Bridging the gap in outreach and compliance with mass drug administration for lymphatic filariasis elimination in an endemic district in Kerala, India: an intervention research approach.

Lymphatic filariasis (LF), a neglected tropical disease is targeted for elimination globally by 2020. National Health Policy of India set the goal by 2017 and annual single-dose mass drug administration (MDA) with anti-filarial drugs is in operation in endemic districts since 2004. Performance and effectiveness of MDA was diverse across the nation and prevalence of infection continues above threshold level in 50% of endemic districts which requires alternative strategies. National programme aims at achieving >65% consumption for transmission control. Post 10 rounds of MDA in an endemic district of Kerala state, a three-arm study identified determinants in gap in outreach and consumption, based on which context-dependent intervention using social group work and networking (SGWN) was implemented and impact assessed. A spill over effect with overall increase in coverage and consumption rates irrespective of arms apparently is due to inclusive improvement in MDA programme whereas, significant relative improvement in intervention arm reflects effectiveness of SGWN strategy. Though reduction in microfilaria prevalence in all arms was observed, it was significant between intervention and comparison arm. This study highlights need for context-dependent communication strategy to improve MDA for accelerating LF elimination by the targeted 2020.

Knowledge, attitude and practice on malaria: a study in a tribal belt of Orissa state, India with reference to use of long lasting treated mosquito nets.

Local knowledge and practice related to malaria is important for the implementation of culturally appropriate, sustainable and effective interventions. In this context, to know people's knowledge, attitude and practice on malaria and its prevention, a study was carried out in two districts viz., Malkangiri and Koraput of Orissa state in India, the former with ongoing insecticide treated mosquito nets (ITNs) programme and the latter without such programme (non-ITNs). Both qualitative and quantitative methods were used for data collection. The local concepts used for malaria describe only the biomedical symptoms of the disease although a few by meaning in local language reflect people's misconceptions about the cause of malaria. About 63% of the respondents mentioned mosquito bite as the cause for this disease and 65% considered malaria as a serious problem. Qualitative data showed that people from remote villages seek treatment from traditional healers, Disharis. About 64% of the respondents stated that avoiding mosquito bites could prevent malaria. Majority (99%) of the people reported using personal protection measures to avoid mosquito bites. Although, majority of the people were aware of the cause and prevention of malaria (about 70% stated sleeping under mosquito net prevents malaria), a sizable proportion still had misconceptions and hence appropriate communication strategies should be developed and imparted alongside ITNs/LLINs distribution for a behaviour change to adopt such preventive measures. Since, the tribes are habituated to seek treatment from traditional healers; they could be involved in motivating people to use ITNs/LLINs to protect from mosquito bites and malaria.

Acceptability, willing to purchase and use long lasting insecticide treated mosquito nets in Orissa State, India.

Long lasting insecticide treated nets (LLINs) that require no re-treatment have been advocated as an effective tool against malaria transmission. However, success of this community based intervention measure largely depends on its acceptability and proper usage by the target population, besides assuring access to bed nets. To determine the acceptability of LLIN, its usage and people's willingness to buy the net, a study was conducted in two tribal districts viz., Malkangiri (with ongoing ITN programme) and Koraput (no ITN programme) of Orissa State, India. Both qualitative and quantitative data collection methods were used to collect information regarding the objective of the study. A total of 2457 LLINs (Olyset Nets) were distributed in the selected villages of these districts at free of cost. In the study villages of Malkangiri, 58% of the households had either ITNs (73%) or other types of mosquito nets aside from the LLINs and in the villages of Koraput, only 8% had other nets, as majority (96%) informed that buying nets from market was not affordable to them. Physical verification of the nets during the house visits revealed that 75.4% and 83% (in ITNs and non-ITNs villages, respectively) of the LLINs and 76% of the other nets (including ITNs) were used by the respondents, the night before the survey as nets were in a hanging position at the time of the visit. Majority of the respondents (76-98%) felt that reduction of mosquito bites as the main perceived benefit of using the LLINs. About 55% and 67% of the respondents from non-ITNs and ITNs areas, respectively, expressed their willingness to buy the LLINs. Among them, 76.8% and 94.7% offered to pay INR<100 for a net and also ready to buy it by cash payment. Social marketing of LLINs at a subsidized price or free supply to the deserving sections of people (socially/economically poor and/or under-privileged) and ensuring the availability of nets during harvesting season could encourage people to buy and use LLINs.

Mattancherry urban agglomeration, a diminishing focus of lymphatic filariasis in Kerala.

Parasitological survey conducted recently in Mattancherry, Kerala showed a low prevalence of microfilariae (mf), with a mf rate of 1.81%, compared to that of 1956 when the mf rate was 14.7%. No brugian infection was encountered in the present investigation, though both bancroftian and brugian infections were reported earlier. Culex quinquefasciatus, the vector of bancroftian filariasis was the most predominant (93.3%) mosquito species, and its infection and infectivity rates were 0.76% and 0.54% respectively. Mansonioides spp., the vectors of brugian filariasis constituted only 0.2% of the total mosquitoes and with no infection. The overall reduction in the prevalence of mf cases and vector infection rates over the years is attributed to the continued activities of the National Filaria Control Programme. The disappearance of brugian filariasis could mainly be due to the drastic reduction in the Mansonioides breeding habitats, as a result of rapid urbanization coupled with improved socio economic conditions.