War on picks up

By GLENDA AWIKIAK
Lymphatic filariasis (LF) commonly known as elephantiasis is a disease that is silently affecting a good number of people in Papua New Guinea.
It is present in 62 of the 89 districts in the country, especially lowland coastal areas and islands.
It is common in low land areas of the highlands region where vector mosquitoes are present like Mt Bosavi in Southern Highlands as well areas of Bundi (Hagahai-Simbai) in Madang towards Jiwaka mountains.
Lymphatic filariasisis a neglected tropical disease that is leaving many with lifetime disabilities. With surveys and mass drug administration (MDA) being done in certain provinces, it has shown that a small number (less than 15 per cent) have clinical symptoms showing swollen legs, hands, scrotums and breasts where the lymph nodes and vessels are blocked by the adult filarial worms in the body.
These symptoms are very severe and can cause a lifetime disability and affect the normal day to day life and activities of the persons infected.
In PNG this health issue is not given much attention because it is not endemic everywhere in the country, also because the outbreak of new infections and frontline diseases like malaria, TB, HIV that are life-threatening have taken much attention.
Further, given the level of cash flow in the country, the Government is prioritising very serious and life-threatening health issues and areas. But that is not stopping the Government through the Health Department, at least efforts are taking place bit by bit in certain provinces that are endemic to the infections and one such area is New Ireland.
LF is caused by a worm called the parasitic filarial worms (Wuchereriabanrofti) which fully infect human beings and are only transmitted through bites of infective female mosquitoes. In PNG filarial parasites are transmitted by the same species of mosquitoes that transmit malaria. Active transmission of the worms from the mosquitoes to a human occurs at night, especially towards the early hours of the morning and that is when these mosquitoes are most active.
According to programme officer for neglected tropical diseases Melinda Susapu, PNG is extremely lucky because of the nation-wide global funded malaria programme where free insecticide treated mosquito nets are given to every household to prevent mosquitoes biting and spreading malaria. The nets also prevent spread/transmission of this worm parasite.
Estimated figures show that about one million in PNG are infected and four million are at risk of lymphatic filariasis infection. Of the one million infected, very little information is available on the exact number of people living with clinical symptoms of LF.
The Government’s commitment to support LF elimination of filariasis as a public health problem has always been there despite financial challenges and it is committed to the cause since 2012 and the health minister at the time signed the agreement to eliminate LF in PNG.
“However, because of the high cost of implementing MDA in the provinces, the programme has been slow to reach every endemic population/province.
“The respective provinces also have to take ownership of this programme to implement MDA for affected populations. Japanese International Corporation Agency (Jica) has been responsible for providing information and communication technology (ICT) card/filarial test strips for prevalence surveys which indicate endemic provinces and also tests for prevalence after two to three rounds of MDA to assess the impact of the drugs on the worm burden. The MDA strategy is the use of three drugs in combination, given once a year to every eligible individual in endemic provinces to kill the baby worms from being transmitted.
Living in an endemic area, the presence of infected individuals and the mosquito vector put people at risk of infection over the years. Infection can lead to lymphedema/elephantiasis and disability, although a high number of infected individuals do not develop grotesque physical deformities.
New Ireland will be implementing its fourth round of MDA this year between October and November, with the help from the health department, World Health Organisation (WHO) and Jica who has committed to continue support this programme to its end. Susapa said also long before this agreement, Jica has been an important partner in this programme since 2008 providing test kits and has funded several trainings for LF in the provinces. Planning and technical support has already started for the first round of MDA in East New Britain.
She said the health facilities and their staff worked tirelessly daily and having many diseases to deal with can be a daunting task.
They also issue key public health messages like keeping areas around houses free from mosquito breeding sites and nightly use of mosquito nets to protect against mosquito-borne diseases like filariasis, malaria and dengue. Health facility staff continue to stress these messages at every chance they get and always give health talks at these opportunities.
The experiences with New Ireland MDA have been very successful where the health workers worked closely with community volunteers to reach all individuals with the medicines for LF.
The progress had shown both provinces are committed to eliminating LF and each province is tasked to secure funds to implement three to four rounds of MDA.
For every province the availability of funding and resources will be different given the demographics and geographical factors.
MDA is a costly exercise and having the commitment and resources to complete a successful MDA programme in a province is key to achieving control and elimination of this dreadful disease.

Future plans
Susapu said there was a LF strategic plan in place just like many other health programmes of the department to address this health problem. This strategic plan is used to guide the programme and provinces with activities.
There is a plan for the expansion of the LF MDA into provinces that have already been approached, where LF is found to be endemic, like West Sepik and West New Britain who will be next in line for the implementation of MDA.