Category Archives: MDA

Lymphatic Filariasis: Why mainstream media must take note

by Navneet Anand and Anuradha Singh, GreyMatters Communications

_M6A7431Recently Global Network for Neglected Tropical Diseases (GNNTD) partnered with us at GreyMatters Communications to run a media awareness program on Lymphatic Filariasis (LF) in India. We took a group of journalists to two affected villages in Odisha to provide them exposure about the problem as well as help them evaluate challenges towards its complete elimination.

The Global Network for Neglected Tropical Diseases, an initiative of the Sabin Vaccine Institute, works to raise the awareness, political will and funds necessary to control and eliminate neglected tropical diseases (NTDs).

Often falling beyond the purview of mainstream media, like many other compelling problems in the country, LF has severe enormity and has persisted in India as well as other countries of the world for many years.

Not many would be aware that LF is the world’s second leading cause of long-term disability. Although filariasis does not kill, it causes debility and imposes severe social and economic burden to the affected individuals, their families and the endemic communities. According to one estimate at one point in time 120 million people in 83 countries of the world were infected with lymphatic filarial parasites, and it was estimated that more than 1.1 billion (20% of the world’s population) are at risk of acquiring infection. Over 40 million people are severely disfigured and disabled by filariasis and 76 million are apparently normal but have hidden internal damage to lymphatic and renal systems. According to the World Health Organization, India, Indonesia, Nigeria and Bangladesh alone contribute about 70% of the infection worldwide.

Indigenous lymphatic filariasis cases have been reported from 20 States/UTs across 250 districts which were identified as endemic for filariasis with a population of about 600 million at risk. In India, a special program to eliminate lymphatic filariasis was launched in 2004 covering 202 endemic districts in 20 States/Union Territories and subsequently scaled up to cover all the 250 (now 255) endemic districts targeting a population of about 600 million.The population coverage during MDA has improved from 73% in 2004 to 83% in 2013, according to a document on National Roadmap for Elimination of LF by Ministry of Health.

It is rather heartening to note that the overall microfilaria rate has reduced from 1.24% in 2004 to 0.29% in 2013 (Prov.) at national level. Out of 250 districts 203 districts have reported overall microfilaria rate to less than 1%. Out of remaining 52 districts, 31 need high priority for focussed intervention as these districts have been persistently reporting microfilaria rate above 1%. Ganjam and Puri in Odisha, where we travelled, are also among the high-incidence districts in the country.

It was rather painful to come across two cases of Lakhender Swain and Kointa Swain in Kapileshwarpur village in Puri. Afflicted with this distressing disease, the two have wasted their most productive years attending to deal with this disabling disease. “I had a dream for my life but the tyranny of this disease was such that I was rendered helpless. For over 20 years now, I have lived with this heaviness in the leg and associated problems including social taboos and boycotts,” rued Lakhender, who is 45 only. Kointa, in her 60s, recalls how at one point she was extremely active and used to work “effectively” till destiny willed otherwise.

“NTDs like lymphatic filariasis hold people back not just physically, but also socially. Misunderstandings about what causes the disease, how it is transmitted and what its effects are can lead to stigma and social exclusion. This lack of understanding can cause communities to push LF patients to the margins, excluding them from employment or educational opportunities, from community festivals or celebrations and making it difficult to marry. The impact can go beyond the LF patient to also affect family members of LF patients. Self-stigma is also a problem and can impact a patient’s mental health. Social isolation compounds the impact of the infection, keeping people from trying to achieve their aspirations or have hope for the future. Although LF tends to be visible in rural and poor communities, LF is spread through mosquitos, like dengue and malaria, so anyone can be infected,” said Nandini Pillai, Programs and Operations Officer, GNNTD.

However, thanks to some serious and sustained intervention by the government as well as work by agencies like GNNTD as well as NGOs like CASA (Church’s Auxiliary for Social Action), the problem is well contained and India may well be on the verge of soon eliminating the disease altogether.

One of the key programs of the Government is Mass Drug Administration where all those at risk are administered medicine free of cost.

“The treatment is a weight-based dose of diethylcarbamizne (DEC), and a single pill of albendazole, to everyone over the age of 2 years and not ill or pregnant. Both drugs are anti-parasitic medications which prevent and expel parasites. These medicines also protect from intestinal worm infections. The treatment is safe and free and delivered to communities through ASHA workers and other community-based drug distributors. The drugs are donations from major pharmaceutical companies, like GlaxoSmithKline (GSK), or procured in India from WHO approved companies. They are completely safe,” informed Shaliesh Vaite, National NTD Advisor, GNNTD.

The 2015 MDA is underway nationwide from December 14-20.

