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PROJECT ON THE
CONTROL OF MALAYAN
FILARIASIS
IN SHERTALLAI - KERALA STATE
VECTOR
CONTROL
FIELD
RESEARCH
CENTRE
STATION
INDIAN COUNCIL OF MEDICAL RESEARCH
SHERTALLAI,
KERALA
CONTROL OF MALAYAN FILARIASIS IN
SHERTALLAI, KERALA STATE
The Indian Council of Medical Research, through one of its
National Institutes, Vector Control Research Centre, Pondicherry
launched a Technology Mission Project for the control of
Malayan Filariasis in Shertallai areas of Kerala State. This
project was a new year gift to the people of Kerala, as
commented by the then Hon. Dy. Health Minister and the
Director General of I. C. M. R. at the time of its inauguration
on the 1st January, 1986. The main thrust was at translating
research findings into the actual implementation of disease
control operation, especially for a disease like filariasis,
which can be aptly called a man-made disease. The project is
engaged in a multi-sectorial action based community programme
aimed at total eradication of Malayan filariasis which has already
gained a strong foothold in this area for centuries due to its
multiple topographic, ecological and socio-economic factors.
The severity of this disease in Kerala in general and Shertallai
in particular is well evident, as the very first filariasis control
programme has been initiated in this place, much before
Independence
by the erstwhile
Maharaja of Travancore.
Eventhough many attempts were made in the past by various
agencies for the control of this disease, they could not make any
significant success due to various reasons. The principal lacuna
in the earlier programmes was the lack of community involve
ment which is absolutely essential for the control of a disease
like filariasis.
The Vector Control Research Centre has designed
a strategy linking entire disease control operations with the
overall developmental programmes of the State involving the
community right from the beginning, so that this disease could
effectively be controlled, within a reasonable period of time.
Shertallai taluk with an area of 304
and a population
Sq. km,
of over 4 lakhs is considered to be the hotbed of this disease
since early part of this century. The first scientific survey
carried out by M. 0. T. Iyengar in 1933 showed an endemicity
rate of 48.1%.
Also the adult parasite of Brugia malayi was
described for the first time from a patient in Shertallai by Rao
and Maplestone in the year 1940. The vectors of this disease,
Mansonioides mosquitoes are well known for their unique breeding
behaviour, exclusively in association with floating aquatic weeds,
such as Pistia stratiotes, Salvinia molesta and Eichhornia crassipes.
The
area
sea
with vast
situated
in
between
Vembanad
water bodies chocked
with
lake
and Arabian
aquatic vegetation
is highly conducive for the proliferation of these vector
mosquitoes. There are over 75,000 domestic ponds, besides a
number of canals/channels and vast areas of seasonal water
collections (fallow lands) providing a total surface area of about
18.43 Sq. km. for vector breeding.
The base line data collected by the VCRC in 1986 showed
that there were pockets in Shertallai with an endemicity rate over
20% and man biting rate (number of mosquitoes biting/
man / night) about 137.0.
Overall Objectives:
(a)
To eliminate foci of
transmission of
B. malayi from
Shertallai endemic belt, thereby producing a new
generation of children free from filarial infection.
(b)
To demonstrate control of vectors of B. malayi using
environmental and naturalistic methods, with commu
nity participation.
(c)
Motivate the community to make vector control a
people's programme by various means.
(d)
Integration of vector control with overall developmental
programmes of the state.
-2-
Strategies adopted:
The newer Strategies adopted through simple known technology
included:
(a)
Integrated vector control management through deweed
ing of ponds, composite fish culture, propagation
of alternative green manure, source reduction etc.
(b)
Health
care
delivery
by
detecting
and
treating
microfilaria positive cases to reduce parasite load in
the community and
(c)
FISH
Health education for enlisting community participation
through different media.
CULTURE
Fish culture programme involving the culture of fast growing
edible varieties of Carps, such as Catla catla, Cyprinus carpio,
Cirrhina mrigala, Labeo rohita, Labeo fimbriatus, phytophagous
fishes viz., Ctenopharyngodon idella and Osphronemus goramy
were
advocated in ponds, which were deweeded by the
community. The Carp fingerlings were procured from the State
Government fish farm and were distributed free of cost.
More than 37,600 ponds are already brought under fish culture.
This programme enabled the community to improve their
financial status while the weed/vector control was achieved
as a by-product.
POPULARISING ALTERNATIVE GREEN MANURE
The aquatic weeds
source of manure for
was
greatly
of the people.
linked
were grown by the community as a
agricultural purposes and this practice
with
the socio-economic aspects of life
For the beneficiaries who maintained the ponds
free of weeds, an alternative better green manure source through
the propagation of leguminous plants. Sunhemp (Crotolaria
junced) was advocated.
-3-
HEALTH CARE DELIVERY
Health Care Delivery is designed with the ultimate goal of
eliminating the foci of filariasis transmission from Shertallai.
