Antigen testing is now recognized as the method of choice for detection of Wuchereria bancrofti infections. Unlike tests that detect microfilariae, antigen tests can be performed with blood collected during the day or night. However, existing enzyme-linked immunosorbent assay (ELISA) tests for filarial antigenemia are difficult to perform in the field, and this has limited their use in endemic countries. In this article, Gary Weil, Patrick Lammie and Niggi Weiss review their experience with a new rapid-format filarial antigen test. They found that the ICT card test was very easy to perform and that it was comparable with ELISA for the detection of filarial antigen in sera from people with microfilaremia. The introduction now of an antigen test suitable for use in the field is especially timely, in that it may facilitate implementation of new strategies proposed by the World Health Organization for control and elimination of lymphatic filariasis.

The ICT filariasis test : rapid format antigen test for the diagnosis of bancroftian filariasis

Unresolved issues in anthelmintic pharmacology for helminthiases of humans.

Lymphatic filariasis (LF) is a disease targeted for elimination. The global strategy is a once-yearly, single-dose, two-drug regimen utilised by communities at risk for LF, with the goal of reaching 80% population coverage yearly, for at least 5 years, in order to interrupt transmission of LF. Where onchocerciasis is co-endemic, the regimen is ivermectin 200 - 400 microg/kg plus albendazole 400mg; elsewhere, the regimen should be diethylcarbamazine 6 mg/kg plus albendazole 400mg. This paper reviews in detail the evidence for the efficacy and safety of these two-drug regimens underpinning the global strategy and makes recommendations for future developments in chemotherapy for LF, focusing on unresolved issues. These include optimal frequency, duration and end point of treatment, tools for monitoring successful therapy and means for detecting the potential development of resistance to any of the three antifilarial drugs on which the Global Programme to Eliminate LF depends.

Treatment strategies underpinning the global programme to eliminate lymphatic filariasis.

Purpose of reviewChemotherapy against onchocerciasis and lymphatic filariasis has been discussed mainly within the framework of mass drug administration with diethylcarbamazine, ivermectin and albendazole. Although strong reductions in infection prevalence were achieved, the regimes for these drugs

Filariasis: new drugs and new opportunities for lymphatic filariasis and onchocerciasis.

BACKGROUND\nClinical vitamin A deficiency affects millions of children worldwide, and subclinical deficiency is even more common. Supplemental vitamin A has been reported to reduce mortality among these children, but the results have been questioned.\n\n\nMETHODS\nWe conducted a randomized, controlled, masked clinical trial for one year in southern India involving 15,419 preschool-age children who received either 8.7 mumol (8333 IU) of vitamin A and 46 mumol (20 mg) of vitamin E (the treated group) or vitamin E alone (the control group). Vitamin supplements were delivered weekly by community health volunteers who also recorded mortality and morbidity. Weekly contact was made with at least 88 percent of the children in both study groups. The base-line characteristics of the children were similar and documented a high prevalence of vitamin A deficiency and undernutrition.\n\n\nRESULTS\nOne hundred twenty-five deaths occurred, of which 117 were not accidental. The risk of death in the group treated with vitamin A was less than half that in the control group (relative risk, 0.46; 95 percent confidence interval, 0.30 to 0.71). The risk was most reduced among children under 3 years of age (6 to 11 months--relative risk, 0.28; 95 percent confidence interval, 0.09 to 0.85; 12 to 35 months--relative risk, 0.46; 95 percent confidence interval, 0.26 to 0.81) and among those who were chronically undernourished, as manifested by stunting (relative risk, 0.11; 95 percent confidence interval, 0.03 to 0.36). The symptom-specific risk of mortality was significantly associated with diarrhea, convulsions, and other infection-related symptoms.\n\n\nCONCLUSIONS\nThe regular provision of a supplement of vitamin A to children, at a level potentially obtainable from foods, in an area where vitamin A deficiency and under-nutrition are documented public health problems contributed substantially to children's survival; mortality was reduced on average by 54 percent.

