A study of coverage, compliance and awareness of lymphatic filariasis and mass drug administration in Osmanabad district

B V Ukarande^*, V M Holambe^**, A S Nagaonkar^***, J V Dixit^****

^*Assistant Professor, ^{**, ***}Associate Professor, ^****Professor and HOD, Department of Community Medicine, Government Medical College Latur, Maharashtra, INDIA.

Email: balaji.uk10@gmail.com

Abstract         Introduction: Lymphatic filariasis (LF) is a mosquito-borne, chronically disabling tropical disease caused by infection with thread-like parasitic filarial worms Wuchereriabancrofti, Brugiamalayi, and B. timori. It is an ancient disease and was recorded in India as early as 6th century BC by the famous Indian surgeon Susruta in his book Susruta Samhita. Aims and Objectives: To Study Coverage, Compliance and awareness of Lymphatic Filariasis and mass drug administration in Osmanabad District Methodology: MDA activity was carried out by health staff of DMO (District Malaria Office) on 14th to 20th December 2015 for 3 days in rural area and for 5 days in urban area. The evaluation was done by Community Medicine, Dept. of GMC Latur, during February 2016 The statistical analysis done by Z-test (Difference between Two Proportions) The overall coverage was 100% and the compliance i.e. No of Eligible who consumed Drug was Overall 94.29% and in Rural Area was Pethsangavi, Turori, Jekekur was 95.83% ( i.e. 437 out of 456) and in Urban area Bharat Nagar (ward )Umarga was 90.28% i.e. 158 out of 175. This observed difference between Compliance of Urban and Rural is statistically significant. (Z= 2.689, P<0.001). The major reason for Not –Swallowing the drugs were Beneficiaries empty Stomach(47.82%), followed by Not aware of Lymphatic Filariasis (23.18%), H/O Complications of Previous year MDA(10.14%) and beneficieries thinks that No need as no symptoms to them (7.24%), Fear of Drugs (5.79%). Beneficiaries choices Drug Distributor were Health worker (Male)-(80.16%), ANM ( -12.39%) AWW-(3.30%), NGO-(0.82%), Volunteer (3.30%) Conclusion: In the present study the coverage and Compliance was found much improved than previous studies but the reasons of not swallowing like are still prevailed in the area like empty Stomach Not aware of Lymphatic Filariasis, history Complications, Fear of Drugs etc. should be worked on these issues to improve future Compliance to drugs.

Keyword: Coverage, Compliance and Awareness Mass Drug Administration, MDA (Mass Drug Administration), Lymphatic Filariasis.

INTRODUCTION

Lymphatic filariasis (LF) is a mosquito-borne, chronically disabling tropical disease caused by infection with thread-like parasitic filarial worms Wuchereriabancrofti, Brugiamalayi, and B. timori. It is an ancient disease and was recorded in India as early as 6th century BC by the famous Indian surgeon Susruta in his book Susruta Samhita.^1,2 In AD 7th century, Madhavakara described signs and symptoms of the disease in his treatise Madhava Nidhana, which hold good even today.^1,2 In 1709, Clarke called elephantoid legs in Cochin as Malabar legs.¹ The discovery of microfilariae in the peripheral blood was first made by Lewis in 1872 in Kolkata (Calcutta).¹ The infection is endemic in 83 countries worldwide, with more than 1.2 billion people at risk and 120 million already infected.³ Of 120 million affected people, 40 million have limb or genital damage recognized as either lymphoedema/elephantiasis (15 million) or hydrocele (25 million) and twice that number with subclinical disease principally of the lymphatics or kidneys.⁴ Southeast Asia region contributes to approximately two-thirds of global cases.³ LF is endemic in 250 districts of 20 states in India and the population at-risk is approximately 600 million.⁵ The Global Programme to Eliminate Lymphatic Filariasis (GPELF) launched by the World Health Organization (WHO) in 2000 with the goal of eliminating LF as a public health problem by the year 2020 is the largest public health intervention program attempted till date.⁶ The unofficial reports from field suggested that actual drug consumption was much lower than the reported coverage by district malaria/filaria offices. ⁷Mid-term evaluation of MDA activities reviews the progress of activities of single dose of DEC mass administration.

AIMS AND OBJECTIVE

To Study of Coverage and Compliance and Awareness of Lymphatic Filariasis and Mass Drug Administration Carried Out in Osmanabad District.

