A.K. Mukhopadhyay

K.N.M.B. Rao

P. Satya Babu

S.K. Patnaik

Journal of Vector Borne Diseases

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J Vector Borne Dis 45, March 2008, pp. 73–75Knowledge on lymphatic filariasis and mass drug administration  (MDA)programme in filaria endemic districts of Andhra Pradesh, IndiaA.K. Mukhopadhyay, S.K. Patnaik, P. Satya Babu & K.N.M.B. RaoNational Institute of Communicable Diseases, Regional Filaria Training and Research Centre, Rajahmundry, IndiaKey words  Andhra Pradesh – filariasis – knowledge – MDA programmeLymphatic filariasis (LF) is a serious socioeconomicand public health problem in the world.  As on De-cember 2006, the total population at risk for LF wasestimated to be 1254 million in 83 endemic countries,of which 64% contributed by Southeast Asia regionalone.  In India, it is estimated that 554.2 millionpopulation are at risk of LF infection in 243 imple-mentation units (districts)1. National Health Policy2002 aims at elimination of transmission and theprevention of disability due to LF by the year 20152.In Andhra Pradesh (A.P.), sixteen districts are undermass drug administration (MDA) programme cover-ing 54 million population with annual single dose ofdiethyl carbamazine citrate (DEC) tablets orally2.Recently, it was estimated that microfilaria (mf) ratein endemic area of East Godavari district of A.P. as4.43% and 3.48% after VI and VII rounds of MDAprogramme respectively3, 4.  There is a growing recog-nition that community involvement and effectivehealth education will play a critical role in the successof elimination of lymphatic filariasis (ELF) fromIndia by 2015. A survey was therefore initiated be-tween September 2006 and May 2007, in five filarialendemic districts of A.P. to know about the knowl-edge of LF and the ongoing MDA programme in thecommunity.Out of sixteen districts endemic for LF, five districts,namely East Godavari, Krishna, Visakhapatnam,West Godavari and Chittoor were selected for thecross sectional study.  Except Chittoor district, allother four districts are costal districts bordering Bayof Bengal. In each district, based on the data availablewith Department of Health, Government of A.P. andwith district NFCP units, two towns and three villageshighly endemic for LF and under MDA programmewere selected for the study.  In each town, two wardsreporting maximum LF cases were selected.Structured, pre-tested, objective type of question-naires was prepared with fifteen simple questions.The questions were prepared in English related to thedisease, knowledge on personal protection and on-going MDA programme in the area.  The question-naires were communicated with responders in locallanguage Telugu, or in Hindi by trained technical staffof this office and with the help of State Governmenthealth functionaries. The respondents included werestudents (Std. X onwards), teachers, service holders,businessmen, home makers, farmers and labourersuniformly selected for the study.  After obtainingclearance from the Directorate of National Instituteof Communicable Diseases, Government of India,Delhi the study was conducted between September2006 and May 2007 involving ten towns and fifteenvillages in the five districts.Detailed district-wise results on knowledge of dis-ease, protection from transmission and ongoingMDA programme are shown in Table 1.  