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This paper reports on DEC distribution and compliance with treatment in a large-scale annual single-dose mass treatment programme to eliminate lymphatic filariasis in the south Indian state of Tamil Nadu. 76.9% of households (82.5% in rural areas and 58.0% in urban areas) were aware of drug distribution for control of filariasis. DEC was given to 70% (= distribution rate) (range 0-92%) of the population and 53.5% (range 12-89%) complied with treatment. The distribution rate was more than 75% in 74% of the villages and compliance was in the range of 51-75% in 76% of the villages. About 5% of the treated population reported side-effects. Distribution and compliance were higher in rural than urban areas and similar between males and females. Qualitative data showed that some socio-economic factors, logistic and drug-related problems and people's poor knowledge and perceived benefits of treatment played a role in a proportion of the population not receiving or taking the drug. The Tamil Nadu programme showed that large-scale repeated annual DEC mass treatment is feasible and that existing health services are capable of delivering the drug to all communities. While even poor to moderate compliance rates can reduce the vector transmission of infection to some extent, improved drug distribution and compliance with treatment are necessary to consolidate the gains of earlier rounds of treatment and achieve the goal of filariasis elimination within a reasonable time frame. [ABSTRACT FROM AUTHOR]

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Tropical Medicine & International Health is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We conducted a 2-year (1997–1999) longitudinal, entomological and virological study in three dengue endemic villages in Vellore district, Tamil Nadu, to understand the dynamics of dengue transmission. Aedes aegypti (Linn.), Ae. albopictus (Skuse) and Ae. vittatus (Bigot) were the prevalent vector species. Aedes aegypti was breeding throughout the year with a Breteau index ranging from 9.05 to 45.49. Aedes albopictus and Ae. vittatus were prevalent mainly in the rainy season. Small water holding containers (cemented tanks/cisterns) were the perennial breeding source of Ae. aegypti, and its abundance was significantly higher in semi-urbanized central areas than the peripheral areas of the villages. From 271 pools (4016 specimens) of adult females, eight dengue virus (DENV) isolates were obtained of which seven were from Ae. aegypti and one from Ae. albopictus. This is the first report of DENV isolation from Ae. albopictus in rural India. Infection rates in the two species were comparable. However, due to higher and perennial prevalence, Ae. aegypti is considered as primary vector with Ae. albopictus playing a secondary role. Despite circulation of all four serotypes (DENV 1–4) detected mainly during the transmission season, the high anthropophilic index of the vectors and their abundance, no human dengue case was reported, suggesting silent dengue transmission. [ABSTRACT FROM AUTHOR]

Lymphatic filariasis (LF) is targeted for global elimination. Repeated annual single-dose mass treatment with antifilarials has been recommended as the principal strategy to achieve LF elimination. This requires an effective and sustainable strategy to deliver the drug, diethylcarbamazine (DEC), to communities. In this study, a new drug delivery strategy – community-directed treatment (comDT) – was developed and implemented and its effectiveness compared with that of the traditional health services-organized drug delivery, in rural areas of Tamil Nadu, India. Qualitative and quantitative data showed that the communities and health services were able to distribute the drug in almost all villages. The drug distribution rate and treatment compliance rate of comDT and health services treatment were statistically compared after adjusting them for clustering. Under the comDT 68% (n=20 villages; range: 0–97%) of the population received DEC, compared with 74% (n=20 villages; range: 48–95%) with the health services treatment strategy (P > 0.05). However, only about 53% (range: 0–91%) of comDT recipients and 59% (range: 32–79%) of those who received DEC from the health services consumed the drug (P > 0.05). Although statistically not significant, the distribution and compliance rates were lower under the comDT strategy. Also, the strategy’s operationalization appears to be difficult because of some social factors, and the tradition of communities’ dependence on health services for treatment, whereas health services-organized distribution was much less cumbersome and found to be more acceptable to people. However, the distribution (74%) and compliance rates (59%) achieved by health services were also only moderate and may not be adequate to eliminate LF in a reasonable time frame. Health services manpower alone may not be sufficient to distribute the drug. We conclude that drug distribution by health services is the best option for India and participation of the community volunteers and village level government staffs in the programme is necessary to effectively distribute the drug and attain the desirable levels of treatment compliance to eliminate LF. [ABSTRACT FROM AUTHOR]

SummaryThis study examined the direct and indirect costs due to acute form of lymphatic filariasis caused by Wuchereria bancrofti to the households in rural communities in Tamil Nadu state in south India. For nearly one-third of the acute adenolymphangitis (ADL) episodes the affected did not seek treatment and for 27% of the episodes they consulted health personnel, underwent treatment and paid for it. On average, the ADL patients spent Rupees (Rs.) 2.35 (US $ 0.07) per episode on treatment, but expenditure was as high as Rs. 32.11 (US $ 0.92) among those who paid. Doctor's fees and medicines constituted 83% of the total treatment costs. Patients with multiple and longer duration episodes and with better living conditions spent relatively more on treatment. The proportion of patients who spent money on treatment was smaller in poorer households, but their treatment costs formed a relatively higher proportion of their income than those of middle and high-income households. The ADL episodes curtailed economic and domestic activities. In 87% of the episodes, the affected were not able to attend any economic activity compared to 37% of the episodes in the case of controls. Patients spent only 0.68 ± 1.91 hours on economic activity compared to 4.40 ± 3.74 hours by the control individuals during the ADL episodes. The sign rank test showed that the mean difference of 3.73 ± 3.81 and 2.14 ± 1.83 hours in the time spent on economic and domestic activity respectively between cases and controls was highly significant (P <0.01) [ABSTRACT FROM AUTHOR]