The medical approach to defeating NTDs is through a set of medications donated by major pharmaceutical companies for free distribution to communities in need. “In India, state governments locally procure some medications and submit their requests for donated drugs to the central government, which then works with WHO to order and deliver the drugs. Community drug distributers are responsible for going door to door to hand out the drugs and ensure that people take them properly. This grassroots method for treating and protecting against NTDs takes the partnership of the whole community working in tandem, and ensures that nobody is left behind,” added Kelly Toves, Communications Officer, GNNTD.

Along with this, if media also undertakes to write more often and inform people about the ways to deal with this scourge, the process of elimination will be faster.

This post was originally published on Communicate, Connect.

Introducing Ishmael Tamba Jalloh, October’s END7 Student of the Month

sl_murraytown_chc.jpgEach month, END7 honors one student who has made a significant contribution to our growing movement of student advocates dedicated to seeing the end of NTDs. We are very proud to introduce our October 2015 Student of the Month, Ishmael Tamba Jalloh, a pharmacy student at the University of Sierra Leone College of Medicine and Allied Health Sciences. Ishmael joined the END7 Campus Leaders Council to raise awareness of neglected tropical diseases (NTDs) in Sierra Leone by engaging students at his university in community engagement and outreach to local leaders.

As we reported while profiling Sierra Leone for our NTD Success Stories series last month, six NTDs are found in all 14 health districts in Sierra Leone, threatening nearly the entire population of the country. Strong leadership from Sierra Leone’s Ministry of Health and in-country partners has helped drive tremendous progress against NTDs like lymphatic filariasis (LF), also known as elephantiasis. More than 57 million NTD treatments had been delivered nationwide by the beginning of 2014, putting the country on track to begin the World Health Organization process of verifying the elimination of lymphatic filariasis (LF) in eight of 14 health districts. Unfortunately, when the West African Ebola epidemic reached Sierra Leone in May 2014, all public health program activities were suspended — including mass drug administration (MDA) for NTDs.

One year later, with the Ebola epidemic receding, MDA restarted in Sierra Leone. Just this month, from October 9-13, the Ministry of Health’s NTD Program, through the District Health Management Team, ran an MDA campaign targeting 1.4 million people with drugs for LF and soil-transmitted helminths (STH). Ishmael volunteered to assist with the MDA, putting his pharmacy education at the service of his community. He shares:

“The mass drug administration campaign ran from October 9th to the 13th. Before the start of the campaign, there was a training for all the health workers and volunteers at the Murray Town Community Health Center [pictured above]. After the training, we were divided into pairs (a health worker and a volunteer) and sent to various communities in Ward 390, Constituency 111, in the western part of Freetown, the capital of Sierra Leone.

“At the start of the drug administration, my team targeted a secondary school, the Sierra Leone Grammar School, in the Murray Town community. At the school, we administered albendazole and ivermectin as a prophylactic treatment for elephantiasis to 850 pupils and 50 teachers. For the remaining days of the MDA campaign, I worked in a slum community called Cockle. In that community, we targeted 1,500 residents for drug distribution.

sl_dosing.jpg“During the campaign, we used a measuring rod as a guide for the dosage we should give [pictured left]. If the individual’s height was at the 4th mark, we administered 4 tablets of ivermectin and a tablet of albendazole; if the individual’s height was at the 3rd mark, we administered 3 tablets of ivermectin and a tablet of albendazole, and so on with the second and first marks. This made it easy to give everyone the proper dose to keep them safe from elephantiasis.

“During the campaign, I found out that people are only aware of one out of the seven neglected tropical diseases — elephantiasis, which is called ‘Big Foot’ in our local language. Now, I am thinking that more work needs to be done about all of the NTDs in Sierra Leone.

“Also, during the campaign, I met an 18-year-old girl named Isatu who for the past two weeks has been developing signs of elephantiasis. Her family are saying her swollen legs are caused by witchcraft or black magic, but I advised them go to the hospital and have Isatu be tested for elephantiasis. I hope she receives the treatment she needs, and I am glad to have met her during the campaign.

“All in all, our campaign targeted 1.4 million people in Freetown. I hope my contribution to the campaign made a difference.”

Now, Ishamel is working to establish the first END7 chapter in Africa at the University of Sierra Leone. We are so grateful for Ishmael’s commitment to the fight against NTDs in Sierra Leone and around the world, and we are excited to see our community of student supporters like him grow. If you are ready to get your school involved in END7’s work, contact the END7’s student outreach coordinator at Emily.Conron@sabin.org to learn how you can get started!

Celebrating NTD Success Stories: India’s Historic NTD Progress

A student holds an Albendazole tablet at a mass drug administration at the Ghorahuan School in Bihar, India.

A student holds an Albendazole tablet at a mass drug administration at the Ghorahuan School in Bihar, India.