Out of 7168respondents, 1216 were from East Godavari district,1108 from West Godavari district, 1596 fromJ  VECTOR  BORNE  DIS  45, MARCH 200874Visakhapatnam district, 1316 from Krishna district,and 1932 from Chittoor district. Out of 7168 respon-dents, 4636 (64.67%) of which 3006 (41.93%) re-spondents were from urban  and 1630 (22.73%) fromrural areas knew that filaria is a disease. Causativeagent of LF, helminths is known to only 1136(15.84%) persons, of which 904 (12.61%) were fromurban and 232 (3.23%) were from rural areas.Kumar5 reported 68.6% participants don’t know thecause of filaria in Orissa which roughly agree withour findings. Twelve (0.16%) respondents belongedto tribal community still believes that LF is a blackmagic. Very little information is available on knowl-edge, attitude and practices of LF in A.P.  Life cycleof filarial parasite and mosquitoes were known toonly 6.75 and 22.09% respondents respectively.  Re-spondents from urban areas showed maximumawareness which may be probably due to quality ofeducation. The finding corroborates with finding ofPatnaik et al6 who noted 66% respondents know thatLF is caused by mosquito bite in East Godavari dis-trict of A.P.About 52.67% in the study area knew mosquito con-trol methods by regular cleaning of water, using in-secticides, and by regular use of mosquito nets.  It wasalso noted that 1204   (16.79%) had mosquito net intheir home but only 647 (53.73%) of them were us-ing mosquito nets regularly while sleeping.  Overallonly 9.02% of the populations mainly from urbanareas under survey were using mosquito nets duringnight which corroborates with finding of Patnaik etal6. Apart from mosquito nets, 26.95% respondentswere using mosquito repellents.On an average only 25.4% population in five districtsof A.P was seeking treatment for LF from Govern-ment sector.  Unlike Patnaik et al 6 comparativelyTable 1. District-wise knowledge on filariasis and MDA programme in Andhra PradeshS. Questions/Items District-wise % responses (Whole No.) TotalNo. East West Visakha- Krishna Chittoor (n = 7168)Godavari Godavari patnam (n = 1316) (n = 1932)(n = 1216) (n = 1108) (n = 1596)1. Filaria is a diseases 68.09 (828) 66.06 (732) 66.41 (1060) 56.23 (740) 66.04 (1276) 64.67 (4636)Filaria is black magic – – 0.75 (12) – – 0.16 (12)2. Filaria caused by helminths 8.55 (104) 6.85 (76) 11.77 (188) 21.88 (288) 24.84 (480) 15.84 (1136 )3. LF transmitted by mosquitoes 72.36 (880) 72.56 (804) 66.91 (1068) 55.31 (728) 61.28 (1184) 65.06 (4664)4. Life cycle of LF 3.28 (40) 2.16 (24) 8.77 (140) 12.46 (164) 6.00 (116) 6.75 (484)5. Life cycle of mosquitoes 17.43 (212) 11.91 (132) 28.82 (460) 37.38 (492) 14.90 (288) 22.09 (1584)6. Persons have mosquito net 10.52 (128) 8.66 (96) 29.32 (468) 19.45 (256) 13.25 (256) 16.79 (1204)7. Persons using mosquito net 46.87 (60) 45.83 (44) 35.02 (164) 62.10 (159) 85.93 (220) 53.73 (647)     (n = 1204)8. Using repellents/coils 33.55 (408) 21.66 (240) 37.34 (596) 21.58 (284) 20.91 (404) 26.95 (1932)9. Knowledge on mosquito control 53.94 (656) 63.89 (708) 62.90 (1004) 44.98 (592) 42.23 (816) 52.67 (3776)10. Heard the name of MDA 57.23 (696) 50.18 (556) 69.17 (1104) 28.57 (376) 57.71 (1115) 53.66 (3847)11. Agency for Item 10    Health persons 79.02 (550) 89.92 (500) 70.19 (775) 58.51 (220) 85.20 (950) 77.85 (2995)Media 18.10 (126) 10.07 (56) 27.17 (300) 41.48 (156) 14.79 (165) 20.87 (803)NGO/Others 2.87 (20) – 2.62 (29) – – 1.27 (49)12. Symptoms of LF 76.97 (936) 76.17 (844) 71.17 (1136) 80.54 (1060) 64.80 (1252) 72.93 (5228)13. Seeking treatment from Govt. 62.82 (764) 2.16 (24) 3.07 (49) 1.82 (24) 49.68 (960) 25.40 (1821)14. Persons received DEC at the 94.57 (1150) 66.33 (735) 53.63 (856) 58.13 (765) 78.10 (1509) 69.96 (5015)time of MDA15. Drug compliance 76.06 (925) 64.89 (477) 59.57 (510) 41.96 (321) 66.86 (1009) 64.64 (3242)MUKHOPADHYAY et al: KNOWLEDGE ON FILARIASIS & MDA PROGRAMME  75high, i.e. 62.8% people were seeking treatment fromGovernment sector in East Godavari district.As per WHO1, DEC coverage in India was recordedas 54.5% during MDA programme in 2006.  