Tag Archives: India

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.

Eliminating Lymphatic Filariasis in Odisha

ASHAs in Ganjam District, Odisha, India

ASHAs in Ganjam District, Odisha, India. Photo: Naveen Pun / Sabin Vaccine Institute

by Dr. Madan Mohan Pradhan

During the late 1990s, I was infected with lymphatic filariasis (LF), or elephantiasis, a neglected tropical disease (NTD) that can cause extreme pain, crippling disability and disfigurement. LF is one of 17 NTDs recognized by the World Health Organization (WHO) as a group of parasitic and bacterial infections, which primarily affect people living in extreme poverty.

The incident occurred after I completed my medical degree. I was eager to work in Odisha and help some of its most vulnerable and under-served communities. It was during this time that I began working on an LF project, making nightly visits to endemic villages to collect blood samples from fevered patients. I knew how LF was transmitted, but had limited knowledge on the preventive aspect. As is typical in most cases, I didn’t present symptoms until years later. When I saw my right foot swelling with redness and pain four years later, I immediately diagnosed the disease and took the full course of diethylcarbamazine (DEC) tablets. I was cured and never had a recurrence again. Though I was fortunate enough to stop the disease at an early stage, many are not as lucky.

During my tenure as a medical officer in rural Odisha, I saw a number of patients with LF. Many of them lived in the poorest communities, with limited resources and support from their families. Social stigma and discrimination, along with misconceptions about transmission of the disease, often made matters worse.

As we observe National Filaria Week from December 14 to 20, it is important to raise greater awareness about this disease, which threatens nearly 352 million people in India. It is particularly important to know the source of transmission of LF. It is not caused by a curse or deeds from a past life. And it is not hereditary.

Lymphatic filariasis is caused by a tiny parasite, which is transmitted by Culex mosquitoes. Globally, more than 120 million people are affected by this disease. People living in poor environmental and unhygienic conditions are vulnerable to the infection as the Culex mosquito breeds in these places. Most LF infected people may not have any symptoms and are found apparently healthy. But the LF parasite can be transmitted from these asymptomatic people to healthy people through mosquitoes. LF affects the lymphatic channels of the body due to which there occurs swelling of breast, lymph nodes, genital organs, and at later stage these swellings can result in disfiguration.

Although LF isn’t fatal, it can lead to disfigurement, disability and chronic pain. As a result, many people with LF are unable to make a living for themselves and their families. Social stigma and discrimination also limit the quality of life for those affected by LF. It is not uncommon for parents to be unable to marry off children with LF.

To facilitate greater progress in combating the disease, the WHO launched a global program to eliminate LF by 2020. They adopted the intervention known as mass drug administrations (MDA), in which two drugs — DEC and albendazole tablets — are co-administered in a single dose. These drugs are cost-effective and safe, and can be administered by trained community volunteers.

If more than 85 percent of the eligible population of at-risk communities consume the drugs once annually for five to seven years, the risk of LF infection will be minimal to zero. That is why the Indian government has prioritized efforts to eliminate LF through the National Vector Borne Disease Control Programme.

Besides the MDA, there are other components for LF elimination and morbidity management, including hydrocele operations. Government and non-profits are working to increase the knowledge and skill of LF-affected persons and family members on home care. For the success of both MDA and morbidity management, community involvement, participation from other government departments and active involvement of civil society organisations is essential. This requires high level political and administrative commitment and raising awareness through community participation

In Odisha, the MDA will be conducted on December 19, followed by two days of mop up rounds. Following 10 districts: Deogada, Boudh, Angul, Dhenkanal, Bhadrak, Jajpur, Jagatsinghpur, Nayagarh, Ganjam and Jharsuguda will be covered under 2015 MDA. During this time, drug administrators such as ASHA workers and other community volunteers, will make door-to-door household visits to administer the two drugs used in MDA. They will explain the safety and importance of taking the drugs and ensure that people consume drugs after eating; and monitor any adverse effects. If we continue our momentum and efforts in Odisha, we can eliminate LF within the next few years. Together, we can help create a filaria-free reality in Odisha and India.

Dr. Madan Mohan Pradhan is the joint director of health services for the National Vector Borne Disease Control Programme in Odisha, India.

This story originally appeared in the Orissa POST and the Political and Business Daily.

Eight Million Toilets and Counting

By Alice Carter

world toilet day 2015Normally, we don’t like to talk about bathrooms. That is a private space that most of us would largely like to avoid thinking about. But on World Toilet Day, we give thanks for our sanitary facilities and celebrate the invention of the toilet, which has saved countless lives as a disease control mechanism, and gives us privacy to, you know, go.

There is a Sesame Street song, a global “urgent run,” and an art show in New York. All of these types of events are celebrations for the often overlooked efficiency of the mundane technology that is a toilet, but also are opportunities to spread awareness of just how precious our access to toilets really is. One in three people around the globe don’t have access to adequate sanitary infrastructure, leaving them at increased risk for neglected tropical diseases (NTDs) that are spread through contact with fecally-contaminated soil. Half of the people who practice open defecation globally live in India, where 1.1 million liters of human excrement enter the Ganges River every minute. Recognizing the toll that open defecation takes on health, education and economic output, the government of India is trying to increase access to sanitation infrastructure and put an end to open defecation.

Prime Minister Modi has pledged that India will be open defecation free by 2019, and under his leadership the government has set up incentives for toilet construction and usage. Swachh Bharat Abhiyan — the Clean India Mission — is a sanitation campaign run by the Indian government, with the joint objectives of reducing open defecation and changing behavior to increase the use of sanitary facilities. Prime Minister Modi launched Swachh Bharat on Mahatma Gandhi’s birthday in 2014. The government also plans to raise Rs 3,800 crore (approximately 550 million USD) from the public to support this initiative, which gives subsidies for toilet construction and helps villages become certified as open defecation free. As of August 2015, 8 million toilets have been constructed as part of the campaign.

Unfortunately, it is tricky to measure the prevalence of open defecation and people’s toilet usage. Simply constructing a toilet in every home and school won’t make people start exclusively using toilets, especially if they don’t know the benefits of sanitation infrastructure and the risks of open defecation. For this, public awareness campaigns are also needed, and people need to be given plenty of reasons to use the toilet exclusively. One motivating factor for people to switch from open defecation to toilet use is awareness of the health risks of open defecation.

In communities that continue to practice open defecation, children playing outside or walking to school with no shoes can be exposed to contaminated soil, putting them at risk for infection by soil-transmitted helminths (STH). Similarly, clean drinking water sources and uncooked fruits and vegetables can be contaminated, increasing the risk of infection.

On the other hand, access to a household latrine has been found to reduce the risk of infection with STH by 40%. Nadia, a district in West Bengal, India, was the first district to be certified as open defecation free, and has since noted a decreased incidence of diarrhea and malnutrition. Reduced NTD infection is a strong indicator of the success of the Swachh Bharat campaign. Including an NTD indicator in Swachh Bharat would give the mission concrete targets to measure exclusive toilet use in communities where the campaign has built toilets, and it would help spread awareness of the negative health impacts of open defecation.

Perhaps on Gandhi’s 150th birthday, in 2019, India will have achieved its goal of ending open defecation. He would be proud, as he often stressed that a society’s approach to private and public sanitation reflects its commitment to true freedom and dignity.


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.