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Budget 2017: Eliminate filariasis

India aims to eliminate lymphatic filariasis by the end of 2017. Previously mentioned in a national health policy in 2002, it was aimed to be eliminated by 2015. Like many of the other disease mentioned during the 2017 budget, previous deadlines for elimination have not been met.

This casts a shadow of doubt over the realistic potential to eliminate the diseases, with many such as filariasis and kala-azar (leishmaniasis) given overly optimistic deadlines of the end of 2017. This may just be the latest of many missed deadlines for the parasitic infection caused by invasion of a human host by filarioidea roundworms.

A time frame of ten months is quite possibly an attempt at political point scoring, rather than a potential prospect. Medical experts have implied that the goal is not possible, as simply mobilising campaigns and medical supplies to affected areas may in itself take more than the intended time frame.

One of the primary issues with elimination of filariasis is the manner in which it is transferred. The roundworms are passed between human hosts via bites from black flies and mosquitos. Thus a declaration of elimination at the end of 2017 could be entirely negated by new cases during the resurgence of mosquitos in 2018.

The symptoms of filariasis vary depending on the level of tissue infiltration of the roundworms, as well as the species of roundworm causing the infection. In the most extreme cases, infection can result in elephantiasis. This is caused by an infiltration into the lymphatic system, causing oedema and thickening of the skin resulting in large scale deformities, primarily in the lower extremities.

While elephantiasis is an unignorable symptom, many who harbour the parasitic ringworms subcutaneously show no symptoms at all. Some infected patients display rashes. Many, despite having mild to no symptoms at all, have been shown to have a degree of lymphatic or kidney damage. Some strains of the roundworm affect other organs, Onchocerca volvulus infiltrates the eye and is responsible for onchocerciasis (river blindness).

Large amounts of resources have already been invested by the Ministry of Health & Family Welfare (MOHFW). In 2015 a campaign of an unprecedented scale was launched to eliminate the disease. Four hundred  million people were provided with medication designed  to prevent the disease. However, many people do not  take the medication due to lack of symptoms. In the long run this will hamper any attempts to eradicate the disease as any untreated person harbouring the roundworms acts as a new source of infection in the next mosquito season.

Even health officials are sceptical. V M Kulkarni, deputy director of health, Latur region in an interview with the Times of India (ToI) speculates the only means of eradicating the disease is to extend the mass drug administration programme (MDA) over a more sustained period of time. This implies that the ten month time frame is again, not possible.
Without assurance that all those provided with medication are following through with the prescription there can be no guarantee of elimination. Large scale government intervention may provide the means to reduce the numbers of infected, but a goal of elimination within 10 months is undeniably out of reach.

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