Babu etal7 noted that in East Godavari district of A.P. 77%population received DEC in MDA programme ofwhich 64% consumed the medicine. Out of 7168 re-sponders from five districts, 5015 (69.96%) personsreceived DEC during MDA programme. Out of 5015who received DEC tablets only, 3242 (64.64%) actu-ally consumed the tablets. Maximum coverage andconsumption of DEC tablets during MDAprogramme was noted from East Godavari district as94.57 and 76.06% respectively. A pilot project onMDA was first introduced in East Godavari districtof A.P. during December 19997. Moreover, nineNFCP units and two Regional Filaria Training andResearch Centres (one RFT & RC run by Govern-ment of Andhra Pradesh and one by NICD, Govern-ment of India) are situated in the district. Therefore,surveillance and supervisory mechanism in the dis-trict was noted better than other districts whichcaused better coverage and consumption rate in EastGodavari district.For ELF and MDA programme inter-personnel com-munication was found to be the best method.  A high77.87% respondents came to know about MDA fromhealth personnel and 20.87% through media (T.V.,Radio and miking), whereas NGO has very little in-volvement (1.24%). In order to eliminate LF fromIndia by 2015, active community participation ishighly essential.  This is possible only if communityhas adequate knowledge about LF and ongoing MDAprogramme.  Therefore, an overall effort is essentialto enlighten the community regarding the programmeinvolving NGO, teachers, students, private medicalpractitioners, community and religion leaders.AcknowledgementThe authors are grateful to the Director, NICD, Delhifor his encouragement and help in this study.  Authorsare also thankful to Dr. A.C. Dhariwal, Joint Direc-tor & Head, Division of Epidemiology & ParasiticDiseases, NICD, Delhi for his constant encourage-ment. Thanks are also due to Mr Jawahar Lal, Mr V.Gangadharam, Mr D. Visweswara Rao and Mr N.Kesavan for technical and secretarial assistance.References1. Weekly epidemiological record. Geneva: World HealthOrganization 2007; 82(42): 361–80.2. Operational guidelines on elimination of lymphatic filari-asis. Delhi: Directorate of National Vector Borne DiseaseControl Programme 2004; p. 10.3. Mukhopadhyay AK, Patnaik SK, Satya Babu P.  Status oflymphatic filariasis in parts of East Godavari district ofAndhra Pradesh.  J Vector Borne Dis 2007; 44(1): 72–4.4. Mukhopadhyay AK, Patnaik SK. Effect of mass drug ad-ministration programme on microfilaria carriers in EastGodavari district of Andhra Pradesh. J Vector Borne Dis2007; 44(4): 275–7.5. Kumar Anil. Household characteristics and peoples percep-tion about filariasis in Khurda district, Orissa. J CommunDis 1999; 32(2): 147–50.6. Patnaik SK, Krishna Rao P, Narayana MV, Kanhekar LJ,Raina VK, Ashok Kumar. Rural community perception andpreventive practice towards filariasis in East Godavari dis-trict of A.P. J Commun Dis  1990; 22(4): 285–6.7. Babu BV, Satyanarayana K. Factors responsible for cover-age and compliance in mass drug administration during theprogramme to eliminate LF in East Godavari district, southIndia. Trop Doctor 2003; 33: 79–82.Corresponding author: Dr A.K. Mukhopadhyay, National Institute of Communicable Diseases, Regional Filaria Training andResearch Centre, Rajahmundry–533 105, India.E-mail: ashokmukhopadhyay1952@yahoo.co.inReceived: 10 December 2007 Accepted in revised form: 8 January 2008

Knowledge on lymphatic filariasis and mass drug administration  (MDA) programme in filaria endemic districts of Andhra Pradesh, India

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Knowledge on lymphatic filariasis and mass drug administration (MDA) programme in filaria endemic districts of Andhra Pradesh, India

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