KERALA MILES TO GO Showkath Ali M.K, Regu K, Rajendran R National - - PowerPoint PPT Presentation

LYMPHATIC FILARIASIS ELIMINATION IN KERALA – “MILES TO GO”

Showkath Ali M.K, Regu K, Rajendran R

National Centre For Disease Control, Kozhikode, Kerala e-mail:ncdcclt@gmail.com

INTRODUCTION

Lymphatic Filariasis (LF) is one of the oldest and the second leading cause

• f chronic disability worldwide

An estimated 120 million people in 81 countries are currently infected and an estimated 1.393 billion live in areas where LF is endemic WHO identified LF as one of the potentially eliminable diseases and recommended a programme of elimination of LF by interrupting transmission and alleviation of sufferings with morbidity Interruption of transmission to eliminate LF by Mass Drug Administration (MDA) annually with single dose of DEC for 5 years with a consumption rate of more than 85% In Kerala 11 out of 14 districts are endemic for LF and thus included in the MDA programme and implemented from 2005 onwards and have completed 7 rounds without satisfactory results

Map of Kerala showing MDA and Non MDA Districts

MDA DISTRICTS

NON MDA DISTRICTS

75.10 76.00 78.60 61.00 48.20 52.00 76.20 69.30 85.50 80.60 84.10 29.10 34.60 30.00 33.70 13.40 17.70 12.60 20.60 34.70 24.90 43.10

10 20 30 40 50 60 70 80 90

Trivandrum Kollam Alleppy Kottayam Ernakulam Trissur Palakkad Malappuram Kozhikode Kannur Kasaragod

Population (%)

Districts

District wise MDA performance in terms of Distribution & Consumption

Distribution Consumption

District wise drug distribution coverage and consumption in Kerala-2005

10 20 30 40 50 60 70 80 90 TVM KLM ALP KTM EKM TSR PKD MPM KKD KNR KSD Coverage Consumption

Year wise MDA Drug distribution Coverage & Compliance in percentage

Kozhikode Alappuzha

10 20 30 40 50 60 70 80 90 100 2001 2002 2003 2005 2005 2007 2008 2009 2012 Coverage % Consumption% 10 20 30 40 50 60 70 80 90 100 2001 2002 2003 2005 2005 2007 2009 2012 Coverage % Consumption%

Reasons District wise factor index * KKD ALP KSD PKD MLM ADMINISTRATIVE Poor remuneration to volunteers 0.8 1.00 0.13 0.3 0.1 Repeated postponement 0.8 0.38 0.50 0.5 0.0 Lack of man power 0.0 0.77 0.30 0.2 0.2 Lack of supervision 0.0 0.07 0.06 0.1 0.1 Lack of co-operation 0.2 0.14 0.13 0.2 0.2 Scarcity of funds 0.0 0.62 0.19 0.2 0.0 TECHNICAL Anti-propaganda 1.2 0.70 0.63 0.3 0.4 Poor IEC activities 0.0 0.92 0.25 0.6 0.4 Lack of motivation among volunteers 0.0 0.70 0.06 0.1 0.0 Loss of faith in programme 0.0 0.07 0.00 0.2 0.0 Refusals 0.4 0.70 0.13 0.1 0.0 Dispute in different systems

• f medicine

0.0 0.07 0.00 0.1 0.1

Reasons for poor performance of MDA (Medical Officers)- 2005

* Number of responses / Number of factors

Reasons for poor drug consumption- 2005 (General Public)

Fear of side reactions Not necessary Treatment for other diseases

• ut station

No specific reason Forgot Children

• ld age

61.8 24.1 7.9 1.3 1.4 1.6 0.6 1

REASONS FOR POOR DRUG CONSUMPTION - 2005 (GENERAL PUBLIC)

Reasons for poor drug consumption - 2005 (Medical Officers)

Reasons District wise factor index * KKD ALP KSD PKD MLM Anti-propaganda 0.85 1.60 0.5 0.44 0.6 Fear of side reactions 0.85 1.40 1.1 0.55 0.4 Poor IEC 0.38 1.40 0.45 0.44 0.4 Repeated postponement 0.38 0.76 2.4 0.33 0.3 Lack of co-ordination 0.23 0.20 0.27 0.0 0.0 Lack of Supervision 0.0 0.07 0.36 0.22 0.1

* Number of responses / Number of factors

Illness reported in MDA participants

Illness CALICUT (DEC) ALAPPUZHA (DEC + ALB)

2000 Feb 01 Nov 01 02 05 12 2000 Feb 01 Nov 01 02 05 12 Number consumed 730 891 839 616 234 432 628 500 467 556 157 545 Fever 0.41 0.11 0.24 0.00 0.43 2.07 1.0 0.64 0.18 0.64 Headache 0.41 0.00 0.36 0.00 0.00 1.91 0.4 1.07 0.36 0.64 Swelling

• f

Limb 0.14 0.00 0.12 0.16 0.43 0.00 0.00 0.00 0.00 0.00 Others 0.00 0.00 0.00 0.00 0.00 0.0 0.00 0.00 0.00 0.54 0.00 TOTAL 0.96 0.11 0.72 0.16 0.85 3.98 1.4 1.71 1.08 1.27

Points Medical Para medical Grade No % No % >90% 8 18.81 0.00 0.00 Satisfactory 80-90 % 15 34.09 16 19.51 Medium < 80 % 21 47.73 66 80.49 Poor Total 44 100 82 100

Awareness of Medical & Para medical staff about lymphatic filariasis and MDA programme

Recommended Measures for Elimination

• f Lymphatic Filariasis
• 1. Training at all levels
• 2. Sustained and intensive local and state level IEC activities
• 3. Improvement of inter-sectoral co-ordination
• 4. Motivation of health staff and drug distributors
• 5. Logistics and budget to be made available well in advance
• 6. Involvement of Health staff in distribution of drug
• 7. Remuneration to drug distributors?
• 8. Improve supervision
• 9. Programme review ?

“and no need to go miles”

Thank you