During the month of October, END7 student supporters are celebrating NTD Success Stories from Haiti, India, Sierra Leone and the Philippines. Each country we are spotlighting has overcome their own challenges, ranging from earthquakes to the Ebola epidemic, to make sure communities receive NTD treatment and progress towards disease control and elimination. The examples of these four diverse countries help communicate not just the scope of the suffering caused by NTDs, but the hope we have of ending these diseases for good. Last week, we celebrated Haiti’s inspiring progress towards the elimination of lymphatic filariasis, and this week we’re looking across the globe to India, a historic leader against that and many other NTDs.

India’s diverse population has experienced rapid economic growth over the past two decades, but the country still faces significant health challenges due to its size and high burden of disease. Almost half of the 1.2 billion people at risk of lymphatic filariasis (LF) infection globally live in India. Additionally, NTDs such as soil-transmitted helminths (STH) negatively impact hundreds of millions of children in the country, causing delays in cognitive and physical development. These NTDs take a heavy toll on economic productivity and chronic infections perpetuate the cycle of poverty. However, the Indian government has one of the largest and most successful NTD programs in the world, and treatment scale-up is paving the way towards the elimination of LF and the control of STH infections on the subcontinent.

The Indian government first launched a pilot program to tackle LF in 1949. Over the next four decades, the government supported important research and demonstration studies that became the technical backbone of the World Health Organization’s Global Programme to Eliminate LF, launched in 2000. India’s experience with LF provided the evidence for the operational and technical feasibility of mass drug administration (MDA) to eliminate LF — a strategy that has since been adopted in countries around the world.

Today, India leads the world’s largest MDA program, reaching more than 400 million people with an annual dose of preventative medicine for LF. To date, India is one of only two countries who have achieved MDA coverage at a national level, and the population at risk of LF in the country has been reduced from 600 million to 460 million as a result. The country has also successfully scaled up efforts to control STH infections at the state level, particularly through school-based deworming programs, and recently launched a National Deworming Day to coordinate multiple platforms for deworming into one cohesive push to tackle STH in children under 19. This initiative will encourage coordinated efforts, budgeting, and monitoring to improve the efficacy and reach of deworming programs.

Several districts in India are in the process of undergoing Transmission Assessment Surveys, evaluations designed to register whether LF transmission has been interrupted and annual MDA can cease. Moving forward, bi-annual MDAs will continue in districts with a high burden of LF. Continued efforts aimed at interrupting transmission of diseases, disease surveillance, early diagnosis and response, as well as continued community mobilization and education to change risk behaviors will be critical to reducing the LF burden in India. Managing the disease among existing patients, particularly those disabled by LF with elephantiasis or hydrocele, is also a high priority.

India’s Ministry of Health and Family Welfare worked with the Global Network for Neglected Tropical Diseases in November 2014 to produce a mass media campaign, Hathipaon Mukt Bharat (Filaria Free India) to raise awareness of LF and encourage people to participate in MDAs. The video created for the campaign, entitled Giant Footprints!, won silver at the Cannes Festival of Creativity in 2015. Bollywood star Abhishek Bachchan is also supporting India’s effort against NTDs as the END7 campaign’s first official ambassador in India.

These ongoing social mobilization efforts will be critical to achieving national, regional and global NTD control and elimination goals by 2020. If India’s current NTD efforts can be maintained and expanded, those at risk for NTDs can live free of these diseases of poverty and their devastating effects. And as the leader of one of the oldest and largest programs to tackle NTDs, India can be a leader in assisting other endemic countries hoping to replicate their success around the world.

There’s ample reason to hope that history will repeat itself in India as the country celebrates the elimination of polio and looks towards new goals, like the elimination of LF. The country’s example shows that directing the expertise of different agencies and organizations towards a common goal can be successful even in a country with a large and diverse population. END7 supporters are eagerly following the good news from India — the second success story we’re spreading in a month that’s already offered many reasons to celebrate — and hoping to see it replicated worldwide.

Success in Vietnam: More than 700,000 School Children Treated!

 

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Over the span of two months, Vietnam’s Ministry of Health, together with World Vision Australia, treated more than 700,000 school children for intestinal worms. Generous donations from END7 supporters helped support this massive effort to reach every primary school in the nine target provinces across the country.

Vietnam’s mass drug administration (MDA) was critical to improving the country’s health. Intestinal worms pose a significant threat to children in Vietnam; more than 8 million children are at risk. If infected, these children are more likely to suffer from malnutrition and anemia. Intestinal worm infections also lead to school absenteeism and decreased cognitive function. In order to reach their full potential, all at-risk children must be treated regularly.

To help address Vietnam’s burden of intestinal worms, END7 donations supported the delivery of abendazole tablets, and the training of teachers and healthcare workers. Now, END7 funds will be supporting the country’s efforts to monitor and evaluate the success of the MDA campaign.

Thanks to our END7 supporters for playing a meaningful role in the fight against neglected tropical diseases!

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