By: Alanna Shaikh
Photo Courtesy of http://www.doh.gov.ph
One of the most effective ways of fighting Neglected Tropical Diseases is through Mass Drug Administration (MDA). Basically, you treat an entire population with the drug for a specific disease. The idea is that by treating everybody at once, you interrupt transmission of the disease. So you get the benefit of treatment for all the individuals involved, and you also put a major dent into the spread of the disease. (If you want to learn more about MDA, there is a good article by Peter Hotez.)
The tricky thing about doing mass administration is that it’s an awful lot of people you need consent from. As soon as people start refusing the treatment – not taking the drugs, avoiding the treatment site, keeping their kids home from school, whatever – then your drug administration isn’t so mass any more. The people who get treated still benefit but you lose the multiplier effect of getting the whole population at once. In a worst case scenario, people do partial treatments. Then there is no individual benefit, no mass treatment benefit, and you run the risk of causing resistance to the drug treatment.
India has a major problem with lymphatic filariasis. 590 million people are at risk for infection (that’s about 7% of the world population). It’s a substantial health problem in rural areas. Lymphatic filariasis is also known as elephantiasis, and it’s characterized by large, painful swelling, especially in the legs. It causes severe disability and even death. You can find out more about lymphatic filariasis in this handy fact sheet.
You’d think that Indians would be lining up to get treatment for such a wretched disease, but you’d be wrong. People don’t know a lot about the causes of lymphatic filariasis, in part because it has a very long incubation period. It starts with infection by worm larvae, which is symptomless. The horrible swelling doesn’t begin until the worms mature, so it’s hard to see the connection between exposure and symptom. And even the mature parasite can live in the body without symptoms for years.
People hate their symptoms, but they don’t understand where they come from. They also don’t understand why the drugs would help, or why they need to keep taking drugs. Lymphatic filariasis requires that people take drugs once a year for five years. It’s not exactly an easily remembered schedule.
The result of all this is that to control lymphatic filariasis, you need at least 80% of the people at risk for infection to take drugs annually for at least five years. India, therefore, needs 472 million people to take drugs once a year for a minimum of half a decade. I think it’s pretty clear why this is a tall order.
But it’s not impossible. A new study has found that you can increase people’s commitment to taking their drugs by educating them about lymphatic filariasis. I looked at a recent program that combined education about lymphatic filariasis and its transmission with advice on how to care for limbs swollen by the disease. The program improved compliance with mass drug administration from 52% to 90%, a clear victory.
I like that the program has a real impact. I like that it helps people who are already infected as well as preventing lymphatic filariasis. And I like having proof that when you give people the information they need to make a good decision, they make one.
Alanna Shaikh is an expert in health consulting, writing about global health for UN Dispatch and about international relief and development at Blood & Milk. She also serves as a frequently contributing blogger to ‘End the Neglect.’
