Race on for zero filariasis by 2027

-new strategies in place

A patient who is infected with lymphatic filariasis.

It is a race to zero as the Ministry of Public Health and the Pan American Health Organisation have set a goal of eliminating lymphatic filariasis in Guyana by the year 2027.

As part of an aggressive five-year strategy, the two agencies  through a mass drug administration (MDA) porgramme are distributing filaria-eliminating drugs Albendazole and Diethylcarbamazine citrate (DEC) to citizens across the country.  The drugs, according to the World Health Organization are deemed to be the safest  and are the best approach to combating lymphatic filariasis.

The campaign, which began in October and concludes this month, targets Regions Three, Four, Five and Ten, and the response to it has been positive. To achieve complete elimination of this neglected tropical disease, Dr. Alexander Jean, a Malaria Control Specialist at the Pan American Health Organisation (PAHO) said, every year at least 65 per cent of the population would have to receive the drug in order for complete elimination to be achieved.

Guyana had signed on to the Millennium Development Goal to eradicate this disease by 2020, but that objective can no longer be achieved since the entire campaign has been re-evaluated and a new approach is being taken.

A patient who suffers from lymphatic filariasis.

Apart from this latest robust MDA campaign, in 2003, the DEC salt campaign, which is well known in households across the country, was launched. However, the success of that campaign is unknown since it was never evaluated. Hence, it is difficult to say if persons were actually using the DEC salt, Dr. Jean said. According to him, the mass drug distribution campaign was started in 2009, but after not seeing the results which they had expected, the entire campaign was re-evaluated and relaunched.

According to Dr. Jean, a successful campaign depends on the nation’s consumption of the pills, since it is deemed the safest way. During an interview with Stabroek News he indicated that this year’s responses have been promising since persons are willingly accepting the dosage of pills.

“There is a positive response, while I was in Region Five and the response I have seen is really encouraging and the reports on the target is that we are getting even more. We have more than 20,000 persons receiving the pills in the first three days,” he noted.

Vector Control personnel at the Ministry of Public Health and the pill distributors in the MDA can testify to the positive response from citizens. However, it was noted by all parties that some persons are reluctant to consume the pills.

“We have persons who are kind of hesitant to taking the pills, but once we educate them and answer their questions they give the consent,” a pill distributor said.

The distributor, who was sharing pills in Herstelling, East Bank Demerara at the time, explained that she believes the consumption of the pills has to do with education and sensitization.

As part of the robust campaign, daily advertisements with information and facts on the vector-borne disease have been placed in the newspapers and broadcast on radio and television.  The health worker believes that the sensitization played an important role in citizens being open to accepting the pills.

She explained that at schools where they shared the pills, the majority of parents gave their consent for their child or children to accept the pills. Parents were presented with a brochure informing them of the campaign and with answers to questions that they might have had.

‘Big Foot’

According to Dr. Jean it is important that persons take the pills since prevention is the only way one can be saved from filaria, commonly known as Elephantiasis or ‘Big Foot’. Lymphatic filariasis infection occurs when filarial parasites are transmitted to humans through mosquitoes. Infection is usually acquired in childhood causing hidden damage to the lymphatic system according to the World Health Organization (WHO).

The WHO website states that lymphatic filariasis is caused by infection with parasites classified as nematodes (roundworms) of the family Filariodidea. There are three species of these thread-like filarial worms; Wuchereria bancrofti, Brugia malayi, and Brugia timori.

Persons suffer from painful and profoundly disfiguring visible manifestations of the disease, lymphoedema, as elephantiasis and scrotal swelling occur later in life and can lead to permanent disability. These patients are not only physically disabled, but suffer mental, social and financial losses, contributing to stigma and poverty, according to the WHO website.

Dr. Jean stated that the filaria worms are parasites gorging on the body and should not be there. Over the years, the parasite “is small but can grow so big, that it can just blow up your system. What will happen, in the initial stage the parasite is small and it is in your body and it gets aggressive because it does not adapt well to your body, but when you get filaria for the first your body just adapts to it, and it multiplies and stays there. When it starts to grow it will be break into your systems.”

He stressed that persons  “infected would develop mild fever but most wouldn’t even know they are infected,” since the diseases takes up to 20 years to show up. He stressed that “when the symptoms are seen there is nothing the infected person can do. But if you kill the parasite it would stay there broken, that’s why the main concern for filaria is prevention,” he pointed out.

He noted that the only help available for men who suffer from elephantiasis are those who have hydrocele. “For hydrocele, you can do a surgery but most people do not develop that,” he said, noting that, “when you develop elephantiasis there is nothing you can do but care the foot until the end.”

He added that while persons are concerned over the drug, it is the safest kind to use.

“The pills are the safest it is a candy you can chew it… some people say when they use the DEC which kills the parasites, and your body starts to react with the chemicals you feel kind of sick and people think it is an allergic reaction but people sometimes get it wrong. What actually happens is the parasites when killed cause these reactions and it is good because it is getting rid of the disease.”

But despite this, many persons have expressed concerns over the drug, as some persons reportedly fainted. According to Dr. Jean, some persons also experience diarrhoea, vomiting, and feeling nauseated.

Clinic

In Guyana, over one hundred infected persons are registered at the clinic which is located at the Vector Control Unit at the Georgetown Public Hospital compound, New Market Street, Georgetown.

Filaria Clinics are held on Tuesdays where patients from around the country are seen by a doctor. At the clinic, patients’ feet are cleaned and treated. In some cases they would receive massages to help with the aches.

