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Elimination of diurnally sub-periodic Wuchereria bancrofti in Andaman and Nicobar Islands, India, using mass DEC-fortified salt as a supplementary intervention to MDA

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Abstract

Feasibility of implementing a DEC-fortified (DEC at 0.2% w/w and iodine) salt strategy to hasten elimination of diurnally sub-periodic Wuchereria bancrofti (DspWB) from the lone foci in Nancowry islands, Nicobar district, India, was assessed. This is a two-arm community-based study: one arm (12 villages, population 2936) received double fortified salt along with annual mass drug administration (MDA) of DEC plus albendazole (DEC-salt+MDA-arm), and another (14 villages; population 4840) received MDA under the National Filaria Elimination Programme. DEC salt was distributed on camp mode supplemented by door delivery. Monthly survey was carried out in fixed and random households to assess the coverage, usage of DEC salt and DEC content. The impact on prevalence of mf at community level and antigenaemia among children was assessed. A total of 21 metric tonnes of free-flow DEC salt manufactured by Tamil Nadu Salt Corporation, India, was distributed for 1 year. In the DEC-salt+MDA-arm, > 90% of the households received and used the DEC salt. DEC was within therapeutic range (0.2–0.32% w/w) in the samples collected from kitchens. Community mf prevalence reduced from 2.27 to 0.14% in the DEC-salt-arm (< 1% in all the villages) and 1.26 to 0.74% (> 1% in 4 out of 14 villages) in the MDA-arm. Ag prevalence reduced to zero from 1.0 (DEC-salt+MDA-arm) and 6.3% (MDA-arm) in 2–3 years old, 1.2 and 3.6% from 2.9 in the DEC-salt-arm and 4.5% in the MDA-arm among 6–7 years old. It was feasible to deliver DEC-fortified salt covering > 90% of the households with compliance reaching the elimination target in the islands.

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Acknowledgments

The authors are grateful to the Andaman and Nicobar Administration for the support extended during different phases of the study. We thank the community from the participating villages in Teressa and Nancowry for their cooperation. We gratefully acknowledge the support extended by the Chief Tribal Council, Nancowry and Teressa Islands and all the Chieftains of the respective villages in both the islands. We sincerely thank the Tamil Nadu Salt Corporation, Valinokkam, Ramanathapuram, for having consented to supply fortified salt. We sincerely thank Dr. H. M. Siddharaju, Chief Medical Officer, Community Health Centre, Kamorta, and Dr. Solomon Mark, Medical Officer, Primary Health Centre, Teressa, for extending their cooperation and assistance, and express our gratitude to the Director, Tribal Welfare, A&N Administration. The authors acknowledge the technical assistance rendered in the field by Mr. Ajay Kumar Das, Sociologist, Mr. Deepak, Mr. Shekhar Roy, Mr. Barun Bacher and Mr. Prabhu, Field Assistants. We gratefully acknowledge the support extended by the ANMs from the respective sub-centres and the staff from Anganwadi.

Funding

This study was supported by a grant from the Indian Council of Medical Research, New Delhi, scheme no. Tribal/52/2010-ECD-II.

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Authors and Affiliations

  1. ICMR-Vector Control Research Centre, Department of Health Research, Ministry of Health & Family Welfare, GOI, Medical Complex, Indira Nagar, Puducherry, 605 006, India

    A. N. Shriram, K. Krishnamoorthy, S. Subramanian & P. Jambulingam

  2. ICMR-Regional Medical Research Centre, Department of Health Research, Ministry of Health & Family Welfare, GOI, Port Blair, Andaman & Nicobar Islands, 744 101, India

    Addepalli Premkumar & P. Vijayachari

  3. Division of Malaria, Filaria & Vector Borne Diseases (NVBDCP), Directorate of Health Services, Andaman & Nicobar Administration, Port Blair, Andaman & Nicobar Islands, 744 101, India

    Amitabha De

  4. Directorate of Health Services, Andaman & Nicobar Administration, Port Blair, Andaman & Nicobar Islands, 744 104, India

    S. K. Paul

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  1. A. N. Shriram
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  2. Addepalli Premkumar
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  3. K. Krishnamoorthy
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Correspondence to P. Vijayachari.

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Shriram, A.N., Premkumar, A., Krishnamoorthy, K. et al. Elimination of diurnally sub-periodic Wuchereria bancrofti in Andaman and Nicobar Islands, India, using mass DEC-fortified salt as a supplementary intervention to MDA. Parasitol Res 119, 1467–1483 (2020). https://doi.org/10.1007/s00436-020-06659-7

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