Reduced mortality among children in southern india receiving a small weekly dose ok vitamin a

Objectives: To assess the nutritional status and morbidity among the school going adolescents in peri urban area Wardha. Materials and Methods: The present study was conducted in the year 2008. 116 children in the age group of 10 to 19 years studying in high school of peri urban area Wardha were examined. Nutritional status of the adolescents was assessed through weight for age (wasting) and height for age (stunting) according to WHO criteria. Data was entered and analyzed by using Epi Info 6.04 software package. Chi- square value was used for testing statistical significance. Results: Mean age of the adolescents was 13.16+ 1.99. 48.3% of the adolescents were found to be normal and 51.7% were underweight. Early adolescents were at highest risk of underweight significantly more 73.3% ( p < 0.05 ) as compared to late adolescents 26.7%. Overall 34.5% of the adolescents were stunted with boys suffering more 72.5% as compared to girls 27.5%. 28.45% of the school going adolescents had anaemia with girls suffering significantly more 38.89% (p < 0.05) as compared to boys 23.75%. 35.34% adolescents had dental caries. 13.79% adolescents were found to be suffering from refractive error. 7.76% adolescents had worm infestation. 6.9% adolescents had skin problems. 2.59% adolescents had tonsillitis and 2.59% had wax in the ear. Conclusion: The study shows the poor health and nutritional status among the adolescents. A periodical and regular health check-up with concerted efforts towards their nutrition along with focused health education will improve the health and nutritional status of these school going adolescents in peri urban area Wardha.

Nutritional Status and Morbidity among School going Adolescents in Wardha, a Peri-Urban area

Filariasis control programmes are moving towards a strategy of repeated single-dose mass treatment of endemic populations. Using a combination, such as albendazole (ALB) to diethylcarbamazine (DEC) gives both macrofilaricidal and antihelmintic activity. However, the safety of the combination versus DEC alone should be established in field studies in large populations prior to incorporation into national programmes. The present study compared the safety, tolerability, and efficacy of single doses of DEC 6 mg/kg + ALB placebo with DEC 6 mg/kg + ALB 400 mg in populations living in two filariasis endemic villages in the district of Wardha in western India. The study was double blind, parallel group, and randomized. Safety and tolerability study were studied in males and females older than 5 years. Safety was assessed by monitoring if adverse events (AEs) over 5 days affected daily acivities. Subjects in the 2 treatment groups experienced insignificantly different effects on daily activities and the combination was shown to be safe. Efficacy was evaluated by microfilaraemia (Mf), immunochromatographic test (ICT) and ultrasonography (USG) at 0, 3, 6, and 12 months of follow up. The efficacy study enrolled 103 male patients (aged 18–50 years) in microfilariae positive, clinical disease and asymptomatic, amicrofilaremic groups. There was no significant difference in efficacy between groups at 12 months. Within the Mf positive group, significant differences were seen in microfilaraemia ( P P P

Safety, tolerability, efficacy and plasma concentrations of diethylcarbamazine and albendazole co-administration in a field study in an area endemic for lymphatic filariasis in India.

Objective: To assess the nutrient intake of rural adolescent girls. Materials and Methods: The cross-sectional study was carried in four adopted villages of the Department of Community Medicine, M.G.I.M.S., Sewagram. A household survey was carried out in the villages. A list of all the adolescent girls in the age group of 10-19 years was prepared by enumeration through house-to-house visit. All adolescent girls were included in the study. A pre-designed and pre-tested questionnaire was used to collect data on socio-demographic variables and anthropometric variables. A 24 h recall method was used to assess nutrient intake. Data generated was entered and analyzed using epi_info 2000. Nutrient intake was compared with ICMR Recommended Dietary Allowances. Nutritional status was assessed by BMI for age. Results: The mean height of the adolescent girls was 142.9 cm. Overall, 57% of the adolescents were thin (BMI for age <5 th percentile for CDC 2000 reference) and 43% of the adolescents were normal (BMI for age between 5 th - 85 th percentile for CDC 2000 reference). The average energy intake, which was 1239.6±176.4 kcal/day, was deficient of RDA by 39%. The average protein intake was 39.5±7 gm/day. It was deficient by 36% and the average iron intake, which was 13.2±2.5 mg/day, was deficient by 48%. Conclusion: The findings reiterate the dietary deficiency among adolescent girls which adversely affects the nutritional status. If the poor nutritional status is not corrected promptly before they become pregnant, it adversely affects the reproductive outcome. If we have to meet out the goals of Reproductive and Child Health Program, intervention strategies to improve the dietary intake of adolescent girls are needed so that their requirements of energy, protein, vitamins and minerals are met.