According to Nurse Cheryl Hopkinson, on clinic days they would see approximately 43 patients. In addition, she pointed out that on average, they would notice a new patient once every three months.

Free testing is done on weeknights, Mondays, Wednesdays and Fridays, from 7pm.  The nurse explained that testing needs to be done in the night, as this is the time when the worms would show up. Persons who are tested receive their results within 15 minutes. Hopkinson said that they are noticing more persons coming for testing.

“I think they are more educated now, and aware of the dangers of filaria, so they are not taking a risk and they are coming and getting tested,” Hopkinson opined.

Dexter, (not his real name), a patient at the clinic said he discovered that he was infected approximately ten years ago. He related that at the time of his discovery he was working as a security guard and his foot would be swollen. “The foot used to swell, and I would drink bush and that carry it down and after a period it comes up again…,” he recalled.

He explained that after the swelling kept returning, he sought medical attention and took the filaria test.  “I took the test and it came back positive and I immediately started the clinic,” he related.

Since he joined the clinic he said that he hasn’t experienced severe pains as the medications given to him helps to reduce the pain and swelling. He noted that he hasn’t suffered any major breakouts, but he would still experience itching occasionally.

Questioned if his life changed after discovering that he was infected, he responded in the negative and explained that  he plants a kitchen garden and is still able to support his family. He nevertheless said that he had to give up playing football, a sport he loved.

My life hasn’t really changed I have decided that I wouldn’t waste my life… I have a small business at home… I have a kitchen garden at home… It has helped me over the years…,” he said contentedly.

Addressing the stigma which comes with the illness, Dexter said “they try to call me ‘Big Foot’ and all kinds a thing but I don’t hear what I don’t want to hear. It didn’t stress me out, I was a no nonsense person and I ignored them. I didn’t take them on.” He suggested persons suffering from stigma should take his approach since they would be able to accept the realty and move on.

“They say prevention is always better than cure… if people don’t want accept the pills it would be on them they would have to bear the blame if they become infected,” he opined, when asked if he thinks persons should consume the pills.

Schools

As a part of the Prevention and Elimination campaign, schools have been targeted since they present a larger population which can help with a successful campaign. The new approach was taken since the house-to-house method was not as successful as health officials would have wished.

“We used to use households, but for some years we haven’t been getting the target we were hoping to achieve. We have to get 65 per cent of the population to have received the tablets. Last year when the evaluation was done, supported by PAHO, we realize that we should consider other strategies,” Dr. Jean explained.

He said with the new approach they are targeting popular areas where people would be, such as markets, religious centres, schools, work places and “try to get as many of those persons then we will use the house-to-house administration as the last resort,” Dr. Jean explained “In Georgetown we have a lot in one place, and if we target the work places we would get a good set of the population, but in Region Five where there are hardly any work places the best strategy is to go to the homes. These are the changes we are making, in order to get to the population.”

Persons in areas that are not targeted but would like to receive the pills can visit any of their Health Centres and request the pills. The pills, Dr. Jean said during the campaign, would be available at every Health Centre in the country.

Apart from the schools enabling access to a much larger population, Dr. Jean said that the children are really important since if they can administer the pills to children they would be able to prevent a case of elephantiasis.  Persons are expected to take the pills in front of the health care worker distributing the pill.

Based on the last study which was done in the early 2000’s, Dr. Jean stated that it showed that 9.8 per cent of the population is affected by lymphatic filariasis. According to him, in order to eliminate the neglected tropical disease, the number of persons living with lymphatic filariasis has to be below one per cent.  However, he said that in the study, it showed that Region One, Barima/Waini had recorded 0.8 per cent of their population living with the sickness, while in Region Four, Mahaica/Mahaicony, a higher number of persons were infected with the parasite which can cause Elephantiasis, making it a concern and one of the target areas in this campaign.

“Our most concerned region is Region Four, where 30 per cent of the population is infected, because this shows that a lot of persons are infected.” He added that because of the country’s population, 9.8 per cent is very alarming because we need to get it under one per cent.

He added that in 2018, they are looking to carry out a new study to assess the population of persons infected with lymphatic filariasis. “We are looking to carry out a new mapping. The Chief Medical Officer, Dr. Shamdeo Persaud is supporting the idea and he was the key person in the previous study and he understands the needs to do a re-assessment, for many reasons,” said Jean.

Meanwhile, Director of PAHO, Dr. William Adu-Krow said that eliminating the disease would be of great significance to the country and PAHO.  If Guyana achieves certification of being filaria free in 2027, it would make the country the fourth territory in the Latin American Region to achieve this goal.

“Guyana has signed on to eliminating neglected tropical diseases by 2020, but obviously, we are not going to do that, and with this aggressive campaign if we continue for five good years here, we are looking at 2022, the verification,” he pointed out, while explaining that the post verification exercise such as mapping and a re-verification, with the plan that we have now that would take us to 2027 and that is where we could probably be certified as filaria free.”

In Latin America Region, Dr. Adu-Krow said Guyana is among four countries working to eliminate filariasis. Lymphatic filariasis is still prevalent in Haiti, Dominican Republic and neighbouring Brazil.

The Pan American Health Organization has reported that in 2011 Suriname and Trinidad and Tobago were declared as filaria free.

A patient who is infected with lymphatic filariasis.

Saved in pictures as Filaria1

Saved as Filaria 2 in pictures

A patient who suffers from lymphatic filariasis.

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