A. S. Kerketta

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

Use of an inclusive-partnership strategy in urban areas of Orissa, India, to increase compliance in a mass drug administration for the control of lymphatic filariasis

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.

Health status of the elderly population among four primitive tribes of Orissa, India: A clinico-epidemiological study

Abstract In India, the programme to eliminate lymphatic filariasis, which is largely based on mass administrations of diethylcarbamazine, has, in terms of coverage and compliance, been generally much less successful in urban areas than in rural communities. An innovative strategy to make the programme more effective in urban settings, largely based on an inclusive partnership and community participation, has recently been developed. An evaluation of the strategys implementation in Orissa, which employed both quantitative and qualitative methods of data collection, revealed significantly higher coverage and compliance in an urban area where the strategy had been implemented than in a similar urban area where there had been no such intervention. Application of this strategy in other urban settings in general, and in small towns in particular, is recommended in India.

Clinicians' attitude on mass drug administration under the program to eliminate lymphatic filariasis: a qualitative study from Orissa, India.

Primitive tribal groups (PTGs) are the most marginalised and vulnerable communities in India. Clinico-epidemiological studies on morbidity patterns among the elderly primitive tribe members are essential to recommend special intervention programmes to improve the health of the elderly in these communities. A community-based cross-sectional study was carried out among the elderly populations of four different PTGs, namely Langia Saora (LS), Paudi Bhuiyan (PB), Kutia Kondh (KK) and Dongria Kondh (DK) living in the forests of Orissa, India. Clinical and anthropometric data were collected using standard methods and haemoglobin was estimated by the cyanomethaemoglobin method. The average number of illnesses per person was 3.0. Common disabilities like vision and hearing impairment and mobility-related problems were found in considerable numbers. Gastrointestinal problems like acid peptic disease were found among 2.6% to 20% of cases. Non-specific fever was marked in 10.2% to 24.2% of individuals. The iodine deficiency disorder, namely goitre, was found among 4.2% to 6.0% of individuals. Diseases of the respiratory tract, like upper and lower respiratory tract infection, asthma, tuberculosis and leprosy, were found in small numbers. The prevalence of hypertension among males and females was 31.8% and 42.2%, respectively. The LS had the highest prevalence of hypertension (63% among men and 68% among women). With regard to anaemia status, severe anaemia was marked in 70% of males and 76.7% of females in the LS, while in other groups the prevalence of severe anaemia ranged from 15% to 33%. Although the prevalence of severe anaemia in other tribal communities is lower than in the LS, mild to moderate anaemia was found to range from 60% to 80%. The present study revealed a high prevalence of physical disabilities with both non-communicable as well as communicable diseases among the elderly primitive tribal members. This warrants the implementation of a special health care strategy to reduce suffering at this crucial age and improve quality of life.

Assessment of the therapeutic efficacy of chloroquine in the treatment of uncomplicated Plasmodium falciparum malaria in a tribal block of the Kalahandi district of Orissa, India.

The global program to eliminate lymphatic filariasis (LF) is currently based on mass drug administration (MDA) with annual single dose of antifilarials. In India, the MDA is implemented by primary health centers (PHC) of the district health system. The aim of the present study was to explore the attitudes of clinicians working at PHC level in three districts of Orissa, India. The data are obtained from interviews of 50 clinicians (35 from PHCs and 15 private). Only 11 PHC clinicians and 1 private clinician opined that the elimination of LF is possible through MDA of diethylcarbamazine (DEC); and 40% PHC and 87% private clinicians strongly felt that the elimination is not feasible through MDA and that the yearly single dose of DEC was not efficacious. The remaining clinicians were unable to comment on the feasibility and efficacy of MDA. The indifferent attitudes arise from lack of knowledge or erroneous beliefs. A good understanding of the program through reorientation and rigorous training should be emphasized to make the MDA successful.The global program to eliminate lymphatic filariasis (LF) is currently based on mass drug administration (MDA) with annual single dose of antifilarials. In India, the MDA is implemented by primary health centers (PHC) of the district health system. The aim of the present study was to explore the attitudes of clinicians working at PHC level in three districts of Orissa, India. The data are obtained from interviews of 50 clinicians (35 from PHCs and 15 private). Only 11 PHC clinicians and 1 private clinician opined that the elimination of LF is possible through MDA of diethylcarbamazine (DEC); and 40% PHC and 87% private clinicians strongly felt that the elimination is not feasible through MDA and that the yearly single dose of DEC was not efficacious. The remaining clinicians were unable to comment on the feasibility and efficacy of MDA. The indifferent attitudes arise from lack of knowledge or erroneous beliefs. A good understanding of the program through reorientation and rigorous training should be emphasized to make the MDA successful.

Living conditions of internal labour migrants: a nationwide study in 13 Indian cities

SUMMARY The study on therapeutic efficacy of chloroquine was carried out in a tribal dominated block of Kalahandi district of Orissa, India. It revealed 94% treatment failure with standard dose of chloroquine in the treatment of uncomplicated P. falciparum malaria cases. The study warrants the change to alternate antimalarials in this region.

Adverse reactions following mass drug administration during the Programme to Eliminate Lymphatic Filariasis in Orissa State, India

In India, rural impoverishment and livelihood opportunities in cities result in rural-urban migration. However, migrants face myriad of challenges at destination. This paper reports living conditions of internal labour migrants living in 13 Indian cities. Quantitative data were collected from migrants, who have migrated to the city within the last ten years but not less than 30 days. Majority of migrants live in non-notified slums in katcha or semi-pucca or squatter houses. About 38% of migrants do not have access to sanitary latrine and depend on open defecation. Only 59% of households had metered electricity connection. Only 23% possess ration card while 57% have voter identification cards. Thus, migrants are deprived of basic amenities and are marginalised to access several social entitlements. Since migrants are an inalienable part of the cities, the governments should recognise them as a vulnerable group that needs targeted interventions.