Impact of mass drug administration on elimination of lymphatic filariasis in Surat city, India.

Lymphatic filariasis (LF) is one of the major public health problems in some of the endemic districts in India including Surat city of Gujarat province. Historical data reveals that in 1960s, Surat city had infection rate of about 23% and infectivity rate of 1.6%. Since then, Surat city has been reporting the cases of Lymphoedema and hydrocele. Filaria Control Unit was established under National Filaria Control Programme to detect and provide treatment to the cases. Based on the reports of NFCP, Surat City has been considered as LF endemic. During 2004, the country launched campaign of Elimination of Lymphatic Filariasis through Mass Drug Administration (MDA) with annual single dose of 6 mg/kg body weight of DEC tablets in all LF endemic districts including Surat city. Four rounds of MDA (2004-2007) had shown 41% reduction in mf rate, with drastic reduction in infection rate of 88% and 100% in infectivity rate. Serious adverse effect (SAE) after 4th round of MDA was insignificant (< 0.5%) during 2007. An assessment by surveying 5058 people in different parts of Surat city revealed the drug distribution coverage of more than 95% but actual drug compliance between 70-90%. Analysis of the data revealed that though the overall Microfilaria rate has been reduced due to MDA, higher Microfilaria rate was noticed in North zone of city where the migrant populations influx is higher. The observation and analysis of the data in Surat city towards elimination of Lymphatic filariasis has been discussed in this paper.

The neglected role of relative humidity in the interannual variability of urban malaria in Indian cities.

The rapid pace of urbanization makes it imperative that we better understand the influence of climate forcing on urban malaria transmission. Despite extensive study of temperature effects in vector-borne infections in general, consideration of relative humidity remains limited. With process-based dynamical models informed by almost two decades of monthly surveillance data, we address the role of relative humidity in the interannual variability of epidemic malaria in two semi-arid cities of India. We show a strong and significant effect of humidity during the pre-transmission season on malaria burden in coastal Surat and more arid inland Ahmedabad. Simulations of the climate-driven transmission model with the MLE (Maximum Likelihood Estimates) of the parameters retrospectively capture the observed variability of disease incidence, and also prospectively predict that of 'out-of-fit' cases in more recent years, with high accuracy. Our findings indicate that relative humidity is a critical factor in the spread of urban malaria and potentially other vector-borne epidemics, and that climate change and lack of hydrological planning in cities might jeopardize malaria elimination efforts.

Independent assessment of Mass Drug Administration in filariasis affected Surat city.

The Mass Drug Administration (MDA) done in Surat city (Gujarat) during 2005, revealed good impact on infection and infectivity in mosquitoes and also on microfilaria rate & mean infection density. The overall impact seen was 23% on mf rate, 28% on mean mf density, 65% on infection rate and 50% on infectivity rate in vectors. Indigenous population contribution to microfilaria cases was 9.7%, whereas migratory population contributed 72.2%; predominant 51.9% from Orissa and 20.3% from U.P. Of the total 3640 persons interviewed for MDA compliance in seven zones of the Surat city revealed that actual drug consumption was 76.7% (2792/3640). Another 11.9% although took the drug but did not consume and 11.4% refused. Important reasons for consuming was fear to get the disease (40.7%) and for not consuming; 'will consume after meal' (6.9%), too many tablets (1.7%), seek consent from doctor (1.5%), lack of awareness (1.4%) etc. Refusal was mainly due to the reason as respondents felt apparently healthy. Assessment of IEC activities suggested that main awareness was created by media (local or national TV, banners or handbills, local news papers or mike announcement) alongwith some impact made through NGO's. These observations clearly indicated the utility of effective health education for optimum community participation and shown that it was crucial for successful community based elimination campaign. However some gray areas also suggest the scope for further improvements.

Field evaluation of biolarvicides in Surat city, India.

BACKGROUND & OBJECTIVES: Two bacterial larvicide (bio-larvicide) formulations--Bacticide and VectoBac containing viable endospores and delta endotoxin of Bacillus thuringiensis var israelensis H-14 were evaluated in 2001 for their mosquito larvicidal efficacy under the operational conditions of urban malaria control programme in Surat city, India. METHODS: Larvicides were applied at the recommended dose in selected breeding habitats of Anopheles (An. stephensi), Aedes (Ae. aegypti) and Culex (Cx. quinquefasciatus) and reductions in the densities of III and IV instars were compared with that of untreated matched controls. RESULTS: At the construction sites in cemented tanks/chambers VectoBac produced reduction in the density of III and IV instar larvae of An. stephensi (98-100%) and Ae. aegypti (100%) in the first week of application whereas Bacticide produced 71-100% reduction in An. stephensi and 100% in Ae. aegypti. Re-application of VectoBac on Day 10 caused better control up to Day 20 when compared with Bacticide. In stagnant water pools, VectoBac produced 27.6-85.3% reduction in the larvae of An. subpictus and 18.5-83.8% in those of Cx. quinquefasciatus whereas Bacticide produced 23.3-30.3% and 39-97.2% reduction in An. subpictus and Cx. quinquefasciatus larval densities in the first week post application, respectively. Bacticide application gave better impact on Cx. quinquefasciatus larvae in the second week after re-application as compared to VectoBac. In storm water drains, VectoBac caused respectively 6.2-100% and 6.4-97.6% reduction in An. subpictus and Cx. quinquefasciatus larvae in the first week of application whereas Bacticide produced 100% and 13.3-98.8% reduction in An. subpictus and Cx. quinquefasciatus larval densities, respectively. INTERPRETATION & CONCLUSION: Both the formulations were equally effective on An. subpictus and Cx. quinquefasciatus larvae after a second application. The results showed that application of these biolarvicides would be required at 7-10 day intervals. The health workers engaged in the application of biolarvicides reported a better ease of handling and application of the liquid formulation (VectoBac) than the wettable powder formulation (Bacticide).