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MASS DRUG ADMINISTRATION 2016

PALAKKAD
DR.K.A.NAZAR
DISTRICT SURVEILLANCE OFFICER &
DEPUTY DISTRICRT MEDICAL OFFICER ,
DMO(H), PALAKKIAD

LF: Global

Caused by W.bancrofti, Brugia malayi & B.timori


Endemic in 81 countries of tropics and subtropics

GLOBAL SCENARIO
947 Million at risk
In 2000 More than 120 million people
infected
40 million disfigured and incapacitated
76 million mf carriers and 44 million
diseased cases
25 million men suffer from genital
disease
15 million people suffer from
lymphoedema or elephantiasis
1 million with occult filariasis (TPE) and
other manifestations

LF Distribution in India

Endemic
areas
Non-endemic
areas
Uncertain
areas

India, Indonesia, Nigeria and Bangladesh


contribute to > 70 % of the global burden
W.bancrofti is distributed throughout periodic
and subperiodic forms.
B.malayi in SEA only India, Indonesia,
Malaysia, Thailand , nocturnally periodic and
subperiodic, animal reservoirs
B.timori in Timor-Leste only

LF: A disease of poverty

LF occurs primarily in poor communities


In urban and rural areas
All age groups and both sexes are affected
Generally infection acquired in childhood and
as many as 1/3 of children infected before
age 5
2nd leading cause of permanent and long
term disability
Lost productivity caused by LF in India US $
1billion
Rarely life threatening

Indian scenario
Endemic in 250 districts of 16 states and 5 UTs
7 states Bihar, UP, AP, TN, Kerala, Orissa, WB
contribute to > 90% of the problem

574 million people at risk (43% of


global)
54 million infected (45% of global)
30.9 million mf carriers and 23.4 million
diseased
>99.4 % of the problem is W.bancrofti
and <0.6 % is B.malayi
W.bancrofti nocturnally periodic except some
islands of Nicobar group, where subperiodic
B.malayi is nocturnally periodic

Kerala
One of the 7 most endemic states
11 of the 14 districts are endemic
Both W.bancrofti and B.malayi are
endemic
B.malayi is on the decline and W.bancrofti
on the increase

History of MDA
Started in 2 districts in 1997- ALP& KKD
Extended to 9 more districts in 2004(Except PTA,
IDK & WND)
Both DEC and Alb. Tablets since 2008
Since 2013 MDA in 6 districts only.
2014 also MDA in 6 districts only.
{2014-15 TAS planned in 5 districts-KLM,
KTM,ALP,EKM,TSR (Successfully completed in all
except ALP)
2015 TAS planned in 4 districts (TVM, ALP,
KKD& KNR)}
2015 MDA in 3 districts only- PKD, MLP & KGD.
2016 TAS planned in 2 districts (MLP & KGD)}
2016 MDA IN PALAKKAD DISTRICT ONLY.

MDA COVERAGE BY DISTRICT REPORTS


DISTRIC
2004 2005 2007 2008 2009 2010 2011 2012 2013 2014
T
TVM

72.6 78.6

90.0

87.7

75.8

78.3

81.4

80.3

77.8

83.1

KLM

83.2 86.3

86.0

94.4

80.0

79.3

85.4

86.5

0.0

0.0

ALP

86.6 79.1

81.7

92.3

82.7

84.4

94.2

83.3

0.0

0.0

KTM

85.3 96.6

97.5

97.1

82.0

79.8

86.1

73.6

0.0

0.0

EKM

75.3 87.1

86.7

91.7

79.3

63.7

87.5

85.0

0.0

0.0

TSR

96.0 91.8

96.8

95.8

77.5

89.1

92.8

97.7

0.0

0.0

PKD

2015

86. 94.
70.
96.0 95.7
84.2 86.0 74.8 80.1 85.1 83.83
5
9
6

MLP

91.4 94.6

96.6

95.0

85.7

93.5

92.6

64.2

67.5

72

KKD

93.1 95.0

87.3

94.8

69.1

85.0

95.2

75.8

68.7

89.5

KNR

89.8 93.4

99.3

91.5

83.8

82.8

94.0

96.0

77.2

88.1

KGD

92.0 98.5

98.5

95.9

61.6

77.1

94.4

74.2

69.5

78.7

KERALA

86.5 90.5

92.4

93.8

77.1

81.6

90.0

81.0

73.5

82.3

All PHCs have >65% coverage in all districts in 2014 MDA

MDA IN
PALAKKAD DISTRICT

MORBIDITY MANAGEMENT

DETAILS

2015

2016

899

940

TOTAL LYMPHOEDEMA
CASES MANAGED
(CUMULATIVE)

117

106

TOTAL LINE LISTED


HYDROCELE CASES
(CUMULATIVE)

442

172

279

110

TOTAL LINE LISTED


LYMPHOEDEMA CASES
(CUMULATIVE)

TOTAL HYDROCELE
CASES OPERATED
(CUMULATIVE)

MDA compliance in Palakkad district -2014


85.18
90
78.37
78.3
76.19
80
69.67 68.85
68.94
Percentage
70
56.86
55.55
54.54
60
50 44.15 41.09 41.44
40.16
37.73 37.37 38.52
37.25
40
30
20
10
0
1

