filaria presentation 2012

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

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Page 1: Filaria presentation 2012

Elimination of Lymphatic FilariasisPresented By

Dr. Debashis RoyDy.Chief Medical Officer of Health - II, Bankura

Page 2: Filaria presentation 2012

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.

Page 3: Filaria presentation 2012

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.

Page 4: Filaria presentation 2012

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.

Page 5: Filaria presentation 2012

Back ground ofElimination 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

Page 6: Filaria presentation 2012

Elimination of Lymphatic FilariasisStrategy

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

Page 7: Filaria presentation 2012

Elimination of Lymphatic Filariasis

Strategy (Continued) Thus we entered in to the age of MDA During 2007, ALBENDAZOLE was added with DEC. 11TH 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 yearsIDEAL 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 ????

Page 8: Filaria presentation 2012

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

Page 9: Filaria presentation 2012

MDA : PlanningMAJOR ACTIVITIES

Updating line list of Lymphedema & Hydrodele cases. Up scaling of hydrocele operation. Pre-MDA Mf Survey. Micro action plan- HSC, PHC/Town, District. Training 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.

Page 10: Filaria presentation 2012

MDA : PlanningDrug Distributors

1 per 100 houses or 500 PeopleDrug Supervisors

1 per 15 Drug DistributorsRapid Response Teams

Training/Orientation of Health Officials at District /

BPHC & PHC Mos’ / Paramedical Staffs / ASHA / VHW

Page 11: Filaria presentation 2012

MDA : ImplementationImplementation is

OPERATIONAL aspect of TRANSLATING plan in to actionsFACTORS 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.)

Page 12: Filaria presentation 2012

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.

Page 13: Filaria presentation 2012

Lymphatic FilariasisTransmission

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.

Page 14: Filaria presentation 2012

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.

Page 15: Filaria presentation 2012

RememberPregnant Woman

Children Below 2 Years of Age &

Seriously Ill Persons Are

Excluded from Treatment

Page 16: Filaria presentation 2012

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.

Page 17: Filaria presentation 2012

Goal National Health Policy (2002) Goal

To eliminate

lymphatic Filariasis

from

INDIA

by the year 2015

Page 18: Filaria presentation 2012

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.

Page 19: Filaria presentation 2012

Side Effects of DECDEC 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.

Page 20: Filaria presentation 2012

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.

Page 21: Filaria presentation 2012

National Filaria DayMass 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

Page 22: Filaria presentation 2012

THE ELF IS COMPLEX AND

DEEP,WE HAVE TO

WORK HUNDREDS OF HOURS

BEFORE WE SLEEP

Page 23: Filaria presentation 2012

THANKS