Situation analysis in a large urban area of India, prior to launching a programme of mass drug administrations to eliminate lymphatic filariasis
Ramaiah, K.D.; Vijay Kumar, K.N.; Ravi, R.; Das, P.K.
Annals of Tropical Medicine and Parasitology 99(3): 243-252
2005
ISSN/ISBN: 0003-4983 PMID: 15829134 DOI: 10.1179/136485905x29701Document Number: 252186
The main strategy now adopted for the elimination of lymphatic filariasis (LF) is based on mass drug administrations (MDA). Annual administration of antifilarial drugs to 65%-80% of the population at risk of the disease is believed to be necessary if LF is to be eliminated, at least as a public health problem, within a reasonable time-frame. To facilitate the development of drug delivery strategies that are sufficient to ensure such high treatment coverages in large urban areas, a situation analysis was undertaken in the city of Chennai, Tamil Nadu, India. The subjects interviewed came from households with high, moderate, low or very low incomes. A lack of information on the prevalence and socioeconomic impact of the disease suggests that LF was not viewed as a major pubic health problem in the study area, even though cases of elephantiasis and hydrocele were detected in 2-8% and 7-20% of the households, respectively. Overall, 40% of the interviewees from very low income households, and 78% of those from middle income households knew that elephantiasis is transmitted by mosquitoes. Only 4% of the subjects from high income areas, and 1% of those from low income areas were aware that filarial infection was a major cause of hydrocele. Most of the subjects (>55% of each of the four socioeconomic groups considered) felt that they were not at risk of developing elephantiasis. When specifically asked, only 35% of the subjects from high income households, but 84% of those from low income households, reported that they would be willing to take diethylcarbamazine to eliminate LF. It is therefore unclear whether high income households in urban areas should be included in MDA programmes. The interviewees felt that an intensive campaign of information, education, communication and advocacy would be necessary if an effective MDA-based programme were to be implemented. Drug distribution through the health services was the most preferred option. Clearly, factors such as a lack of appreciation of the socioeconomic impact of LF, a general belief that the risk of elephantiasis is low, doubts about the need to include all sectors of the eligible population in MDA, and a common dependence on private practitioners makes successful MDA against LF in urban areas a challenging task. On the positive side, however, an urban population is often covered by a huge network of colleges, private practitioners, non-governmental organizations and residents' associations, and such networks provide new opportunities in the development of effective drug delivery strategies.