60
51.76

Distribution %
CONSD

10

1.Palakkad Municipality 2. Chittoor municipality 3. Kannadi


4. Thenkurissi 5. Kodumbu 6. Akathethara 7. Kunissery
8. Kozhalmannam 9. Puthussery 10. Koduvayoor

Drug distribution and consumption coverage in Palakkad district


100
88.04

90
80

76.2
72

71.82

70

67.4

70.87

62.5

Distribution
%

60
50
42.16

41.6

42.64

42.13

40
31.35

30

27.2

20
12.6

10
0

3.5

28

Drug distribution and consumption in Rural and Urban areas of Palakkad district
80

72.66

69.65

70
60
50

42.66

42.63

40
30
20
10
0

Urban

Rural

Assessed
distribution
Consumption

Drug distribution and consumption coverage in Palakkad district -2014


90
80
70
60
50
40
30
20
10
0

80.1

70.87

60.16
42.64

Reasons for non compliance -Palakkad district 2014

other reasons; 13%


partial consumption; 2%
Fear of side reactions; 33%
Treatment for other diseases; 12%

Not necessary; 39%

SIDE EFFECTS
Lythargy/Weakness(4.7%)
Fever(0.9%)
Vomiting/Headache(0.3% each)
Nausea(0.2%)
Sedation/Body pain/Abd.pain(0.1%
each)
Itching(0.03%)
Others(8.7%)

STRATEGIES

NOV-11TH

1ST PHASE
TO 24ST IN HOT SPOTS/ HR
AREAS

2ND PHASE
NOV- 25TH TO DEC 8TH IN ALL OTHER
AREAS.

HOT SPOTS 2016

1.PALAKKAD MUNICIPALITY
2.MARUTHARODE
18.MALAMPUZHA
3.PUTHUSSERY
4.PIRAYIRI
5.PUTHUPARIYARAM
6.AKATHETHARA
7.KODUMBA
8.KODUVAYUR
9.KOLLENGODE
10.NEMMARA
11.KUNISSERY
12.ALTHUR
13.MATHUR
14.KOTTAYI
15.COYALMANNAM
16.THENKURISSY

17. PALLASSENA

19.KANNADI

Objectives

To assess the
Drug distribution coverage
Drug consumption
coverage
Adverse reactions
Reasons for noncompliance
Status of microfilaria &
vector infection and
infectivity

MDA 2016 - PALAKKAD


Drug distributors

ASHA workers
Anganwadi workers
Health staff
Nursing students
JHI/JPHN Trainees

STRATEGY FOR 2015 MDA


1st Phase -NOV-11th to 24st in Hot Spots/ HR areas
Intensive house to house IEC/BCC campaign by HWs/ ASHAs/
AWWs- NOV.1st to 10th
Miking & Community gatherings with political leaders- NOV
11-12th
House to house campaign for drug administration by Volunteers
& health workers - NOV-13,14,15
Mop Up rounds NOV 16th to 18th
Transit booths- Bus stand/Rail way stationNOV-13,14,15
Mobile teams by Health Workers for Offices/ other institutionsDec- 14th & 17th

Booths from Nov-11th to 30st in


All Hospitals (Government and Private)/CHC/PHC

STRATEGY FOR 2015 MDA


2nd Phase -NOV- 25th to DEC 8th in all other areas.
Miking &Community gatherings with political leadersNOV 25,26
House to house campaign by Volunteers & health
workers -NOV-27,28,29
Mop Up rounds - NOV 30, DEC 1,2
Mobile teams by Health Workers for Offices& other
institutions-NOV 28,29
Transit booths- Bus stands/Rail way stationsNOV 27,28,29

Booths from NOV 25th to DEC14th in


All Hospitals (Government and Private)/CHC/PHC

STRATEGY FOR BETTER


COMPLIANCE
Special focus to tribal pockets, urban
slums, and Residential areas to increase
the consumption.
At the end of the program, the
consumption coverage must reach above
85%.
Report 1st PHASE DEC 30th to district HQs.
Final consolidated report to State- 15 th
Jan/2015

STRATEGY FOR BETTER


COMPLIANCE
IEC to reduce the fear of side reactions
Benefit is much more than the negligible side
reactions
Side reactions are mild and self limiting usually
Fever and inflammation are signs of hidden
disease.
Those who suffer from side reactions are the
persons who should consume drugs to prevent
lymph edema in future

STRATEGY FOR BETTER


COMPLIANCE
IEC to promote drug consumption
This is also useful to control
Allergy
Asthma
Eosinophilia
Worms
Absence of disease does not mean disease free
You may develop lymph edema in future

STRATEGY FOR BETTER


COMPLIANCE
Health promotional activity through
Doctors associations
IMA and AYUSH

Paramedical staff associations


Faith based organizations
NGO
Civil Society Organizations- Res.Assocns

STRATEGY FOR BETTER


COMPLIANCE
Social mobilization through
Print and Electronic media
Discussion, phone- in program, health talk etc through
AIR and TV

Social network sites


Involvement of NCC, Scouts, NSS etc
Mobilization of residence associations
Mass rallies, quiz programs, essay competitions
Cultural programs
House to house campaign by health workers.

CONCLUSION
65 to 80% consumption for 4-6 years
is required for stoppage of
transmission
Adverse reactions are nil, however
fear of side reactions is the major
reason for non consumption. Not
necessary is the second major reason
for non consumption
Advance planning, intensive IEC
activities, co-ordinated efforts and

THANK YOU