Hence, the avenues created under this component were aimed
at parasitological and clinical detection of filariasis cases and
imparting appropriate treatment.
A total of 123,769 persons were screened for filariasis by
conducting Sample Surveys (31,054),
General Community
Health Camps (16,222), Filariasis Detection Camps (26,497)
Filariasis Detection and Treatment Centres (20,042) and Clinics
at the Centre (29,954). As many as 8,035 patients were given
necessary treatment.
Impact of therapeutic measures:
Diethyl carbamazine (DEC) and other supportive therapy were
imparted to 103 recent oedema (RO) and 132 persistent
oedema (PO) cases. Response to therapy (reduction/no pro
gression) was noticed in 88 (85.4%) recent and 102 (77.3%)
persistent cases. Regression in oedema was maximum (70.4%)
in RO cases, moderate (52.4%) in PO
cases without skin
change and minimal (36.2%) in PO cases with elephantiasis.
A significant correlation was observed between the degree
of reduction and number of DEC courses, (upto 5) in RO cases.
In PO cases, though DEC courses, duration and initial volume
of oedema appeared to influence the oedema regression, the data
were at limits of significance by statistical test.
CONTROL OF MALAYAN FILARIASISA COMMUNITY ACTION PROGRAMME
The ultimate objective
of community participation is the
creation of a change in living style that is conducive to
control, if not eradication, of the disease. This could only be
brought about by an integrated planned programme of action
in tune with existing socio-cultural and economic infrastructure.
This is being achieved by a strong sociological component
which has fanned out to all strata of the community, using
various tools and means.
-4-
People's Movement:
A
number of
of political
area were
undertake a
social
and
cultural
organizations,
independent
influence which were actively functioning in this
identified
to create a 'People's Movement' to
programme
for the control of
filariasis, which
hitherto did not cause much concern for the local community.
As a result of this, a 'People's Movement' came into being in
the name of 'F1LCO Movement' (Filariasis Control Movement) with
the catalytic efforts of VCRC. As many as 83 organizations
with a membership of about 16,000 have been amalgamated
under the banner of this Movement. Now it is a registered
body under the "Charitable Societies Act, 1955". The movement
recognized filariasis
than a
as a social
problem in
Shertallai,
disease. Its primary objective is to organize
rather
filariasis
control activities in Shertallai taluk. Such a mass movement
for the control of a disease is probably only one of its kind
in India.
Student's Movement:
It is well known that health and development are inseparable
and they begin with children.
The maximum potential for
physical, mental and spiritual development vests in children
when compared to adults, with whom it reached a
To orient the people towards
necessary to incorporate health
static stage.
health consciousness, it is
education in the school and
curriculum. Health education carried out in all the
Educational Institutions of the area helped in creating a sense
college
of responsibility among
control
programmes
them, to actively participate in vector
and resulted
in the
birth
of 'Students'
Filariasis Control Clubs' [SFCC], which at present have a
membership of over 3,000 volunteers from 30 secondary schools.
-5-
TECHNOLOGY TRANSFER TO THE COMMUNITY
The
extent
technology
of
a period of time
is
transfer
the real
to the
community
over
of
progress of
the
measure
programme. The newer strategies developed by the VCRC
through the known technologies against filariasis were simple
and
acceptable
to the
community and therefore, they
gradually .absorbed these strategies into the main stream of
their day to day life.
a)
Bankable scheme for Fish Culture:
Convinced
by the
multifarious
the National Bank for
[NABARD] has brought
gains
of
the
fish
culture,
Agriculture and
Rural Development
this scheme under the purview of
their activities. The total financial
outlay sanctioned
for the
scheme in the first phase [1989-90 and 1990-91] is Rs. 57.5
lakhs. The expected total financial
return to the community
will be to the tune of Rs. 1.9 crores
when this scheme
is extended to the entire taluk. A situation has been created
where the community can take care of fish culture, with
the assistance of Banks, which eased off the burden on VCRC.
b)
Vector Control linked with Agricultural
Development Programme:
The green manure
in a village,
Village
programme
was successfully
demonstrated
(Population: 2,500) under 'Sunhemp
a collaborative venture of Krishi Bhavan, the
Ponnittuseri
Project',
VCRC and Farmer's Club, a voluntary organization of farmers of
the area, towards 'Complete Coconut Care Programme' under
taken by the Agricultural Development Agencies. Through this
programme, the villagers were ensured of a better alternative
green manure for agriculture, while they got rid of the noxious
aquatic weeds. Further, the enhanced coconut yield is estimated
to fetch an increased
community.
profit
of Rs.
