The seminar discusses the National Filaria Control Programme (NFCP) launched in India in 1955 to combat lymphatic filariasis, a disease caused by parasitic worms transmitted by mosquitoes. It highlights the disease's epidemiology, symptoms, and the strategies for control, including mass drug administration and community engagement. The goal is to eliminate lymphatic filariasis as a public health issue by 2020, supported by innovative treatment methods and a comprehensive management plan for affected individuals.

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. FILARIAVECTORS
 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
1. 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 theVHN/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 DrugTherapy (IDA) has been
successfully implemented in 5 districts
namely Arwal (Bihar) and Simdega
(Jharkhand), Nagpur (Maharashtra),Varanasi
(Uttar Pradesh),Yadgiri (Karnataka) on
20th
December 2018, 10th
January 2019,
20th
January, 2019, 20th
February, 2019 and
13th
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 PLANTO 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
levelsTo 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