Nutrient intake amongst rural adolescent girls of Wardha

Background: The NRHM framework supports decentralized planning and monitoring upto the grass root level. Therefore, it was decided to entrust village level committees of the users group for the planning, monitoring and implementation of NRHM activities into villages of the country. Objectives: To study awareness regarding constitution and responsibilities among the VHNSC members; to study the current role of VHNSC in healthcare delivery at village level and preparation of village health action plan; and to understand the composition and process within VHNSC during conduct of a meeting, decision-making, resource management and conflict resolution. Methodology: Qualitative research methods (focus group discussion and in-depth interview) were conducted with VHNSC members during January to April 2011. The study was conducted in the selected villages of five sub-centres of PHC Anji, Wardha district of Maharashtra state. In each sub-centre, two villages were identified; one sub-centre village and another village purposively selected from among rest of the villages where the VHNSC was constituted and functional. Data was analyzed manually and transcripts were prepared using thematic analysis framework. Results: Awareness about VHNSC, its roles and responsibilities was highest among ANMs and AWWs. Awareness about objectives of VHNSC was highest among ANMs followed by AWWs, and least among panchayat members, ASHAs and SHG members. Most of the members were unaware of their roles and responsibilities and admitted to having received no formal training, before being made members of these committees. Regarding use of fund, majority of the VHNSC members were unaware about the areas where the funds were utilized. Most of VHNSC members said that either president or secretary decided about use of the funds without consulting other members. Conclusion: Capacity-building program of VHNSC members regarding rationale of VHNSC and its role in healthcare delivery should be considered towards better performance of NRHM.

Performance of village health, nutrition and sanitation committee: A qualitative study from rural Wardha, Maharashtra

Background: The National Rural Health Mission has introduced village-level female community health worker, accredited social health activist (ASHA) who acts as an interface between the community and the public health system. The is study was conducted to assess the awareness and perceptions of ASHA regarding their roles and responsibilities in health-care system and factors affecting their performance in delivering health-care services. Methodology: A qualitative study was conducted in seven selected villages under Talegaon Primary Health Centers, Wardha district, Maharashtra, which is also field practice area of a medical college. Nonprobability sampling (purposive sampling) was done. In-depth interviews were conducted on ASHAs (n = 7) of those selected villages till saturation of data. Data were analyzed using the thematic framework approach. Results: ASHAs perception regarding their job responsibilities appeared to be incomplete. They had good awareness regarding their roles and responsibilities as a link worker. They were found to be mostly interested in higher incentive performances. ASHAs clarity regarding their roles and responsibilities as facilitator, social activist, and service provider was found to be somewhat compromised. They were ignorant about their roles and responsibilities under various newly launched national programs. The positive factors influencing ASHAs performances were regular supervision of their performances and appraisal by higher authority and support from community, family, and good relations with coworkers and staff. Challenges faced by most of the ASHAs were more workload, poor orientation to program, lack of quality training, and inadequate and delayed monetary incentives. Conclusion: Good quality training with regular refresher training sessions and regularization of incentives are required to motivate them ASHAs.

Qualitative Assessment of Accredited Social Health Activists (ASHA) Regarding their roles and responsibilities and factors influencing their performance in selected villages of Wardha

AM Mehendale

Papers

Nutritional Status and Morbidity among School going Adolescents in Wardha, a Peri-Urban area

Safety, tolerability, efficacy and plasma concentrations of diethylcarbamazine and albendazole co-administration in a field study in an area endemic for lymphatic filariasis in India.

Nutrient intake amongst rural adolescent girls of Wardha

Performance of village health, nutrition and sanitation committee: A qualitative study from rural Wardha, Maharashtra

Qualitative Assessment of Accredited Social Health Activists (ASHA) Regarding their roles and responsibilities and factors influencing their performance in selected villages of Wardha