Historical Background/Periodical Development
The National Filaria Control Programme launched in the state since 1957 , based on the findings of one man commission report. National Filaria Control Programme is implemented through following health institutions.

1. Filaria Survey Units. 06
2. Filaria Control Units. 16
3. Filaria Night Clinics. 10
4. Filaria Training Center 01

DEC treatment has been given to the MF positive patients detected through above centers, DEC tab are also available in the Govt. Hospitals, PHCs, Nagar Palika Hospitals, Municipal Hospitals etc.

The programme function under the guidance of the Jt. Director of Health Services, (Malaria & Filaria) Pune. On the lines of Directives received from the Director, National Anti Malaria Programme, Delhi. The Asstt. Director of Health Services,(Filaria) Pune co–ordinance the activities of the National Filaria Control Programme Units.

The population covered under National Filaria Control Programme is 53.68 lakhs. The current anti – larval measures, treatment of Mf carriers, mass drug therapy with diethyl carbomazine (DEC) & Hydrocele operation with vasectomy.

A) Filaria Survey Unit
Filaria Survey Units determines the endemicity by surveying population on random sample basis. State has six survey units (Thane, Pune, Nagpur, Akola, Nasik & Aurangabad) at revenue division headquarters. State has completed all district except Brihanmumbai. As per directives of third assesment committee survey unit should be engaged for resurvey of the old survey district if routine survey has been completed. So resurvey is started of the old surveyed districts.

B) Filaria Control Unit
Main activity of Filaria Control Unit is to control vector density by spraying antilarvals, weekly time spray schedule covers all breeding places in jurisdiction. Assessment survey is carried out of confirming the efficacy of anti larval operations. Detection &Treatment is carried out by Filaria Control Unit.

C) Filaria Night Clinics
The population covered under each Night Clinic is about 50000 and the screening of the total population will take about 2 and half year. 100 % detection and treatment is carried out by Filaria Night Clinic.

The Filaria Research cum training center was established in 1965 at Wardha. Then it is shifted to Nagpur in 1993.The institution was started with a view to give basic training about Filaria to peripheral staff. At present basic training is given to Entomological Assistant/Laboratory Technician/filaria Inspector/Insect Collector & Superior Field Worker in this training Cum Research Centre.

Objectives
The National Filaria Control programme had its objectives as given below

1. To carry out surveys in different parts of the state where the problem was known to exist in order to determine the extent of prevalence, types of infection and their vectors.
2. To undertake large scale pilot studies to evaluate the known methods of filariasis control in selected areas in different parts of states.
3. To train professional and ancillary personnel required for the programme.

The strategy for elimination of Lymphatic Filariasis is revised considering the past experience with mass DEC treatment. Due to poor coverage on account of side effects like fever, headache, body pains, nausea, vomitting, swelling of body parts etc. among mf carriers, during 2001, as per the recommendations of Technical Advisory Group, mass drug administration was carried out in various districts with co–administration of Albendazole. Observing a conclusion, instead of 12 day drug regime with DEC, a single day treatment once a year was found equally effective in reducing the transmission. The new strategy is envisaged to encompass a four pronged attack on the disease.

These are

1. A single day mass DEC treatment at a dose of 6 mg per kg body weight once a year.
2. Management of acute and chronic filariasis episodes to reduce the morbidity associated with frequent acute infections at the doorstep of patients.
3. Information, Education and communication (IEC) to inculcate individual/community based protective and preventive habits as an integral part of filaria control strategy.
4. Continuation of existing control measures in NFCP towns to supplement single dose annual treatment with DEC. National level Goal: To eliminate lymphatic filariasis from India by the year 2015.

Maharashtra State

1. To reduce & eliminate transmission of LF by Mass Drug Administration of Diethyl Carbamazine Citrate (DEC).
2. To reduce & prevent morbidity in affected persons, and
3. To strengthen the existing health care services.

Activities of National Filaria Control Programme
Surveillance

• Organization of Hydrocele operation camps for suitable patients.
• Introduction of Guppy fish in breeding places.
• Spraying on mosquito breeding places with Abate, Baytex, & MLO.
• Morbidity clinics for Filaria patients.
• Minor Engineering.
• Health Education.

Filaria Disease Surveillance has been carried out during 16th to 31st August 2004, in this special surveillance 66072 diseased patients have been find out. (Hydrocele = 27506, Lymphatic Filariasis = 38566).

Mass drug administration (MDA)
100 % population covered by one day Mass Drug Administration (MDA) of DEC tablets on 5th June 2004, in 14 endemic districts viz. Solapur, Chandrapur, Gadchiroli, Nagpur, Bhandara, Wardha, Godia, Yeotmal, Amaravati, Jalgaon, Nandurbar, Thane, Sindhudurga, & Nanded

• No. of districts selected – 14
• Population covered – 1.58 crores
• % coverage : 76.52%

In the year 2005–06 Mass Drug Administration (MDA) campaign carried out during 11th to 13th November 2005 in 18 districts, four newly added districts for the campaign are Ratnagiri, Latur, Osmanabad, & Akola. MDA will continue in next five years.
Strategy of National Filaria Control Programme
The strategy of filaria control has been given as follows

1. Detection and treatment of microfilaria carriers and
2. Recurrent anti mosquito measures.

Anti larval measures and detection cum treatment of micro filaria carriers are the two methods adopted to control filaria transmission in the selected areas where the programme is implemented. The larvicide under use include temephos, Fenthion and MLO. The selection of breeding places for treatment with a particular larvicide is done judiciously. Detection and treatment of microfilaria carriers will be carried out in the existing control units by establishing Filaria Clinics at the rate of one per 50,000 population.

