Community's knowledge and perceptions about filarial elephantiasis and hydrocele in coastal Orissa, India.

This study assesses people's knowledge and perceptions on transmission, prevention and eradication of elephantiasis and hydrocele, common manifestations of chronic lymphatic filariasis (LF). The assessment was done during mass drug administration (MDA) of the programme to eliminate LF in the State of Orissa, India. A household survey with pre-tested interview questionnaire was conducted in four LF endemic districts of Orissa state, India, where the MDA has been taken place. The sampling units (clusters of households) of the household survey are taken based on (1) urban/rural and (2) type of or absence of health facility. A total of 1,448 respondents were selected randomly. Majority of the respondents heard about elephantiasis and hydrocele. About one third of them know that mosquito bite is the cause of elephantiasis but very few people know about hydrocele. Around 50% of the respondent believed that elephantiasis could be cured completely, while almost 60% said that it could be totally removed from the community. But for hydrocele, more than 80% of respondents showed a positive approach for cure and nearly about 70% said that hydrocele could totally be eradicated from community. Various causes and methods of cure and prevention were suggested. Around 55% of respondents suggested that elephantiasis can be eradicated by taking medicine, but only 40% felt that hydrocele can be cured by taking medicine. Basic knowledge on LF is poor and relatively low proportion of people knows that LF can be eliminated by taking medicine. As there are plans to undertake further rounds of MDA in Orissa, people's knowledge has to be strengthened and perception and attitudes have to be addressed to achieve positive behavioural change, which eventually lead to higher compliance of MDA.

Use of the Dermatology Life Quality Index in filarial lymphoedema patients.

The global programme to eliminate lymphatic filariasis has alleviation of suffering and disability as one of its components, and many efforts are being taken across the globe in this direction. However, there is no effective tool to assess the impact of these efforts on patients' quality of life and/or lessening of disability and suffering. The present paper reports the use of the Dermatology Life Quality Index (DLQI) in filarial lymphoedema patients. DLQI scores were collected from 203 patients recruited from a clinic and from the community. The DLQI score ranged from 0 to 17, and a mean score of 2.7 (SD 4.4) or 9.0% disability. This score is lower than many skin diseases reported so far. The scores for individual questions vary, but the degree of consistency of responses between questions is high. The differences between sexes, place of recruitment and grades of lymphoedema are not significant. Although the DLQI measures the quality of life due to lymphoedema, this study further warrants development of a good quality-of-life index for lymphoedema patients.

A randomized clinical trial to compare the efficacy of three treatment regimens along with footcare in the morbidity management of filarial lymphoedema.

The progression of lymphoedema to elephantiasis associated with increased incidence of episodic adeno-lymphangitis (ADL) is of great concern, as it causes physical suffering, permanent disability and economic loss to lymphatic filariasis patients. This randomized clinical trial aimed to assess the efficacy in terms of reduction of oedema and ADL frequency of three treatment regimens among lymphoedema patients from Orissa, India. The regimens were: (I) oral penicillin--one tablet of 800 000 U penicillin G potassium twice daily for 12 days--repeated every 3 months for 1 year; (II) diethylcarbamazine--6 mg/kg bodyweight for 12 days-repeated every 3 months for 1 year; and (III) topical antiseptic, i.e. betadine ointment. Foot care was part of all regimens. All three drug regimens are efficacious in reducing oedema and frequency of ADL episodes. Although the efficacy was slightly higher in regimen I, the difference was not significant. About half of all patients had reduced oedema after the 90 days of treatment, with oedema reduction of 75-100% in 20%. A major proportion of the remaining patients had oedema reduced by less than 25%. The proportion of people whose oedema reduced was slightly but not significantly lower in regimen II. anova revealed that lymphoedema reduction varied according to grade; being greatest at grade 1 lymphoedema, followed by grade 2. All three regimens significantly reduced ADL frequency after 1 year of treatment. This may be because of foot care as well as use of antibiotics. The estimated costs of treatment per patient for a period of 3 months are US$2.4, 1.5 and 4.0 respectively for regimen I, II and III. Thus affordable treatments with simple antibiotics and foot care can give substantial relief to the patients and reverse early lymphoedema.

Treatment costs and work time loss due to episodic adenolymphangitis in lymphatic filariasis patients in rural communities of Orissa, India.

OBJECTIVE: To determine the economic loss in terms of treatment costs and loss of productive time because of acute episodes of adenolymphangitis (ADL) caused by lymphatic filariasis (LF) in a rural population of coastal Orissa, India. METHODS: Data on expenditure on treatment and loss of work along with other epidemiological information were collected through a 1-year surveillance of 113 acute episodes of ADL from 72 individuals of the study population (5.42%). The activity patterns of patients for 24 h of one episode were documented, and data on age- and sex-matched controls were also collected. Standardized Z-test, paired t-test, logistic and multiple regressions were used. RESULTS: Those patients who did incur expenses spent Indian Rupees 92 on average (approximately US$ 1.85) on each episode. The ADL episodes curtailed the productive activity of patients. Patients (88%) were unable to attend to any economic activity compared with 47% of controls who had no history of disease. Similarly during 55% of episodes, females (vs. 8% of controls) could not attend to any domestic work. The mean number of hours spent on economic or domestic activities was significantly lower among patients. Disease status and sex had significant influence on total absenteeism from gainful employment; and similarly, age, family type and disease status influenced total domestic work hours among women. CONCLUSIONS: The results demonstrate the extent of the economic burden caused by acute LF and provide justification for strengthening the ongoing LF elimination programme.

The economic loss due to treatment costs and work loss to individuals with chronic lymphatic filariasis in rural communities of Orissa, India.

This paper is based on 1 year round case control study to investigate the economic burden, in terms of treatment costs and loss of work to people affected with chronic lymphatic filariasis in rural communities of Orissa, Eastern India. Around three-fourths of the chronic patients have sought treatment for their condition and spent, on average an amount of INR 396 (approximately US$ 8.7) per year. The major component of the expenditure is the cost of medicines. The data on loss of work time due to chronic condition reveal that the total absenteeism to the work is significantly higher among chronic filariasis patients than controls. The total number of working hours spent per day by patients and controls are 4.94 and 6.06, respectively with a significant difference. The total absenteeism and the total number of working hours per day are influenced significantly by disease condition and other personal characteristics, namely age, sex and family type. The chronic patients lose a total of 68 days of work per year, which is equivalent to 19% of the total working time of the year. The present results show that the chronic conditions of lymphatic filariasis pose considerable burden on the patient, family and community.

Lymphatic filariasis in Khurda district of Orissa, India: an epidemiological study.

A cross-sectional survey was undertaken to determine the prevalence of disease due to lymphatic filariasis in Khurda district of Orissa, India. The total disease attributable to filariasis was significantly higher in males (14.79%) than females (10.04%). However, elephantiasis is more prevalent in females, and adenolymphangitis is more prevalent in males than their counterparts. The prevalences of various forms of the disease are age dependent in both sexes. About one-seventh of men and women of higher age groups suffered from chronic debilitation forms of the disease. The study suggests that overt clinical forms of lymphatic filariasis constitute a major public health problem in the study area.