Mass Drug Administration

കേരള സംസ്ഥാനത്ത് ഫെബ്രുവരിമാസത്തില്‍ സമൂഹ മന്തുരോഗചികിത്സാ പരിപാടി  (മാസ്ഡ്രഗ് അഡ്മിനിസ്ട്രേഷന്‍)നടപ്പിലാക്കും. മന്തുരോഗത്തിന് എതിരെയുള്ള ഡി.ഇ.സി, ആല്‍ബന്‍ഡസോള്‍ എന്നീ പാര്‍ശ്വഫലങ്ങളില്ലാത്ത മരുന്നുകളാണ് വിതരണം ചെയ്യുക.  ആരോഗ്യ പ്രവര്‍ത്തകര്‍, നേഴ്സിംഗ് വിദ്യാര്‍ത്ഥികള്‍, അംഗണ്‍വാടി പ്രവര്‍ത്തകര്‍, ആശ പ്രവര്‍ത്തകര്‍ എന്നിവര്‍ വീടുകളും സ്ഥാപനങ്ങളും സന്ദര്‍ശിച്ചു പ്രതിരോധ ഗുളികകള്‍ വിതരണം ചെയ്യും.മുന്നോരുക്കമെന്ന നിലയില്‍ മന്ത് രോഗികളായിട്ടാരെങ്കിലും അവരവരുടെ പ്രവര്‍ത്തന മേഖലയിലുണ്ടെങ്കില്‍ ആയവരുടെ വിശദാംശങ്ങള്‍ നിര്‍ദ്ദേശാനുസരണം ഉടന്‍ ശേഖരിച്ചു റിപ്പോര്‍ട്ട് ചെയ്യുകയും വിവിധ തലങ്ങളില്‍  പരിശീലനങ്ങളും  മുന്നൊരുക്ക യോഗങ്ങളും നടത്തുകയും ചെയ്യേണ്ടതുമാണ്. 

 
രാത്രികാല രക്തപരിശോധനകളില്‍ കൂടി മാത്രമേ മന്തുരോഗം തിരിച്ചറിയാന്‍ സാധിക്കുകയുള്ളൂ. ആരോഗ്യവാനായി തോന്നിപ്പിക്കുന്ന മന്തുരോഗ ലക്ഷണങ്ങള്‍ പ്രകടമാക്കാത്ത രോഗവാഹകരായ ആളുകളിലൂടെയാണ് രോഗം പകരുന്നത്. കൊതുക് മൂലമാണ് മന്ത് പകരുന്നത്. രോഗലക്ഷണങ്ങള്‍ മൂര്‍ച്ഛിച്ചാല്‍ മന്ത് ചികിത്സിച്ച്ഭേദമാക്കാന്‍കഴിയുന്നതല്ല. 
മനുഷ്യരില്‍നിന്ന് കൊതുകുകളിലേക്ക് രോഗാണുക്കളുടെ പകര്‍ച്ച തടയുകയാണ് സമൂഹചികിത്സാപരിപാടിയുടെ ലക്ഷ്യം. പൂര്‍ണ വളര്‍ച്ചത്തെിയ മന്തുവിരയുടെ ആയുസ്സ് നാലു മുതല്‍ ആറു വര്‍ഷം വരെയാണ്.

വര്‍ഷത്തില്‍ ഒരിക്കല്‍ തുടര്‍ച്ചയായി മുഴുവന്‍ ആളുകള്‍ക്കും ഗുളികകള്‍ നല്‍കി മൈക്രോ ഫൈലേറിയയുടെ അളവ് കുറക്കുകയാണ് പരിപാടി.

ഈ പ്രക്രിയയിലൂടെ കൊതുകുകള്‍ വഴിയുള്ള രോഗപകര്‍ച്ച പൂര്‍ണമായി ഇല്ലാതാക്കാം.രണ്ടു വയസ്സില്‍ താഴെയുള്ള കുട്ടികള്‍, ഗര്‍ഭിണികള്‍, ഗുരുതരരോഗികള്‍, പ്രായാധിക്യം ബാധിച്ചവര്‍ എന്നിവരെ സാമൂഹിക ചികിത്സയില്‍നിന്ന് ഒഴിവാക്കിയിട്ടുണ്ട്.

WHAT IS Mass Drug Administration(MDA)?