Recurrent anti–larval measures at weekly intervals.
Environmental methods including source reduction by filling ditches, pits, low lying areas, deweeding, desilting, etc.
Biological control of mosquito breeding through larvivorous fish.
Anti–parasitic measures through ‘Detection’ and ‘Treatment’ of microfilaria carriers and disease person with DEC by Filaria Clinics in towns covered under the programme.

Revised Strategy
Annual Mass Drug Administration with single dose of DEC was taken up as a pilot project covering 41 million population in 1996–97 and extended to 74 million population. This strategy was to be continued for 5 years or more to the population excluding children below two years, pregnant women and seriously ill persons in affected areas to interrupt transmission of disease.

Strategy for Elimination of lymphatic filariasis
Mass drug administration (mda)
The strategy for achieving the goal of elimination is by Annual Mass Drug Administration of DEC for 5 years or more to the population excluding children below two years, pregnant women and seriously ill persons in affected areas to interrupt transmission of disease.

Home based management of cases who already have the disease and hydrocelectomy operations in identified CHCs and hospitals.

Annual Mass Drug Administration with single dose of DEC was taken up as a pilot project covering 14 endemic districts of Maharashtra State viz. Solapur, Chandrapur, Gadchiroli, Nagpur, Bhandara, Wardha, Godia, Yeotmal, Amaravati, Jalgaon, Nandurbar, Thane, Sindhudurga, & Nanded. during Jun 2004. 1.58 Crore selected population was covered under MDA in 2004 and extended to 2.68 Crore population in 18 districts for the year 2005. Four newly added districts for the campaign are Ratnagiri, Latur, Osmanabad, & Akola. This strategy is to be continued for 5 years or more to the population excluding children below two years, pregnant women and seriously ill persons in affected areas to interrupt transmission of disease.

Objectives of MDA

1. To review the progress of activities of single dose DEC mass administration in the selected districts.
2. To make independent assessment of the programme implementation with respect to process and outcome indicators.
3. To recommend mid–course corrections and suggest necessary steps for further course of action.

The Basic Principle of Revised Strategy for the Single Dose Mass DEC Administration

1. Interruption of disease transmission and
2. Treatment of problems associated with lymphoedema (disability prevention and control)

Parasite control with DEC is often relatively cheap when compared with vector control. The drug is safe and effective for human lymphatic filariasis. There is basic difference between individual and community treatment of filariasis. In the first case, it is usually the patient who is in need of help and therefore he or she is more likely to comply with the treatment. In a community, on the other hand, only a small proportion of the population is suffering from acute clinical filariasis at any one time and therefore a few people feel the need for help.

During a large–scale treatment programme, the key to success is the ability of the peripheral (village/subcentre) level team involved in MDA to communicate effectively with the community. Once the mutual confidence is built–up, the communication with people becomes easy and the treatment objectives and nature of possible reactions would be explained to them. The success of the strategy also depends on the speed of control measures put forth in order to prevent parasite becoming re–established within a stipulated period of time.

In filariasis, the life cycle of the parasite is relatively long. In contrast to malaria parasite, it does not multiply in the mosquito vector. The infective larvae transmitted by mosquito do not multiply in the human host. Prolonged exposure is required to develop patent infection in man. The incubation interval is one year or more. Therefore, the parasite never causes epidemics.

Achievements of National Filaria Control Programme
Filaria Cases

Year	Persons Examined	Cases detected		Hydrocele Operations
		MF	Disease
2001–02	971658	13142	2374	1642
2002–03	1003222	13848	2527	2666
2003–04	1055505	13292	1396	2287
2004–05	1086526	10311	1776	4232
2005–06	1045770	8270	1024	3615
2006–2007	925331	5588	623	3056
2007–2008	1049923	4705	655	4250
2008–09 up to May	194855	825	216	133

Note: B. S. above are Collected in the jurisdiction under filaria control units & filaria survey units & not in the whole state.
Expected Community Participation
Involvement of Panchayats in successful indoor residual insecticide spray is an essential aspect of the programme. Panchayats/villages/local bodies/village heads/BDOs/Mahila Mandals, religious groups etc. are to be informed about the spray schedule at least before a fortnight.

This advance information must be mopped up by surveillance workers/Malaria inspectors/DMOs so as to facilitate the villagers to extend full co–operation in getting actual spray inside of human dwelling with the objective of full coverage of targeted population.

Role of NGOs

1. Non Governmental Organizations (NGOs), Community Based Organisations (CBOs), Faith Based Organisations (FBOs) can play an important role in LF elimination.
2. These organisations should be invited to discussions when the annual strategic plan is prepared, so that they can identify areas of interest for their participation, which could be incorporated in the national plan.
3. A list of NGOs, DBOs, FBOs and enterprising Panchayats with the possible areas of partnership should be prepared.

The possible areas of partnership for an active role of voluntary organisations for Elimination of Lymphatic Filariasis (ELF) in India are identified in the following three specific areas

1. Mapping of areas through morbidity surveys.
2. Social Mobilization for drug compliance.
3. Supporting mass drug administration and management of adverse reactions.
4. Morbidity Management at community level.

Important Health Education Messages
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Role of other Sectors
The private health sector represents a substantial resource, especially in urban areas. Private medical practitioners can also be motivated through the professional organizations. These organizations can also identify areas in which the support of private physicians could best be utilised in mass drug administration and in morbidity (disability) management.

The private sector, industrial houses and private educational institutions are also important groups for organizing mass treatment campaigns for their employees. Large industries provide health services to their employees and their families and sometimes also provide health services to the industrial township or rural area where they are located. An inventory of private establishments will enhance planning for drug distribution.