(Written by K Madan Gopal)
For a malnourished body, a parasitic infection can mean not just a poor response to the disease itself, but also further depletion of the body’s nutrients, severely slimming the chances of recovery and rehabilitation. In the case of a neglected tropical disease like lymphatic filariasis (LF), commonly known as “Hathi Paon” or Elephant Foot — causing disfigurement and disability due to a mosquito bite injecting coiled worm-like microfilariae into the human bloodstream — healthy nutritional behaviours can lead to the elimination of the disease.
A public health challenge for the country, LF (endemic to 256 districts across India) puts over 650 million Indians living in tropical or subtropical regions at risk for chronic conditions like elephantiasis and hydrocele (scrotal swelling). About 90 per cent of the LF burden in the country comes from eight states — Uttar Pradesh, Bihar, Jharkhand, West Bengal, Chhattisgarh, Maharashtra, Odisha, and Madhya Pradesh — which are also home to a significant number of the 117 aspirational districts identified by the NITI Aayog, that register rampant malnutrition and form major focus areas for POSHAN Abhiyan or the National Nutrition Mission. According to the World Health Organisation, LF is stated to be the second leading cause of long-term disability.
Notably, diseases caused due to infectious organisms tend to occur amongst the poorest of the poor, who are already at risk of diarrheal diseases, respiratory tract infections, malaria, and HIV. What is often forgotten is that these diseases occur among those who are chronically undernourished as well. Undernutrition increases the risk of infection, the severity of the disease, and the risk of child mortality, while the physical damage, loss of appetite, and host responses during chronic infection can contribute substantially to undernutrition.
The transmission of LF can be checked by improvements in the districts’ nutritional status, in addition to disability alleviation and mass drug administration (MDA) — an annual dosage of anti-filarial drugs given to eligible people in affected areas. This triple-drug therapy is being scaled up by the Centre and will help achieve India’s public health goal of lymphatic filariasis elimination by 2021.
Studies have shown that malnutrition is closely related to filariasis, and their compounded effect can put the affected person at higher risk. With the use of nutritional indicators as the monitoring mechanism for the elimination of LF, effective implementation of the provisions under the national nutrition program can have a positive bearing on both personal and public nutritional status, while eliminating a debilitating disease from Indian soil.
The POSHAN Maah in September is a key reminder for all stakeholders to make the fight for filaria elimination into a Jan Andolan, a people’s movement drawing on active participation from public and private actors. While making a case for the value of nutritional supplements after treating neglected tropical diseases, one recognises that truly integrated control programmes need more than medicines and pills. What is required is a broad approach in addition to mass drug treatment, including nutritional rehabilitation, behaviour change initiatives, and public health measures to prevent reinfection. While mass drug administration can help reduce the parasite load in an affected body, and diminish sources of reinfection, a collaborative effort in nourishing locals will go a long way in securing health and well-being.
Along with uptake of schemes like take-home ration at the district level, community-based initiatives such as promoting the development of kitchen gardens and sourcing locally-available foods to diversify food consumption, can serve as important contributions to this Jan Andolan. With sources of supplementary nutrition like take-home ration, finding local nutrient-rich foods can also fit within the financial framework of a family, also helping with building stronger immune responses to the virus causing the COVID-19 during the ongoing pandemic.
Rehabilitation of affected persons is also required for extensive recovery of deficits in the health, nutrition, and education status of children — as the infection is usually acquired in childhood and can clinically manifest in one’s youth — and alleviation of symptoms of disease in all age groups. Positive behavioural change can also prevent the risk of reinfection with LF as well. Finally, clean water, environmental health, and sanitation are essential to keep people and their excreta apart and prevent vectors and flies from breeding – paving way for the elimination of lymphatic filariasis achieved through governmental intervention and collective health action of “suposhit” or well-nourished communities.
The writer is Senior Consultant (Health) at NITI Aayog. Views expressed are personal
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