Ramesh C Mahajan
Department of Parasitology
Postgraduate Institute of Medical Education & Research
WHO Focal Point
Dr Jamsheed ahmed Mohamed
Medical Officer-VBN SEARO WHO New Delhi
World Health House
New Delhi 110002, India
World Health Organization Regional Office for South-East Asia - www.searo.who.int
South-East Asia comprises of 5 countries namely, Bangladesh, India, Maldives, Nepal and Sri Lanka. It harbours nearly half the world's lymphatic filariasis burden. Sri Lanka with a formidable 50000 strong volunteer force has been able to target its entire endemic population of 9.8 million during the past 4 years with a reported coverage of over 80% in the MDAs of 2002 and 2003. An independent assessment of coverage carried out on 4000 individuals in all implementation units revealed that 79% of the targeted population received the drugs but only 71% had taken them. Compliance was thus about 10% less than the reported figures. The MDA for 2004 was carried out on the 10th of August 2004 and the mopping up operation is now in progress.
India has a major problem with 450 million people at risk. They scaled up to 71 million in 2002. Of this 21 million were given DEC/Albendazole and 50 million DEC only. India carried out a large scale study on the comparative efficacy of DEC/Albendazole versus DEC alone and the results indicate that DEC/Alberndazole is the better option. In 2004 India launched an ambitious programme to carry out MDA in 201 districts(population 407 million). 89 districts(population 174 million) have been treated already with DEC monotherapy. The remaining 112 districts (population 233 million) will be treated by November 2004---7 districts with DEC/ALB and 105 with DEC alone.
Bangladesh started off MDA in a 800,000 population district in 2001 and scaled up to 4.2 million in 2002 .They have a sound healthcare infrastructure which has enabled them to carry out house to house treatment and achieve over 80% coverage . In Jan to June 2004 MDA took place in 6 districts (total population 8.7 million). The observed compliance was 75.7 to 81.6% (actual coverage among eligibles 79.2 to 86.5%).
Nepal after a few teething problems started their MDA programme in 2003 in one district with a 500,000 population and achieved a coverage of 83%. It has planned to conduct MDA in 3 districts (population 1.5 million) in September 2004.
In the Maldives only 8 of the 200 islands are endemic for filariasis and the microfilaraemia rate has been below 1%. As these surveys were carried out in 1995 the Ministry of Health has planned to re-survey all the endemic islands in 2004 and carry out MDA where applicable.
Bangladesh, Nepal and Sri Lanka have attributed their 'over 80% coverage' to two key factors, firstly to a good health infrastructure and secondly to vigorous social mobilisation. All three countries carried out a comprehensive COMBI exercise including appropriate training programmes for health staff and volunteers. The COMBI programme has been funded by WHO, LF Support Centre Liverpool, USAID etc. Sustainability of this programme as the MDA is scaled up is bound to be difficult. One of the major constraints to scaling up MDA is inadequate financial resources and countries such as Bangladesh and Nepal are finding it difficult to expand their programmes.
Although much attention has been paid to MDA the same concern has not been in evidence on steps taken to prevent disability and control morbidity associated with lymphatic filariasis. Existing filariasis clinics have been used so far on an ad hoc basis to treat clinical filariasis and to impart health education on the prevention of secondary infection. Training programmes on hydrocelectomy have been held in some countries. Bangladesh, through the initiative of its Programme Manager and with Japanese assistance have set up a filaria hospital as an active centre for the treatment of lymphoedema and hydrocele.
WHO organised a Regional Workshop on the Prevention of Disability associated with Lymphatic Filariasis in Sri Lanka in November 2003 for the South-East Asia and Mekong Plus Countries. Model implementation plans were drawn up by the country teams to set up pilot projects in their respective countries for Community Home-based Health Care for LF disability.