Filaria and the community-based drive to mass distribute drugs

By Jarryl Bryan

At the age of 76, Brenda Fox lives with a chronic case of Lymphatic filariasis. She still moves about, but aided by a walker. And on occasions when the pain becomes unbearable, Mrs Fox is sometimes left bed ridden in hospital.
Fox, who resides in Werk-en-Rust, Georgetown, does not remember the exact circumstances under which she first contracted the disease. But it only takes one fateful bite from a mosquito carrying any one of three varieties of nematode worms in order to transmit it; and as such, she knows the importance of prevention.
“Every day I gotta take tablets. It’s just something that happened. I had a lot of pain, went in hospital, come out, all of that. But I use to work (until) I get fever and I fell sick. Then afterwards I start getting (swollen lymph nodes) and the foot (started) paining,” she related.

Mrs Fox noted that her persistent illness raised a number of questions in her mind and tests later confirmed exactly what she had. It goes by forbidding names such as Elephantiasis or “big foot”. But essentially, Mrs Fox was diagnosed with Lymphatic filariasis.
She credits her husband, as well as her son and primary caregiver Brian Fox, for her life being as undisrupted as possible. Brian noted that while his mother’s filariasis has been exacerbated by a stroke, her infection is not the end of the road, as she still maintains a certain level of mobility.

Global phenomenon

According to information from the World Health Organisation (WHO), the disease is caused by three species of thread-like nematode worms, known as filariae – Wuchereria bancrofti, Brugia malayi and Brugia timori. Male worms range from three to four centimetres in length, and female worms eight to10 centimetres.
The worms target the lymphatic system, which is an essential component of the body’s immune system as they are essentially a network of nodes and vessels that maintain the delicate fluid balance between blood and body tissues. But when someone is infected, the male and female worms form “nests” together in this vital system.
Filarial infection can cause a variety of clinical manifestations, including lymphoedema of the limbs, genital disease (hydrocele, chylocele, and swelling of the scrotum and genitals) and recurrent acute attacks, which are extremely painful and are accompanied by fever – a symptom mentioned by Mrs Fox.
The majority of infected people are asymptomatic (no symptoms), but virtually all of them have some kind of damage to the Lymphatic system and as many as 40 per cent can register kidney damage, with proteinuria (excess protein in the urine) and haematuria (blood in the urine).
Back in 2000, the WHO launched the Global Programme to Eliminate Lymphatic filariasis (GPELF). According to the WHO, mass treatment for Lymphatic filariasis is ongoing in 45 countries. Ten countries have not started treatment or have submitted evidence indicating treatment is not required.
But data from the Organisation also indicates that of 73 countries listed by the WHO as having endemic lymphatic filariasis, 18 countries have completed interventions and are conducting surveillance to validate elimination. China and the Republic of Korea were declared to have eliminated lymphatic filariasis as a public health problem in 2007 and 2008, respectively.
An additional 22 countries have conducted Mass Drug Administration (MDA) in all endemic areas and are described by the WHO as being on track to achieve elimination. The remaining 33 countries have not been able to achieve 100 per cent geographical coverage; 10 of these have yet to initiate preventive chemotherapy or submit evidence that MDA is not required.

In Guyana
But how exactly can one ensure they are protected? In the years gone by, the then Health Ministry laid out an aggressive drive to distribute and raise awareness about the use of diethylcarbamazine (Dec) salt.
Recently, National Coordinator of Guyana’s Elimination of Lymphatic filariasis Campaign, Dr Fabu Moses had said that there were hiccups with administering the ‘Dec salt’ programme. According to her, mapping showed that 90 per cent of the populace was at risk but keeping track of the amount of persons using ‘Dec salt’ was difficult.
The current Government has been focused on the distribution of tablets intended to insulate persons from contracting the disease. The workers attached to the campaign can be seen braving the scorching sun and sometimes the soaking rain. But they have a mandate to deliver and for the most part, they fulfil this mandate.
Guyana Times sat down for an interview with General Medical Officer, Dr Whitney Munroe, who oversees distribution activities in the district extending from Durban Street to Carifesta Avenue and is based at the South Road Clinic.
“The distribution process has been for two weeks, starting the 16th October and it ends the 29th of October. Before that, we had training sessions which extended a little while. Presently we have 42 distributors,” she related.
Dr Munroe noted that the distribution efforts have been largely successful thus far, with residents usually willing to receive their pills. The doctor attributed this to the increased awareness of the dangers of ‘big foot’, buoyed by the Government sponsored advertisements. She also went into details about exactly what medication residents are receiving.
“The campaign is about filariasis. Presently in Guyana, we are using two tablets; albendazole and diethylcarbamazine. Depending on the age range, different amounts (are distributed). So what we are basically doing, we are attacking the worm that causes filaria,” She stated.
“Wuchereria bancrofti (worm) is the main one that affects the Guyanese populace. And that is the worm we are attacking. This year, the distributors will be moving in different locations for approximately two weeks.”
Dr Munroe noted that while the campaign of roving pill distributors will end today, distributors will be at fixed locations such as health centres to ensure that everyone is given a chance. This extension will last until November 9.
“Our target for this location is approximately 38,800. And thus far, we have captured 75 per cent of that. So we are doing well thus far (and) despite some shortcomings, we are pressing on,” Dr Munroe said.