To interrupt the transmission of lymphatic filariasis, WHO recommends mass drug administration (MDA) with diethylcarbamazine (DEC) and albendazole to the entire endemic population. A single dose is administered annually for 4-6 years. Those excluded from MDA are children below two years and pregnant women  By 2010, 53 endemic countries had started implementing MDA. Of the 53 countries that had implemented MDA, 37 had already completed five or more rounds of MDA in at least some of their endemic areas. World Health Assembly Resolution 50.29 encourages Member States to eliminate lymphatic filariasis as a public-health problem. In response, WHO launched its Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000. The goal of the GPELF is to eliminate lymphatic filariasis as a public-health problem by 2020.

 WHY DO WE DO Mass Drug Administration?

 Lymphatic filariasis is one the only six infectious diseases considered eradicable by WHO with the available tools. Though the disease is not fatal, it is responsible for considerable morbidity causing social stigma among men, women and children. It is usually acquired during early childhood. It mainly afflicts poor people in both urban and rural areas. 

·         More than 1.3 billion people in 72 countries worldwide are threatened by lymphatic filariasis, commonly known as elephantiasis.

·         Over 120 million people are currently infected, with about 40 million disfigured and incapacitated by the disease.

·         Lymphatic filariasis can result in an altered lymphatic system and the abnormal enlargement of body parts, causing pain and severe disability.

·         Acute episodes of local inflammation involving the skin, lymph nodes and lymphatic vessels often accompany chronic lymphoedema.

·         To interrupt transmission WHO recommends an annual mass drug administration of single doses of two medicines to all eligible people in endemic areas.

Lymphatic filariasis

Lymphatic filariasis, commonly known as elephantiasis, is a neglected tropical disease. Infection occurs when filarial parasites are transmitted to humans through mosquitoes. When a mosquito with infective stage larvae bites a person, the parasites are deposited on the person's skin from where they enter the body. The larvae then migrate to the lymphatic vessels where they develop into adult worms in the human lymphatic system.

Infection is usually acquired in childhood, but the painful and profoundly disfiguring visible manifestations of the disease occur later in life. Whereas acute episodes of the disease cause temporary disability, lymphatic filariasis leads to permanent disability.

Currently, more than 1.3 billion people in 72 countries are at risk. Approximately 65% of those infected live in the WHO South-East Asia Region,

Lymphatic filariasis afflicts over 25 million men with genital disease and over 15 million people with lymphoedema.

Cause and transmission--Lymphatic filariasis is caused by infection with nematodes (roundworms) of the family Filariodidea. There are three types of these thread-like filarial worms:1.Wuchereria bancrofti, which is responsible for 90% of the cases2.Brugia malayi, which causes most of the remainder of the cases3.B. timori, which also causes the diseases.

Adult worms lodge in the lymphatic system and disrupt the immune system. They live for 6-8 years and, during their life time, produce millions of microfilariae (small larvae) that circulate in the blood.Lymphatic filariasis is transmitted by different types of mosquitoes for example by the Culex mosquito, widespread across urban and semi-urban areas; Anophelesmainly in rural areas, and Aedes, mainly in endemic islands in the Pacific.

Life cycle of Wuchereria bancrofti

 Symptoms-Lymphatic filariasis infection involves asymptomatic, acute, and chronic conditions. The majority of infections are asymptomatic, showing no external signs of infection. These asymptomatic infections still cause damage to the lymphatic system and the kidneys as well as alter the body's immune system.

Acute episodes of local inflammation involving skin, lymph nodes and lymphatic vessels often accompany the chronic lymphoedema or elephantiasis. Some of these episodes are caused by the body's immune response to the parasite. However most are the result of bacterial skin infection where normal defences have been partially lost due to underlying lymphatic damage.

When lymphatic filariasis develops into chronic conditions, it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (fluid accumulation). Involvement of breasts and genital organs is common.

Such body deformities lead to social stigma, as well as financial hardship from loss of income and increased medical expenses. The socioeconomic burdens of isolation and poverty are immense.

Morbidity management--------Morbidity management and disability prevention are vital for public health improvement and should be fully integrated into the health system. The GPELF focuses on training health-care workers and communities to dispense proper care and treatment.

Clinical severity of lymphoedema and acute inflammatory episodes can be improved using simple measures of hygiene, skin care, exercise, and elevation of affected limbs. Hydrocele (fluid accumulation) can be cured with surgery. Patients with chronic disabilities like elephantiasis, lymphoedema, or hydrocele are advised to maintain rigorous hygiene and take necessary precautions to prevent secondary infection and aggravation of the disease condition.