MATERIAL AND METHODS

MDA activity was carried out by health staff of DMO (District Malaria Office) on 14th to 20th December 2015 for 3 days in rural area and for 5 days in urban area. The evaluation was done by Community Medicine, Dept. of GMC Latur, during February2016. The specific objective of this evaluation study was to find out coverage, compliance and reasons for non- compliance and awareness of disease and preventive measures. Four clusters, one from urban (out of 8 urban areas) and three from rural areas, (one village from one primary health Centre) were selected randomly to cover entire rural and urban area of Osmanabad Dist. and from each cluster 30 houses were surveyed. To select 30 houses the area was divided into 5 regions by salient landmarks such as temple, chawadi or majjid and then from each region 6 houses were selected randomly. The head of the family or responsible member present at the time of survey was interviewed with predesigned and pretested proforma. The statistical analysis done by Z-test (Difference between Two Proportions)

RESULT

Table 1: Population selected, eligible and Covered by DMO for MDA

Coverage reported by district malaria office, of mass drug administration done by drugdistributors i. e. health worker male and anganwadi worker was over all90.91%, it was little higher in rural area 91.12% than in urban area 90.00%

Table 2: Compliance of MDA founded by Community Medicine Department Team

From Table 2 : The overall coverage was 100% and the compliance i.e. No of Eligible who consumed Drug was Overall 94.29% and in Rural Area was Pethsangavi, Turori, Jekekur was 95.83% ( i.e. 437 out of 456) and in Urban area Bharat Nagar (ward )Umarga was 90.28% i.e. 158 out of 175. This observed difference between Compliance of Urban and Rural is statistically significant. (Z= 2.689, P<0.001).

Table 3: Reasons for Not –Swallowing the drugs

From Table 3: The major reason for Not –Swallowing the drugs were Beneficiaries empty Stomach(47.82%), followed by Not aware of Lymphatic Filariasis (23.18%), H/O Complications of Previous year MDA(10.14%) and beneficiaries thinks that No need as no symptoms to them (7.24%), Fear of Drugs (5.79%).

Table 4: Beneficiaries choices Drug Distributor

Beneficiaries choices Drug Distributor were Health worker (Male)-(80.16%), ANM (-12.39%). AWW-(3.30%), NGO-(0.82%), Volunteer (3.30%).

DISCUSSION

Success of mass drug administration approach to eliminate lymphatic filariasis by killing microfilaria present in blood of infected patients thus interrupting the transmission of disease by mosquitoes to others depends upon how sincerely health staff motivates people to consume drugs, that too in the absence of obvious signs or symptoms of disease. Thus coverage as well as compliance of MDA by people in endemic area is challenging job for health staff. To increase the compliance, drugs should be given when people are at home i.e. at night time or as per convenience of people and with enough motivation. In endemic areas, DEC coverage of more than 85% continuously for 5 years is required to achieve the interruption of transmission filariasis and elimination of this disease in India.^8,9 In the present study the Coverage of the Drug was 100 % in both the Rural and Urban area this shows that the efforts done by the workers were good for the supplementation of drugs the nex important thing in the Filaria elimination is drug swallowing by the Eligible persons i.e. Compliance the Overall Compliance found was 94.29% and in Rural Area was Pethsangavi, Turori, Jekekur was 95.83% ( i.e. 437 out of 456) and in Urban area Bharat Nagar (ward ) Umarga was 90.28% i.e. 158 out of 175. This observed difference between Compliance of Urban and Rural is statistically significant. (Z= 2.689, P<0.001). This indicates that the Rapoo of the Heallth workers in rural area is better than the Urban area as the coverage of drug was 100% but Reluctance found for swallowing drugs in the Urban area. In present study, observed coverage by Community Medicine team during evaluation survey was 100% as all 120 houses surveyed received drugs These findings are in Confirmation with Godale Lata B¹⁰ i.e. 100 % Coverage but not in confirmation with, Ravish K.S. et al3(86.%), B.V. Babu.¹³ Compliance found by Godale Lata B¹⁰ was 73.1%, Compliance rate found by various authors In the study by Ambrish Mishra¹⁴, DEC coverage in surveyed district was 91.02% and consumption rate was 84.66%. Such as Ravish K. S. et al¹¹ (45.9%), B. V. Babu et al¹³ (41.5%), P. Ray et al¹² (69.43%) was much lower than present study 94.29%. This could be due to Improvement of Services and Administration of Public health regarding the issue of Filarisis not only for the distribution but also for the swallowing of the drug. The major reason for Not –Swallowing the drugs were Beneficiaries empty Stomach (47.82%), followed by Not aware of Lymphatic Filariasis (23.18%), H/O Complications of Previous year MDA (10.14%) and beneficiaries thinks that No need as no symptoms to them (7.24%), Fear of Drugs (5.79%),Absent at the timing of drug Distribution (5.79%) B.V Babu et al¹³ found fear of side reactions in 82.1% but Ravish et al3 (15.2%), P Ray et al¹² (30.84%) found less percentage for reason of fear of reaction. In a present study 19.06%people told that they don’t know about lymphatic filariasis while Ravish et al¹¹ (51.8%), P Ray et al⁵ (27.8%) had higher percentage and reason is that enough motivation was not there due poor IEC activities. 4.9% people were not at home at the time of distribution of drugs and same percentage was found by B. V. Babu et al¹³ (.6%) and P. Ray et al¹² (5.26%). 8.58% peoples said that disease is not there so there is no need to take the drugs while B V. Babu¹³ reported same reason in 3.6%.In study done by Godale L¹⁰ 9.2% said that drugs were not given in their hands or D. D did not insist for consuming them.8.58% people said that they are healthy and 1.84% were sick and Ravish et al³ found same reason in 7%.

