Health

Eliminating a scourge

Image for representation purpose only.

Image for representation purpose only.   | Photo Credit: AFP

The end of the monsoons in India signal a welcome turn in the climate. While the drop in temperature brings relief, the spike in vector-borne diseases invariably turns into a public health nightmare. Of the many mosquito-transmitted diseases that wreak havoc during this time, dengue, malaria and chikungunya often capture headlines. However, not many know about Lymphatic Filariasis (LF), a neglected tropical disease that affects the poorest sections of society and is ranked by the World Health Organisation (WHO) as the second most common cause of long-term disability, after mental illness.

Most of us associate disability with polio, which causes acute flaccid paralysis in the limbs. It has taken years of battle and a successful eradication programme to wipe out polio from this country. However, LF lacks visibility. Patients suffer from painful enlargement of the limbs (lymphoedema) and swelling in the scrotum (hydrocele) — conditions that keep them from leading physically-active lives or even supporting their families financially. Luckily, LF is preventable through chemotherapy, i.e. by simply taking tablets distributed by the government, free-of-cost, every year, during mass drug administration (MDA) campaigns under the national LF elimination programme.

On a recent field visit to Bihar, I met Meena (name changed), a girl with LF infection, who was studying to complete her graduation course. However, she had been unable to attend most of her classes because of her swollen leg, and was depressed, with apprehensions about her not being able to land a job or get married. To make matters worse, she never sought any government-approved treatment for LF; instead her family had spent huge sums of money on ‘alternative medicines,’ with little success.

According to the Indian Council of Medical Research (ICMR), over 31 million people in India, like Meena, may have the disease. Also, 630 million Indians, across 256 districts, are at risk. Patients and families affected by LF in the country lose over $842 million every year in treatment cost and foregone work time.

Every year, a brigade of health workers has been going door-to-door campaigning across the country during MDA to help people protect themselves from LF. In fact, over 100 of the 256 endemic districts have been successful in bringing down infection rates. However, a major challenge has been low compliance to treatment — large sections of society do not consume medicines due to a lack of awareness about the disease and an unfounded fear of side-effects. This, in turn, has resulted in MDA persisting far longer than required, weighing heavily on the government exchequer.

Involve the community

Community ownership of the LF elimination programme can be a key contributor in making MDA successful. Even as the government works to ensuring provision of anti-filarial medicines to the population at risk, we all must do our bit. It is our responsibility to alert health workers about any LF patients in our household or neighbourhood so that they can receive timely treatment.

On the other hand, LF-related research and development has resulted in innovative strategies such as triple-drug therapy, which involves the administration of a single annual dose of three anti-filarial medicines and is expected to significantly shorten the time to clear LF parasites from communities. Indian research institutes, such as the ICMR, have made a significant contribution to development of this drug regimen and India will be the first South Asian country to introduce it. What we need now are strong monitoring and surveillance systems to record field data to improve the quality and timeliness of programme planning and implementation. Additionally, robust funding will be crucial to LF elimination efforts. In 2016-17, the National Vector Borne Disease Control Programme (NVBDCP) formed 1.6% of the total National Health Mission budget, while LF accounted for 6.2% (₹360 million) of the total NVBDCP budget. With India harbouring 40% of the global disease burden, it this is largely inadequate, and will need stronger financial commitment by the government.

Elimination of LF is no distant dream. It’s been more than a decade since China and South Korea were declared filaria-free. Since 2016, a dozen more countries, including the Maldives, Sri Lanka, and Cambodia, have accomplished this goal. There is no reason why India should continue to grapple with this debilitating disease. All we need is for the entire community to pledge commitment in the fight to free our nation from the clutches of this ancient scourge.

Dr. Bhupendra Tripathi is with the Bill & Melinda Gates Foundation, India

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Printable version | Apr 6, 2020 10:15:36 PM | https://www.thehindu.com/sci-tech/health/eliminating-a-scourge/article25414625.ece

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