ഒക്ടോബര്‍ ഒന്ന്‍ ലോകവൃദ്ധദിനം;വരും തലമുറകള്‍ക്കുവേണ്ടി സ്വന്തം  ആരോഗ്യവും ശരീരവും മനസും ചിന്തകളും നിസ്വാര്‍ത്ഥമായി സമര്‍പ്പിച്ച നമ്മുടെ മുതിര്‍ന്നപൗരന്മാര്‍ക്കുവേണ്ടി, നമ്മുടെ പ്രിയപ്പെട്ട   മാതാപിതാക്കള്‍ക്കുവേണ്ടി ഒരു ദിനം-- നമ്മള്‍ മറന്നുപോകരുതാത്ത ഒരു ത്യാഗത്തിന്റെ ബാക്കിപത്രമായി രോഗങ്ങളും ഏകാന്തതയും ഏറ്റുവാങ്ങി ജീവിക്കുന്നവര്‍ക്കുവേണ്ടി ഒരു ദിനംകൂടി.കേരളത്തില്‍2011-ലെ  കാനേഷുമാരി പ്രകാരം വൃദ്ധരുടെ എണ്ണം ഏകദേശം 12 ശതമാനം ആയതായാണ് കണക്ക്.ഇനി നമ്മള്‍ നമ്മുടെ ചിന്തകളിലും  ആസൂത്രണ പ്രക്രിയകളിലും  ഈ കണക്കുകൂടി നിശ്ചയമായും പരിഗണിക്കേണ്ടതാണ്.ഇതുകൊണ്ടുതന്നെയാവണം ഈ വര്‍ഷത്തെ ലോകാരോഗ്യദിനത്തിന്‍റെ ചിന്താവിഷയം “വാര്‍ദ്ധക്യത്തിലെ ആരോഗ്യം” എന്നായി നിശ്ചയിക്കപ്പെട്ടിട്ടുള്ളത്.നമുക്കും നമ്മുടെ മക്കള്‍ക്കുംവേണ്ടിമാത്രമായി  എല്ലാ കണക്കുകളും കൂട്ടിക്കിഴിക്കുന്ന നമ്മുടെ മനസിലെങ്കിലും മുതിര്‍ന്നവര്‍ക്കായി സ്വസ്തമായ ഒരിടം നമുക്കും കരുതിവയ്ക്കാം.എല്ലാ മനുഷ്യരും എത്തിച്ചേരുന്ന ഈ അവസ്ഥയുടെ പ്രത്യേകതകളിലേക്ക് നമുക്കൊന്ന് കണ്ണോടിക്കാം.വാര്‍ദ്ധക്യത്തെ അറിയുകയുംഅതിജീവിക്കുവാനുംസഹായിക്കുവാനുംസ്വയം തയ്യാറെടുക്കുകയും ചെയ്യാം. 

Geriatrics

The term geriatrics comes from the Greek  geron meaning "old man" and iatros meaning "healer".

Geriatrics IS the branch of health care dealing with the problems of aging and diseases of the aged; it is related to the science of gerontology, which is the study of the aging process in all its aspects, social as well as biologic. Geriatrics grows increasingly important as modern medicine and a rising standard of living lengthen life expectancy and increase the proportion of aged persons in society. It is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people which aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician. Rather, this decision is determined by the individual patient's needs, and the availability of a doctor.

An important part of geriatrics is helping older persons live happy and satisfying lives,encourage the patients to follow useful and interesting pursuits and to adopt a sound mental attitude toward aging itself. The prevention of disease is also important in geriatrics, and stress is placed on suitable exercise, rest, and nutrition, and on maintenance of proper body weight. Regular and thorough medical examinations are another essential factor in the control of illness.And there is also a concern for the older person's psychological welfare, such as social contacts, economic security, interest in living, work opportunities after retirement, and continuing sense of belonging to society. Geriatrics recognizes that health of mind is essential to the health of the body

Ageing is referred to the  accumulation of changes that render a person more vulnerable to death. Usually the term ‘old age’ is a reference to people who are at the end of an average lifespan or, to those who have exceeded it. In many societies retirement, usually after the age of 60-65, is the doorway to old age.

