– success attributed to multi-sectoral approach

GUYANA has finally managed to ‘meet the mark’ for Filaria coverage through the first round of its Mass Drug Administration (MDA) Campaign by recording a whopping 86 per cent coverage in four regions.

National Coordinator for the Elimination of Lymphatic Filariasis Campaign, Dr. Fabu Moses, revealed this information during her presentation of the 2017 MDA report on Friday at the Ramada Princess Hotel.

According to her, “This [2017] was a very significant year for the programme.” It was significant because, as she explained, the 86 per cent coverage signals the first time that the country has managed to “meet the mark” for filaria prevention.

The MDA was conducted in Regions Three, Four, Five and 10, where approximately 509,165 persons — ranging from preschool-aged children to adults — have received their Diethylcarbamazine Citrate (DEC) and Albendazole (ALB) pills which are responsible for eradicating the bacteria.

Though the disease is not curable and its visible manifestations are irreversible, these pills can help with the prevention of Lymphatic Filariasis (LF) or as it is commonly called ‘Filaria’. LF affects the body’s lymphatic system, which functions to remove unwanted fluids from the body and transports ‘lymph’– a fluid which contains white blood cells that help to fight infections.

The World Health Organisation (WHO) states that this disease is caused by infection with parasitic worms called nematodes, classified as ‘filarial worms.’ In Guyana, the disease is caused by the wuchereria bancrofi worm and spread by the culex mosquito.

To eliminate the disease, the WHO states that the MDA must be run for at least five years (referred to as ‘rounds’) and must cover 65 per cent of the population at minimum.

NEW STRATEGIES
Achievement of this historical coverage was attributed to the employment of new strategies, whereby there were concerted efforts aligning with global efforts to eliminate the ailment.

In 1997, the World Health Assembly adopted a Resolution calling on member states to initiate steps to eliminate Lymphatic Filariasis as a public health problem by 2020. In response, the WHO launched the Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000.

“Strategies that we used last year were a bit new and fashioned off of the WHO’s GPELF,” Moses said and acknowledged that these were instrumental in the success of the programme.

The house-to-house strategy was employed as in older MDAs, but only served to reinforce the other strategies.

Health centre and regional micro-planning were newer strategies employed, which allowed for a grassroots-level connect though this demanded more resources. The doctor highlighted that micro-planning was, in fact, the first to be used in any MDA and that approximately 72 health centres were involved in this MDA.

Also demanding a lot of human resources was the ‘fixed point’ strategy, where pill distributors were present at market squares or in front of nursery schools just to make administering the pills more accessible for citizens. “What we really wanted was to capture the people where they really were,” Dr. Moses said. There were about 1,051 pill distributors across the four regions.

The most notable strategy, however, was perhaps collaboration with the Ministry of Education to disseminate pills within schools.

In the regions targeted, the campaign targeted about 523 public and private schools — ably bridging the gap between schoolchildren and dissemination of the pills.

Reflecting on a previous MDA, Pan American Health Organisation and World Health Organisation (PAHO/WHO) Representative to Guyana, Dr. William Adu-Krow, related that it was pointed out to him that a major hindrance to the requisite 65 percent coverage was the younger age demographic.

He highlighted that he reached out to Minister of Education Nicolette Henry with this “emergency” and soon enough, the campaign was initiated in schools.

Though the collaboration with schools was instrumental in achieving the campaign’s success, one demographic, the two to five-year-old group in Region Three failed to meet the 65 per cent pass mark, according to Dr. Moses. This was the only group from all four regions to fall below the mark.

During her remarks, Minister of Public Health, Volda Lawrence, lauded the collaboration with the education ministry and PAHO. She posited that a “multi-sectoral approach” yields more impact and fosters synergy.

Despite the many positives of the campaign, education and awareness remain fundamental tenets.

Though minute, sections of the target population did refuse to take the pills. An overall four percent of the population accounted for this refusal.

Furthermore, there was the incident last year where many were led to believe that a six-year-old child Princess Kissoon of ‘D’ Field Sophia, died after being administered the pill. Dr. Moses noted that because of a “lack of education” there were a lot of “rumours” that pinpointed the MDA as the cause of death, but it was proven that there was no link between the death of the child and the pills.

This lack of education is something the Vector Control Unit and its partners (the government ministries and PAHO/WHO) have been working assiduously to correct as it continues the campaign.

Since 2000, Guyana signed onto the WHO’s GPELF and had attempted to eliminate the disease through previous MDA campaigns.

In 2003, the ‘DEC Salt’ campaign was launched but proved tricky, since it was difficult to determine the number of persons using the DEC salt against their regular cooking salt, whether the quantity being consumed was enough, or even if persons consumed the salt in their diets. In 2008, the programme was altered to include the dissemination of pills and continued thereafter.

Mapping was a prerequisite to elimination attempts however and in 2001, it was done to determine to what extent the country was affected. Alarmingly, Region One, Barima-Waini, was the only administrative region that was not endemic with the disease.

It is for this reason, Dr. Moses told the Guyana Chronicle, that only nine of the 10 regions will be targeted. Additionally, she mentioned that another mapping exercise must be done, since the last one was done 17 years ago.

As aforementioned, the MDA must be successfully implemented for another four years, so that Guyana can declare that it has eliminated the disease.

PAHO/WHO Specialist for Malaria Prevention and Control, Dr. Jean Alexandre, noted that if five consecutive years of the MDA is completed successfully, the country must conduct a ‘Transmission Assessment Survey’ twice to verify whether the disease has in fact been eliminated.

If the MDA falls below 65 per cent coverage, it has to be restarted. In his remarks, Dr. Adu-Krow also revealed how much money has been expended to foster these attempts to eliminate the disease. He had highlighted at the launch of the MDA campaign in September 2017 that the estimated cost was US $1M.

He said, “We have to do better and I’m glad in 2017, we did better.”