Endemicity of Lymphatic Filariasis : An Experience from Field Monitoring

Author: Sushree Nibedita Panda, Public Health Researcher, ICMR-Regional Medical Research Centre , Bhubaneswar, Odisha, India.

Lymphatic filariasis(LF) has been a significant public health threat to India since decades. More than 650 million Indian residing in 21 states and union territories are estimated to be at constant risk[1]. India accounts for more than 40% of all cases worldwide, predominantly from eastern and north-eastern Indian states[2]. Among the endemic regions, Odisha was recognized historically as one of the highly endemic. There are eight districts in Odisha which have high burden of Lymphatic Filariasis[3]. During my recent external monitoring work for World Health Organization-National Polio Surveillance Project unit Kalahandi, I monitored and validated Lymphatic Filarial cases in the district of Balangir, Odisha. The purpose of this program was to validate filarial cases in the endemic areas and to assess the real time data to provide patients advance treatment and Morbidity Management and Disability Prevention(MMDP) kits.  

Image credit: Grade assessment of Lymphatic Filariasis by Sushree Nibedita Panda

The pervasiveness of stigma acts as a deterrent to patients with Lymphatic Filariasis seeking medical attention, some still believe that it’s caused by evil eye or magic. The repercussions of hydrocele and lymphedema, two chronic Lymphatic Filarial conditions, negatively affecting both the quantity and quality of people’s occupations like cotton cultivation, agricultural work and weaving. Handloom weaving tradition in western Odisha has been prevailing since decades and carved a niche in international market. Weavers have to vigorously move their bodies while seated on the loom, making it quite challenging for filarial patients to sit on looms for long periods of time. In addition to the physical discomfort, marital abandonment has also seen in these endemic areas leading them various mental illnesses.

 The improper identification of Lymphatic Filariasis cases can be one of the major issues.  To overcome the improper identification challenge, Accredited Social Health Activists (ASHAs) can undergo training to accurately classify and identify Lymphatic Filarial cases and instruction can be provided on a routine basis to aid in the elimination of Lymphatic Filariasis. Despite the fact that Accredited Social Health Activists are aware of Lymphatic Filariasis, this training session can strengthen their knowledge on treatment. However, atypical lymphatic nodules quite prevalent in older adults in the district without presence of disease specific manifestation which is generating clinical dilemma and calling for urgent attention and more research needs to be done.

According to the World Health Organization, lymphatic filariasis is the second leading cause of disability globally[4]. It causes long term disability. Even if there is no way to reverse the disability that was brought about however, they can be classified as disabled persons under the “Rights of Persons with Disability Act,2016.” They can become one of the categories. In light of this, it is essential to emphasize the significance of economic, social rehabilitation and access to mental health care of the affected people. They can be provided with some financial assistance and promotion of economic developmental activities for the benefit of people with chronic Lymphatic Filariasis is a need of the moment.

Reference

1.        Kumar SP (2020) Lymphatic Filariasis in India: A Journey towards Elimination. J Commun Dis (E-ISSN 2581-351X P-ISSN 0019-5138) 52:17–21

2.        Cromwell EA, Schmidt CA, Kwong KT, et al (2020) The global distribution of lymphatic filariasis, 2000–18: a geospatial analysis. Lancet Glob Heal 8:e1186–e1194

3.        FILARIA ENDEMIC DISTRICTS :: National Center for Vector Borne Diseases Control (NCVBDC). https://nvbdcp.gov.in/index4.php?lang=1&level=0&linkid=453&lid=3733. Accessed 17 Dec 2022

4.        WHO (2013) Global Programme To Eliminate Preventing Disability. 1–53