In the latest progress report published by the World Health Organization on the global programme to eliminate lymphatic filariasis (LF), India’s submitted figures may not be all that they seem.

The country, which has a population of over 1.2 billion, reports that they have achieved 98.6% geographical coverage when it comes to mass drug administration (MDA). This is the process in which government health workers deliver preventative medication once a year for five years to each household in a bid to eliminate the parasitic disease which causes severe swelling to body parts.

The global programme working towards the elimination of the neglected disease, sometimes known as elephantiasis, says there needs to be 85% geographical coverage of the national population for elimination to occur. While India’s 98.6% figure would imply it is well on the way to achieving that, international charity, Lepra, has findings which say otherwise.

In a recent study they conducted in the Indian states of Odisha and Andhra Pradesh, they found that while the drugs had been distributed to 83% of the 4,152 interviewees, only 50% had actually consumed the medication. This means that, while the recent WHO figures look impressive, if the consumption rates across India are similar to those found in Odisha, then in fact India is far from reaching the global target to eliminate the disease by 2020.

Lepra argues that in order to reach the target, the MDA process must be accompanied with health education and community mobilisation.

Sarah Nancollas, Chief Executive of Lepra, said their new research, which sees similar figures in the state of Bihar, has confirmed what they long believed to be the case:

“It is not enough to merely hand a person a pill and hope that they will take it without adequate explanation and understanding as to why. Given that many won’t have the disease, it can be hard for them to justify the reasoning to take a pill for something they show no symptoms of. We have proven that, combined with campaigns that really tell people what LF is, along with information on the medication itself, consumption rates rise significantly.”

The UK based charity previously conducted research in the district of Puri, also in the state of Odisha, and found that by implementing education campaigns around LF the consumption rate doubled to 92%.

“The government needs to be more strategic in their administration. They need to think about when they are visiting households, is it meal time, is it a holiday period? The pill has to be taken with food and distributing it around meal times will increase the likelihood of somebody consuming the tablet. It is not enough to merely handover a pill and assume it is being taken – after all would you take a drug if a stranger handed it to you on your doorstep?”

There is a real danger that if not enough investment is made to ensure that people take the drug, through community mobilization and health education, LF could eventually be declared eliminated in India when many are still at risk of contracting it and millions are still enduring the painful effects.

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