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Feb 10, 2014 News
– city’s insanitary state perfect breeding ground for mosquitoes transmitting parasite
By Sharmain Grainger
Superstitious beliefs have been one of the primary reasons some persons do not adhere to medical treatment. Moreover, it is not at all unfamiliar when workers attached to the Ministry of Health’s Mass Drug Administration (MDA) project hear remarks such as “somebody do meh” when persons are found with the symptoms of lymphatic filariasis.
Lymphatic filariasis, which is sometimes simply referred to as filiariasis or elephantiasis, is in fact a vector transmitted parasite that can severely affect the human body. In fact according to Coordinator of the MDA Project, Rohan Sagar, when the parasite multiples in the body it causes some clinical symptoms resulting in physical disfigurement, complemented by excruciating pain.
According to Sagar, filiariasis in its manifested form causes lumphedema, which is popularly known as “big foot” and hydrocele which persons simply call “godee”. And there are instances, Sagaris noted, that limbs and the breasts are affected as well.
He disclosed that the condition is one that is highly stigamtised. “Persons who have this disease are (sometimes) socially excluded; some are even tantalised on the road…it could be an economic burden to the family because this condition could cause persons – productive member of the family, the breadwinner – to have to stay at home,” according to Sagar.
In fact, according to Supervisor of the MDA Project, Nurse Faye Jones, this state of affairs has even caused some families to break-up. She disclosed that some individuals are so bent on refusing the condition as a disease that can be medically treated that they opt to fervently embrace a superstitious standpoint. “One woman, with ‘big-foot, said that because she “get do” she had to dry frog and rub it on her foot….,” confided Nurse Jones.
And then there are cases where men with hydrocele prefer to insist that “‘I strain myself lifting weights’…and some even try to convince you that it is a hernia,” Sagar divulged during an interview with this publication.
According to him, although hydrocele can be surgically removed, unless persons are treated for filariasis, it is likely to reoccur.
In the quest to reduce, if not eradicate the disease, the MDA Project a few years ago embarked on a DEC Tablet distribution mission to target persons living at risk of contracting filariasis. Formerly the use of DEC salt was encouraged to fight the disease.
According to Sagar the project, which officially commenced in 2012, was in fact the off-shoot of a discussion between the Government of Guyana and the Inter-American Development Bank (IDB) about the rehabilitation of the Georgetown sewerage system network. During that conversation, Sagar intimated that the nexus between sanitation and health was amplified. It was noted then that “the city’s sanitation was a perfect reservoir or breeding site for mosquitoes and these specific species are known to transmit filariasis,” noted Sagar.
There are currently three known vectors – Aedes aegypti, Culex and Anopheles – in Guyana that can transmit the disease. And according to Sagar while these vectors are known to mostly thrive in the hinterland Regions, there is evidence to suggest that at least the Culex is present on the Coastland.
Moreover, the IDB agreed to grant the Government a loan to fund the rehabilitation of the sewerage system, complete with a component to interrupt and reduce the presence of vectors capable of transmitting the filiariasis parasite within Region Four.
Following the agreement, a baseline study was done in March of 2012 to ascertain the prevalence of the disease in the Region, and according to Sagar, two communities – Lodge, Georgetown, and Melanie, East Coast Demerara – were chosen. Lodge, he noted though, has historically had high incidences of filariasis.
Between the two communities, close to 1,000 individuals were tested and it was discovered that at least four per cent of that target population had the filiariasis parasite. This of course amplified the need for treatment to commence forthwith, since based on the recommendations of the World Health Organisation (WHO), only a one per cent or less prevalence is acceptable.
And so an initial phase of the MDA project was officially fast-tracked in November 2012 and concluded in July 2013. This, according to Sagar, saw MDA workers being dispatched to target communities in Region Four.
This saw the distribution of Diethyl Carbamazine (the DEC Tablet) and Albendazole tablets for flushing out the parasites.
Each DEC tablet of 100-milligram strength is administered based on age. Children between the ages of two and five are given one tablet, while those between the ages of six and 15 are administered two. However, those 16 years and older are given three tablets, Sagar said.
To complement the DEC Tablet all individuals, regardless of age, are given a standard 400-milligram strength dose Albendazole tablet. “When used together this is the perfect combination for destroying the parasites,” said Sagar, who added that the tablets must be used once per year for five consecutive years for the parasites to be entirely destroyed.
However, he cautioned that once the disease has started to manifest its symptoms are mostly irreversible although the use of the drugs will help to destroy the parasites thereby preventing it from spreading to other persons. “If a person who has the disease is bitten by a mosquito, the mosquito picks it up from that person and transmits it when it bits someone else…there are persons walking around out there looking physically very good and normal but the parasite is in them,” related Sagar.
It is for this reason Nurse Jones said that filariasis is regarded as “a childhood infection and an adult disease because it takes years to manifest. You can be infected as a child and not see the manifestation until you reach adulthood.”
Currently, the MDA project is in its second stage of distribution whereby workers are tasked with going house to house to distribute the filariasis eradicating drugs. And according to Sagar, persons should not be opposed to taking the tablets. “We would want to believe the Guyanese people are serious about their health, and so even if they have not taken the tablets;if there is an uncertainty we would encourage them to take it…it helps to reduce the disease and the tablets are completely safe,” he assured.
The distribution in Central Georgetown is expected to be completed by this weekend and according to Nurse Jones efforts will then be made to reach communities on the East Coast and East Bank of Demerara.
After the five-year period of mass drug distribution would have elapsed, a Transmission Assessment Survey will be conducted with a view of determining whether the exercise was effective in reducing the impact of the disease to one per cent or below. And should it not reach the desired goal, Sagar said that the IDB is prepared to fund an additional two years of the MDA project.
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