There was a time when it was thought that a silver streak in  a person’s hair was  the  first sign of ageing. But in these modern times of stress, pollution and diseases,  premature graying is the order of the day. Nevertheless, classical symptoms such as  liver spots on the skin, graying and loss of hair, diminished sight and hearing, reduced  agility and memory are some of the signposts along the path of ageing The branch of medicine dealing with old age, called ‘Geriatrics’ still remains an  ill-defined branch of medicine. The fact that the elderly have a set of physical and   psychological needs which are different from young or middle aged adults, was   traditionally ignored. ‘Geriatric psychiatry’ was a term ‘waiting in the wings’ -yet to be coined.  The discovery of antibiotics, in the latter half of the twentieth century, helped to  increase the number of the elderly substantially enough to be taken seriously.  Today older individuals comprise of an ever- expanding population thanks  to better treatment strategies for  chronic conditions including Coronary Artery  Disease (CAD) and Cancer. And Geriatrics, as a speciality, has almost come of age!  Chronic diseases and increased mortality  are often cited as  the hall mark of old age.  There is a long-standing belief that ageing and diseases  are  inseperable. However,  studies  have revealed that ageing is inevitable, but diseases are not. Nevertheless,  a correlation has been observed between age and  chronic diseases such as cardiovascular  diseases, diabetes,  cancer,  arthritis, osteoporosis, alzheimer’s and   dementia.  Older people are often referred to as  ‘seniors’ or  ‘elderly’ in an attempt to soften  the impact of the prejudice that exists towards them. Although growing old is an integral  part of the human  life span, old people are often discriminated against, often by their own family. This could  be because they are physically weak and need looking after or because they suffer from  mental changes due to conditions such as dementia. These changes, whether physical  or mental, may become a burden on the family. As an extreme manifestation, this  discrimination against the elders can lead to neglect and isolation and it is not uncommon  for elders to be totally abandoned.                                   GERIATRIC PROBLEMS Present scenario in INDIA •Cataract &Visual impairment- 88% •Arthritis &locomotion disorder-40% •CVD &HT – 18% •Neurological problems- 18% •Respiratory problems including Chronic bronchitis- 16% •GIT problems- 9% •Psychiatric problems- 9% •Loss of Hearing – 8%    GERIATRIC PROBLEMS can be classified as follows                                                HEALTH PROBLEMS PSYCHOLOGICAL PROBLEMS SOCIAL PROBLEMS Joint problems Impairment of special senses Cardio vascular disease Hypothermia Cancer, Prostate enlargement, Diabetes&Accidental falls Emotional problems Suicidal tendency Senile dementia,  Alzheimer’disease Poverty,  Loneliness, Dependency, Isolation, Elder abuse, Generation Gap  In general, most of common geriatric problems consist of 5 types, they are: 1. Cognitive Loss; including Alzheimer and dementia 2. Depression 3. Visual impairment 4. Joint pain  5. Hearing problems Cognitive loss means problems occur related to loss of memory. Include loss of reasoning,  concentration, intelligence, and other mental functions. This happened a lot in senior community.  Alzheimer and dementia are advanced form of cognitive problems. There is no cure for this  problems but antioxidant can be used as a treatment. Depression is a medical illness which intense feelings of sadness appeared. It also related to  low mood that affect someone’s behavior and thoughts. Some of senior feel depression  throughout their lives. Feel loneliness may be the most common factor behind depression.  If we have a relative who are geriatric one and feel depressed we should give our care to them. Visual impairment connects with some loss of vision. Sometimes even with eyeglasses  you may not see well. Visual impairment can be grouped into 3 degrees: low vision,  severe vision and legal blindness. Geriatric patient commonly have low and severe  vision that include glaucoma also. The treatment would be available by prescription  medication. Depends on the problem, whether you have cataract or glaucoma. You  should seek your doctor for immediate assistance. Regular screening is also recommended  for senior since this condition tends to grow as become older the person is. Joint disorder experienced by many elderly. This happened because as people grow  older the cartilage at the joint became weaker. Osteoarthritis is the example. Exercise  regularly is more like prevention rather than medication. Anti-inflammatory medications   may help relieve the pain even no cure for it. Hearing problems associated with sudden or gradual decrease in how well you can hear.  It is usually worsen when you become older. Almost half of geriatric patient have a problem  with hearing loss. It could be missing certain sounds and also total deaf. Using hearing   aids can help. But some medication or special training can be very helpful also.  Seek physician opinion regarding this matter, sometime surgery also an appropriate  option if you want to hear completely.