World Health Organization
Representative to India
|
|
World Health Organization Representative to India |
|
|
|
 |
|
|
|
Filariasis
National Filariasis Control Programme In India and New Strategies for Its Control
I. Summary
Two species namely Wuchereria bancrofti and Brugia malayi are prevalent in India and the former contributes 99.4 % problem in the country. In mainland India, the microfilariae (mf) exhibit nocturnal periodicity, necessitating night blood surveys between 8.00 pm and 12 midnight to detect mf carriers. Subperiodic form of W.bancrofti was detected among aborigines inhabiting a few islands of Nicobar group of islands.
W.bancrofi infection has been showing increasing trend during the last five decades. During 2001, it was estimated that 473 million population (348 million in rural and 125 million in urban areas are exposed to the risk of infection. About 31 million mf carriers and 23 million disease cases are estimated to be living in 20 endemic States/UTs in the country.
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 man the programme. The main control measures were mass DEC administration, antilarval measures in urban areas and indoor residual spray in rural areas. NFCP was assessed in 1960 which revealed the failure of mass DEC administration due community non-cooperation and ineffectiveness on insecticidal indoor spray due to high resistance in vector. The programme was withdrawn from rural areas while in urban areas, antilarval measures continued to be the main control method. The First Assessment Committee recommended reorganisation of control units on the basis of population and establishment of new control units. The Assessment Committee in 1970 recommended selective mf carrier treatment at a dose of 6 mg/kg per day for 12 days as a compliment to antilarval measures, delimitation of the problem in unsurveyed districts and regionalisation of control measures in contiguous areas. The Third Assessment in 1982 recommended extension of NFCP to rural areas through primary healthcare system with 100% Central assistance for material & equipment, undertaking DEC medicated salt regimen in high endemic districts and control of B.malayi infection. The Fourth Assessment in 1995 recommended integrated vector control measures, implementation of model bye-laws in towns, new technique on detection of mf carriers and fresh delimitation surveys.
The programme component of NFCP was transferred from NICD to NAMP in 1978 while research and training components were retained with NICD. Presently, the programme covers 53 million people (about 11% of endemic population) through 206 control units and 198 filaria clinics in 18 of the 20 endemic States/UTs. The delimitation surveys are conducted by 27 survey units in these States. During Fourth Five Year Plan the NFCP was 100 per cent Centrally sponsored programme. But in Fifth Five Year Plan, only material and equipment were supplied by the Centre and the entire operational cost was borne by the States. However, from 1978 onward the Central assistance was further reduced by sharing the cost of material and equipment on 50:50 basis. Up to Seventh Five Year Plan the NFCP budget was separate and the same was merged with budget of Urban Malaria Scheme during Eighth Five Year Plan continuing the sharing the cost of material and equipment on 50:50 basis between the Centre and the States. The organophosphorus compounds like temephos and fenthion and drugs are supplied by the Centre while MLO, etc. are procured by the States.
Medicated salt regimens in India during 1968-69 showed very encouraging results in pilot trials in the Uttar Pradesh and Andhra Pradesh. The distribution of 0.1% DEC medicated salt to general public for one year was implemented in Lakshadweep, comprising a population of 25,000 during 1976-77 which reduced mf rate by 80% and circulating mf by about 90%. The DEC medicated salt project with 0.2% concentration was concluded at Karaikal, Pondicherry which gave 98% reduction in mf.
B.malayi control undertaken as a 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 is being implemented by VCRC Pondicherry in Shertally Taluk of Ernakulum district, Kerala.
Revised Strategy for the control of Lymphatic Filariasis in India was launched in 1996-97 in 13 districts in seven endemic states namely Andhra Pradesh, Bihar, Kerala, Orissa, Uttar Pradesh, Tamil Nadu and West Bengal, where Mass Drug Administration was undertaken. These seven States contribute over 86% of mf carriers and 97% of disease cases in the country. The main strategy comprises of: i) single day mass therapy at a dose of 6 mg/kg body wt annually, (ii) management of acute and chronic filariasis through referral services at selective centres, (iii) IEC for inculcating individual/community based protective and preventive measures for filaria control, (iv) antivector measures to continue in all the NFCP towns as complimentary to antiparasitic measures and mf carriers detected in filaria clinics and elsewhere to receive the standard dose of 6 mg/kg body wt. per day for 12 days.
For the management of acute and chronic filariasis, the actions envisaged are: (i) adequate referral centers for filaria case management to be developed in selected centres initially which would be extended to other areas. (ii) treatment of adenolymphangitis (ADL) with antibiotics to be augmented since majority of acute episodes appear to be of bacterial aetiology, (iii) rigorous local hygiene measures with or without local antibiotic and antifungal agents to be promoted to prevent ADL so as to permit the reversal of lymphoedema, (iv) early treatment with standard 12-day therapy of mf carriers to be adopted to prevent further lymphatic damage and renal failure, (v) community health education on the importance of local hygiene to the affected to be intensified and self-help support groups through NGOs to be organized, (vi) project proposals to be taken up for imparting training to medical profession on the latest surgical techniques in filariasis in selected medical institutions through ICMR in collaboration with WHO and other bilateral agencies.
Pulse treatment with DEC as single dose annually in some endemic countries has been found to possess: (i) the similar effectiveness as the 12 day treatment as a public health measure, (ii) It has lesser side effects thus enhancing public compliance, (iii) it involves decreased delivery costs, (iv) it does not require complex management infrastructure, (v) it can be integrated into the existing primary health care system for delivery (vi) single dose mass pulse treatment annually in combination with other techniques already eliminated lymphatic filariasis from Japan, Taiwan, South Korea and Solomon Islands and markedly reduced the transmission in China.
It was proposed to observe a particular day every year for National Filaria Day (NFD) which is to be observed in the 13 endemic districts, covering a population of over 40 million. The extension of NFD to other endemic places will be considered in a phased manner after evaluating the results after the conclusion of the present pilot trials. |
||
|
534, "A" Wing, Nirman Bhawan, Maulana Azad Road, New Delhi - 110 011 Phone: 91-11-23018955, 23792179, 23793632, 23017993; Fax: 23012450 |