CONCLUSION

In the present study the coverage and Compliance was found much improved than previous studies but the reasons of not swallowing like are still prevailed in the area like empty Stomach Not aware of Lymphatic Filariasis, history Complications, Fear of Drugs etc. should be worked on these issues to improve future Compliance to drugs.

REFERENCE

1. Raghavan NGS. Epidemiology of filariasis in India. Bull World Health Organ 1957; 16(3):553–79.   
2. Sabesan S, Vanamail P, Raju K, Jambulingam P. Lymphatic filariasis in India: epidemiology and control measures. J Postgrad Med 2010; 56:232–8.
3. Ottesen EA, Hooper PJ, Bradley M, Biswas G. The global programme to eliminate lymphatic filariasis: health impact after 8 years. PLoSNegl Trop Dis 2008; 2:e317.   
4. Ottesen EA. Lymphatic filariasis: treatment, control and elimination. AdvParasitol 2006; 61:395–441.   5. WHO. Global Programme to Eliminate Lymphatic Filaraisis.Progress report 2000–2009 and strategic plan 2010–2020. Geneva: World Health Organization, 2010. Available at: http:// www.searo.who.int/entity/vector_borne_tropical_diseases/topics/lymphatic_filariasis/LFREP.pdf (last accessed on December 11, 2014).   
5. Molyneux DH, Zagaria N. Lymphatic filariasis elimination: progress in global programme development. Ann Trop Med Parasitol. 2002;96:S15–S40
6. Lahariya C, Mishra A. Strengthening of mass drug administration implementation is required to eliminate lymphatic filariasis from India: an evaluation study. J Vector Borne Dis 2008; 45: 313–20.
7. National Vector Borne Disease Control Programme. Guidelines on Elimination of Lymphatic Filariasis India.Availableat: http://nvbdcp.gov.in/doc/guidelines-filariasis-elimination-india.pdf (last accessed on December 12, 2014).
8. Kumar P, Prajapati P, Saxena D, Kavishwar AB, Kurian G. An evaluation of coverage and compliance of mass drug administration 2006 for elimination of lymphatic filariasis in endemic areas of Gujarat. Indian J Community Med 2008;33(1):38–42
9. GodaleL, Ukarande B, A Study On Coverage Evaluation, Compliance And Awareness Of Mass Drug Administration For Elimination Of Lymphatic Filariasis In Osmanabad District. Natl J Community Med 2012;3: 391–4.
10. Ravish KS, Riyaz TS, Basha S. Coverage and compliance of mass drug administration for elimination of lymphatic filarisis in endemic areas of Bijapur Dis. Karnataka, International journal of Basic Medical Science. july 2011; 2(2):86-89.
11. Karmakar PR, Mtra K, Chatterjee A, Jana PK, et al. A study on coverage, compliance and awareness about mass drug administration for elimination of lymphatic filarisis in a district of West Bengal.India J Vector Borne Dis. June 2011; 48:101-104.
12. Babu BV, Kar SK. Coverage compliance and some operational issues of mass drug. Administration during the programme to eliminate lymphatic filariasis in Orissa, India. Tropical Medicine and International Health. June 2004; 9 (6):702-709.
13. Mishra A, Trivedi R, Sharma D, Niranjan A, Sharma S. Mid-term assessment of mass drug administration of DEC for filariasis in Rewa district of Madhya Pradesh. Int J Med Sci Public Health 2015; 4(4): 549-553.