcentrally sponsored programme. But in Fifth Five Year Plan,only material and equipment were supplied by the Centrefrom its share and the entire operational cost was borne bythe States.
However, from 1978 onward the Central assistance wasfurther reduced by sharing the cost of material andequipment on 50:50 basis.
Up to Seventh Five Year Plan the NFCP budget was separateand the same was merged with budget of Urban MalariaScheme during Eighth Five Year Plan continuing the sharingthe cost of material and equipment on 50:50 basis.
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FILARIA CONTROL STRATERGY
Vector control through anti larval operations
Source reduction
Detection and treatment of microfilariacarriers
Morbidity management
IEC
i i d i l l
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Anti-mosquito and anti-larval
measures :
Anti-larval measures with temephos in prescribed dosagein water storage tanks every week and application ofMineral larvidcidal oils on water surface are practiced.
The larvicide under use includetemephos, Fenthion andMLO. The selection of breeding places for treatment with aparticular larvicide is done judiciously.
Recurrent antilarval measures at weekly intervals.
Environmental methods including source reduction byfilling ditches, pits, low lying areas, deweeding, desilting,
etc. Biological control of mosquito breeding through larvivorous
fish.
Home based management of
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Home based management of
lymphedema cases and upscaling of
hydrocele operations The line listing of lymphedema and hydrocelecases were initiated till 2004 by door to door
survey in filarial endemic districts.Initiation
has also been taken to demonstrate thesimple washing of foot to maintain hygiene for
prevention of secondary bacterial and fungal
infection in chronic lymph edema cases,sothat the patients get relief from frequent
acute attacks.
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Mass drug administration (MDA)
DEC dosage schedule: The DEC dosage adopted
in the programme is 6mg/kg body wt. per day
for 12 days.
The strategy for achieving the goal of eliminationis by Annual Mass Drug Administration of DEC for
5 years or more to the population excluding
children below two years, pregnant women andseriously ill persons in affected areas to interrupt
transmission of disease.
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During 2008 around 121 million population in
selected districts of Tamil
Nadu,Karnataka,Kerala and Andhra Pradesh
were covered with co administration of singledose of DEC+Albendazole.Rest the districts
were covered with DEC alone.The MDA
coverage was 82.75% in 2007 and 85.9% in2008.
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Objectives of MDA
To review the progress of activities of singledose DEC mass administration in the selecteddistricts.
To make independent assessment of theprogramme implementation with respect toprocess and outcome indicators.
To recommend midcourse corrections andsuggest necessary steps for further course ofaction.
Th B i P i i l f R i d
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The Basic Principle of Revised
Strategy for the Single Dose Mass DEC
Administration
Interruption of disease transmission
Treatment of problems associated withlymphoedema (disability prevention and
control)
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One of the main reasons for "non-compliance"
to the MDA programme is the occurrence of
side-effects reported by consumers. DEC is
reported to be safe, and does not produce anychronic toxicity.
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Medicated salt regimens in India
The DEC medicated salt project with 0.2%
concentration was concluded at Karaikal;
Pondicherry which gave significant reduction in
microfilaraemia.
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B.malayi control
The pilot project under the auspices of NICD in
Kerala has revealed that the vectors of
B.malayi are amenable to indoor residual
spray of HCH at a dose of 0.2 g/m2 per round,three rounds a year. Integrated vector control
approach for control of this infection was
being implemented by VCRC Pondicherry inCherthala of Alapuzhadistrict, Kerala.
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National Filaria Control Programme in
kerala
Filariasis is prevalent in the entire coastal belt and insome pockets of Kerala. About 6.3 million people areexposed to the risk Filarisis and 2.8 million people areprotected by NFCP.The programme was launched in the State during1955-56. Now it is implemented through 16 NFCPunits, 2 Filaria Survey Units and the Filaria controlworks at Cherthala. Attached to the Filaria Units, 11Filaria clinics are functioning. The Filaria Survey Unit at
Thrissur was shifted to Thiruvananthapuram in May 95and continues to function as main central unit atValiyathura in Thiruvananthapuram.
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Activities
Control Mosquito larvicidal spraying
operation, pistia removal and anti parasitic
(DEC) treatment.
Assessment Entomological and parasitological
(filaria survey)
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Monitoring Agency
The State Headquarters Bureau of Filariasis
under the Assistant Director (Filaria) attached
to the Directorate of Health Services is
monitoring and assessing the work at theState level
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Achievements of National Filaria Control
Programme
Year Persons Examined
Cases detected
Hydrocele Operations
MF Disease
200102 971658 13142 2374 1642
2002
03 1003222 13848 2527 2666
200304 1055505 13292 1396 2287
200405 1086526 10311 1776 4232
2005
06 1045770 8270 1024 3615
20062007 925331 5588 623 3056
20072008 1049923 4705 655 4250
200809 up to May 194855 825 216 133
A k h t d l th i i bj ti d
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A workshop to develop the vision, objectives and
strategies for the approach paper
to the twelfth five year plan
The filaria elimination strategies were also discussed.
Kerala should aim to eliminate filariasis through activecase detection and
through effective implementation of MDA campaign.
Rehabilitation of patients including surgery andartificial aids should also be done effectively.
An effective waste management and source reduction
for mosquito is a necessary condition for reduction of incidence of communicable
diseases.
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Expected Community Participation
Involvement of Panchayats in successful
indoor residual insecticide spray is an essential
aspect of the programme.
Panchayats/villages/local bodies/villageheads/BDOs/MahilaMandals, religious groups
etc. are to be informed about the spray
schedule at least before a fortnight.
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Role of NGOs
Non Governmental Organizations (NGOs), CommunityBased Organisations (CBOs), Faith Based Organisations(FBOs) can play an important role in LF elimination.
These organisations should be invited to discussions
when the annual strategic plan is prepared, so thatthey can identify areas of interest for theirparticipation, which could be incorporated in thenational plan.
A list of NGOs, DBOs, FBOs and enterprising Panchayatswith the possible areas of partnership should beprepared.
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Mapping of areas through morbidity surveys.
Social Mobilization for drug compliance.
Supporting mass drug administration and
management of adverse reactions.
Morbidity Management at community level
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MID-COURSE CORRECTIONS
A geographically identified risk area or PHC should be madean intervention unit.
Vector control should be a component in the LF eliminationcampaign. It is not wise to depend only on MDA.
A single strip of two tablets, one each of DEC and Alb inblister pack could be used in the programme.
Programme managers should be encouraged to adopt theprinciple of 'directly-observed treatment'.
DEC-fortified salt and vector control as an adjunct should
be introduced in all residual foci, including the areas whereother intervention measures are weak.
An intensive information, education, communication andadvocacy campaign involving professional bodies is crucial.
NURSES ROLE
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NURSES ROLE
Active detection of cases through surveys.the co-ordinated effort of peripheral level workers has to beensured.
Supply of DEC tablets as per the government policiesand explaining the benefits.Removing the
misconception of the people regarding adverse effectsof DEC is essential.
Health education and promotion of IEC activities aboutthe disease,vector control,environmentalsanitation,removing social stigma of disease etc
Ensuring adequate treatment for identified cases.
Co-ordinating the efforts of NGOs and non voluntaryorganizations in filarial control activities.
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CONCLUSION
Elimination of filariasis using annual MDA is
one of the most economical and beneficial
disease control strategies undertaken so far in
public health programmes. Now, the wholeworld is looking at the progress of the LF
elimination programme in India as the
population living at risk of infection is high,and hence the height of its achievement will
greatly have a bearing at the global level.
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