-6-
10 lakhs per year, for the
c)
Fiiariasis Detection and Treatment Centres (FDTC):
The parasitological screening and subsequent treatment of 'mf'
positive cases, hitherto carried out by the Governmental agencies
are now extended to ordinary motivated citizens from voluntary
organizations. Volunteers possessing middle level education
were given intensive training on these lines, which enabled
them to open FDTC in their respective villages. There are 75
such centres right now spread over to the entire taluk, actively
engaged in this programme. As many as 20,042 blood smears
were collected by these centres. 209 persons detected positive
for microfilaraemia, were given treatment with a course of DEC.
d)
Low Dose DEC-Mass Drug Administration-
"BY THE PEOPLE FOR THE PEOPLE”:
Community volunteers who are readily acceptable to the local
public were identified through the member organizations of
FILCO Movement. They were given a thorough orientation in DEC
administration, which not only helped the people to realise
the importance of chemotherapy but also to accept and involve
themselves actively in the modified programme of action - "BY
THE PEOPLE FOR THE PEOPLE". Towards this venture 103
volunteers were engaged in giving Mass Drug Therapy of Low
Dose DEC in a highly endemic locality (Mararikulam, Population:
7,507) of Shertallai, as a prophylactic measure.
EVALUATION AND FEEDBACK
The
ultimate
aim of a vector
borne
disease
control
programme
is
the
liquidation
of
parasitaemia
in
the
population and a reduction of the vector population to the
tolerable limits. Hence, the efficacy of the control activities
was constantly monitored employing standard techniques and
the shortcomings, if any, were rectified. A survey of the
pre-primary and primary school children in the age group
of 0-10 years before and after launching the control opera
tions showed a reduction in the incidence of the disease
[2.47% to 1.17%]. The impact of intensive chemotherapy was
evidenced by the reduction of microfilaraemia by 79.14%.
J.
and-/-
* <
S
U
The effectiveness of
weed/vector
control
was
reflected
in the drastic reduction of man-vector contact [MBR] from
137 to 18.45. The infection and infectivity of the vector
mosquitoes were also brought down from 7.5% and 2.7% to
0.99% and 0 respectively.
ONGOING RESEARCH PROGRAMMES
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"
-
-
-
-
-
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Influence of biotic and abiotic factors on the breeding
habits of Mansonioides mosquitoes.
Ecology and Bionomics of Mansonioides mosquitoes, viz.,
Mansonia annulifera, M. uniformis and Af. Indiana, the vectors
of Malayan filariasis,.
Population
dynamics of the
vectors - fecundity - immature
duration/survival - gonotrophic cycles
parity status - adult
survival-net reproduction rate [Ro]-finite rate of increase etc.
Transmission potential of Mansonioides - Risk of Infection
Index (De Meillon) - Annual Transmission Index (Baye and
Gurian)-Annual Transmission Potential- Critical density etc.
Feasibility studies on the use of biocontrol agents and
Insect Growth Regulators against immatures of Mansonioides
mosquitoes.
Studies on the culture and biology of Osphronemus goramy,
an endangered phytophagus fish.
Evaluation
of the larvivorous potential
of fresh water
fishes both in laboratory and under simulated field conditions.
Feeding behaviour and food preference of fishes of public
health importance.
Development of a rating system for the selection of
appropriate fishes for Mansonioides control.
Pattern of change in Infection and Disease prevalence.
Post treatment observations on the acute and lymphoedema
cases.
Longitudinal studies on microfilaria carriers and lymphoedema
cases.
Rationale on the use of DEC against filariasis.
Clinical spectrum of Malayan filariasis.
Socio-economic factors influencing the persistence and
control of Malayan filariasis.
Impact of Health Education and the role of community on
a self-help basis in filariasis control programmes.
-8-
SCIENTIFIC STAFFING OF THE PROJECT
P. K. Rajagopalan,
M.Sc., Ph.D., M.P.H. (Calif.), F. I. Biol.
Principal Investigator
Dr.
Dr. K. N. Panicker, M.Sc., Ph.D.
Project ■ in-charge
Dr. S. Sabesan, M.Sc., Ph.D.
Officer-in-charge
Entomology
Mr. N. Pradeep Kumar, M.Sc.
Mr. G. Rajendran, M.Sc.
Mr. D. Thavaselvam, M.Sc.
Epidemiology
Dr.
K. Krishnamoorthy, M.Sc., Ph.D.
Dr.
Dr.
Prathibha Jayasimhan, B.Sc., M.B.,B.S.
R. Radhakrishnan, M.B., B.S.
Mrs. Abidha, M.Sc., M. Phil.
Ichthyology
Ms. M. Jayasree, M.Sc.
Mr. K. M. Kuriakose
Sociology
Mrs. B. Nandha, M.S.W.
Mrs. Ambili Kumar, M.A.
Mrs. A. Krishnakumari, M.A.
Mrs. K. S. Snehalatha, M.A.
Mr.
31-12-1989
K. Govindan, B.Sc.
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