Case Scenario
Case 1: In a Near by village 'Patnali' of Dharan municipality, we found a case of elephantiasis. she was very reluctant to talk about this chronic condition, however, after multiple visits during our family health exercise for MPH student, she started to give her details whatever she could recall. she really didn't recall the exact time when she started having this sort of problem but she knew it was present when she was child and when she was aware of her physical appearance, she already had this disfigurement. Her reluctance to talk openly about it, is one of the indirect consequences of Filariasis. Importantly, she was also unaware of the the fact that this disease could be transmitted by the bite of mosquito. Patnali village lies in tropical region of Nepal, where the mosquitoes are endemic especially during Summer.
Case 2: I got an opportunity to meet a Female community health volunteer from the Prastoki, Duhabi the day after mass drug administration of Diethyl carbamazine Citrate and Albendazole. She shared that many people were reluctant to take the drugs as people feared of its adverse effects, they experienced last time. She , herself experienced adverse effects especially, dizziness and headache for one day following the ingestion of the drug.
Filariasis
Filariasis is one of neglected tropical diseases and remained as a public health challenge in certain districts of Nepal . It is caused by the parasite 'Wuchereria Bancrofti'. This is transmitted person to person by the vector 'Culex' mosquito. The adult worms only live in the human lymph system. Male worms are about 3–4 centimetres in length, and female worms
8–10 centimetres. The male and female worms together form “nests” in the
human lymphatic system. Filarial infection can cause a variety of clinical manifestations,
including lymphoedema of the limbs, Elephantiasis (A syndrome brought on from long-term obstruction of
lymphatic vessels that leads to engorgement and thickened skin. It
causes disfigurement, often of the leg.), genital disease (hydrocele,
chylocele, and swelling of the scrotum and penis) and recurrent acute
attacks, which are extremely painful and are accompanied by fever. The
vast majority of infected people are asymptomatic, but virtually all of
them have subclinical lymphatic damage and as many as 40% have kidney
damage, with proteinuria and haematuria.
Transmission of Filariasis
Mass Drug administration of Diethyl Carbamazine Citrate (DEC) and Albendazole
Government of Nepal has brought the yearly mass drug administration (MDA) program of DiethylCarbamazine Citrate (DEC) and Albendazole since 2003 starting from Parsa district and this has been scaled up to all endemic districts of Nepal.
Eligible population for drug ingestion: people residing in endemic area except pregnant women, children less than 2 years and seriously ill person.
All districts should go through six rounds of MDA program by 2018 to achieve the national objective of eliminating lymphatic filariasis as public health problem by 2020. However, the major challenges is the noncompliance to the drugs. According to Annual report of Department of Health services, Nepal, in
one fiscal year, among 18,900 people were interviewed it has been
revealed an average of 57.9% drug ingestion against 68.9% reported
coverage. Many people didn't take the drugs due to fear of adverse effects such as dizzines, Headache, GI disturbances, anorexia. This non-compliance is partly also because of inability to convey the relevance of the ingestion in breaking the chain of transmission. As the people are free of signs and symptoms of filariasis, there is high chance that they won't feel necessity of its ingestion.
Immunological disturbances can be induced by disintegrating microfilariae and dead adult worms. The incidence and severity of these reactions are correlated both with the degree of microfilaraemia and with the dose of diethylcarbamazine. Such adverse effects, immunological disturbances and relevance should have been covered highly before mass drug administration.
Why we don't treat only the infected one in the community
People living in filaria endemic areas, who look healthy, may be carrying microfilaria (mf) in their blood without any recognizable symptoms at the initial stage and finding the infected persons at this stage and giving them alone treatment is demanding. DEC kills mf and some adult worms and albendazole normally clears other intestinal worms which is an added benefit. When both the drugs are given together, it has effect on adult worms too and therefore the parasites will be destroyed preventing the infected person from becoming a source of parasites in the future. When every individual in the community takes drugs under MDA, microfilaria will be cleared and not present in the blood for the mosquitoes to transmit.
Even though the mass drug administration initiative is very purposeful and has fair coverage, strategies to increase its compliance and coverage is needed to achieve the national goal of making Nepalese people free of risk of filarial disease transmission.
Sources:
Annual Report 070/71. DOHS. MOHP
Diethylcarbamazine. http://apps.who.int/medicinedocs/en/d/Jh2922e/3.5.html
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