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 of 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

District wise MDA performance in terms of Distribution & Consumption 90 84.10 85.50 80.60 78.60 80 76.00 76.20 75.10 69.30 70 Population (%) 61.00 60 52.00 48.20 50 43.10 40 34.60 34.70 33.70 30.00 29.10 30 24.90 20.60 17.70 20 13.40 12.60 10 0 Trivandrum Kollam Alleppy Kottayam Ernakulam Trissur Palakkad Malappuram Kozhikode Kannur Kasaragod Districts Distribution Consumption

District wise drug distribution coverage and consumption in Kerala-2005 90 80 70 60 50 40 30 20 10 0 TVM KLM ALP KTM EKM TSR PKD MPM KKD KNR KSD Coverage Consumption

Year wise MDA Drug distribution Coverage & Compliance in percentage Kozhikode Alappuzha 100 100 90 90 80 80 70 70 60 60 50 50 40 40 30 30 20 20 Coverage % Coverage % Consumption% 10 10 Consumption% 0 0 2001 2002 2003 2005 2005 2007 2008 2009 2012 2001 2002 2003 2005 2005 2007 2009 2012

Reasons for poor performance of MDA (Medical Officers)- 2005 District wise factor index * Reasons KKD ALP KSD PKD MLM Poor remuneration to 0.8 1.00 0.13 0.3 0.1 volunteers 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 ADMINISTRATIVE 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 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 0.0 0.70 0.06 0.1 0.0 volunteers TECHNICAL 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 0.0 0.07 0.00 0.1 0.1 of medicine * Number of responses / Number of factors

Reasons for poor drug consumption- 2005 (General Public)

REASONS FOR POOR DRUG CONSUMPTION - 2005 (GENERAL PUBLIC) 1.3 1.4 1.6 0.6 1 Fear of side reactions Not necessary 7.9 Treatment for other diseases out station 24.1 No specific reason 61.8 Forgot Children old age

Reasons for poor drug consumption - 2005 (Medical Officers) District wise factor index * Reasons 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 Nov 02 05 12 2000 Feb Nov 02 05 12 01 01 01 01 Number 730 891 839 616 234 432 628 500 467 556 157 545 consumed Fever 0.41 0.11 0.24 0.00 0.43 0 2.07 1.0 0.64 0.18 0.64 0 Headache 0.41 0.00 0.36 0.00 0.00 0 1.91 0.4 1.07 0.36 0.64 0 Swelling of 0.14 0.00 0.12 0.16 0.43 0 0.00 0.00 0.00 0.00 0.00 0 Limb Others 0.00 0.00 0.00 0.00 0.00 0.0 0.00 0.00 0.00 0.54 0.00 0 TOTAL 0.96 0.11 0.72 0.16 0.85 0 3.98 1.4 1.71 1.08 1.27 0

Awareness of Medical & Para medical staff about lymphatic filariasis and MDA programme Medical Para medical Grade Points No No % % Satisfactory >90% 8 18.81 0.00 0.00 80-90 % 15 34.09 16 19.51 Medium < 80 % 21 47.73 66 80.49 Poor Total 82 100 44 100

Recommended Measures for Elimination of 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”

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