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.
 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 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.
 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.

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