Pervasive Developmental Disorders

PDD-NOS Module

PDD-NOS Module

PDD-NOS Module

Data

Data Collection
It summarizes information about the data sources needed to monitor &  evaluate the program.
The plan should include information for each data source such as:
• The timing and frequency of collection
• The person/agency responsible for the collection
• The information needed for the indicators
• Any additional information that will be obtained from the source

Data Quality
Data quality is important to consider when determining the usefulness of various data sources; the data collected are most useful when they are of the highest quality.
It is important to use the highest quality data that are obtainable, but this often requires a trade off with what it is feasible to obtain. The highest quality data are usually obtained through the triangulation of data from several sources. It is also important to remember that behavioral and motivational factors on the part of the people collecting and analyzing the data can also affect its quality.

Some types of errors or biases common in data collection include:
• Sampling bias: occurs when the sample taken to represent population values is not a representative sample
• Non-sampling error: all other kinds of measurement, such as courtesy bias, incomplete records, or non-response rates
• Subjective measurement: occurs when the data are influenced by the measure

Here are some data quality issues to consider:
• Coverage: Will the data cover all of the elements of interest?
• Completeness: Is there a complete set of data for each element of interest?
• Accuracy: Have the instruments been tested to ensure validity and reliability of the data?
• Frequency: Are the data collected as frequently as needed?
• Reporting Schedule: Do the available data reflect the time periods of interest?
• Accessibility: Are the data needed collectable/retrievable?
• Power: Is the sample size big enough to provide a stable estimate or detect change?

Data Use
The term data refers to raw, unprocessed information while information, or strategic information, usually refers to processed data or data presented in some sort of context.

Collecting data is only meaningful and worthwhile if it is subsequently used for evidence-based decision-making. To be useful, information must be based on quality data, and it also must be communicated effectively to policy makers and other interested stakeholders.
M&E data need to be manageable and timely, reliable, specific to the activities in question, and the results need to be well understood.

The key to effective data use involves linking the data to the decisions that need to be made and to those making these decisions.
The decision-maker needs to be aware of relevant information in order to make informed decisions.
When decision-makers understand the kinds of information that can be used to inform decisions and improve results, they are more likely to seek out and use this information.

Health Information Systems (HIS)

Health information systems refer to any system that captures, stores, manages or transmits information related to the health of individuals or the activities of organisations that work within the health sector. This definition incorporates things such as district level routine information systems, disease surveillance systems, and also includes laboratory information systems, hospital patient administration systems (PAS) and human resource management information systems (HRMIS). Overall, a well-functioning HIS is an integrated effort to collect, process, report and use health information and knowledge to influence policy and decision-making, programme action, individual and public health outcomes, and research. Sound decision-making at all levels of a health system requires reliable health statistics that are disaggregated by sex, age and socioeconomic characteristics. At a policy level, decisions informed by evidence contribute to more efficient resource allocation and, at the delivery level, information about the quality and effectiveness of services can contribute to better outcomes.

Information systems, particularly at lower levels of the health system (closer to the collection source), need to be simple and sustainable and not overburden health delivery staff or be too costly to run. Staff need feedback on how the routine data they collect can be used and also need to understand the importance of good quality data for improving health. Capacity building is required to ensure policymakers at all levels have the ability to use and interpret health data, whether it originates from routine systems, health surveys or special operational research. It is also important that health system staff understand the significance of local data for local program management, and that their needs for strengthened capacity for critical health statistical analysis are met. Local use of data collected at lower levels of the health system is a key step for improving overall data quality. Furthermore, aggregate patient information collected at various points of service delivery and made interoperable with routine HIS improves the quality and use of health information.

1.     Health Information Systems Resources

These include the legislative, regulatory and planning frameworks required for a fully functioning health information system, and the resources that are required for such a system to be functional. Such resources involve personnel, financing, logistics support, information and communications technology (ICT), and coordinating mechanisms within and between the six components

2.     Indicators

A core set of indicators and related targets is the basis for a health information system plan and strategy. Indicators need to encompass determinants of health; health system inputs, outputs and outcomes; and health status

3.     Data Sources

These can be divided into two main categories; (1) population-based approaches (censuses, civil registration and population surveys) and (2) institution-based data (individual records, service records and resource records). A number of data-collection approaches and sources do not fit into either of the above main categories but can provide important information that may not be available elsewhere. These include occasional health surveys, research, and information produced by community based organisations

4.     Data Management

This covers all aspects of data handling from collection, storage, quality-assurance and flow, to processing, compilation and analysis

5.     Information Products

Data must be transformed into information that will become the basis for evidence and knowledge to shape health action

6.     Dissemination and Use

  The value of health information is enhanced by making it readily accessible to decision-makers and by providing incentives for, or otherwise facilitating, information use.

Source taken from: http://phinnetwork.org/resources/health-information-systems-his/

Manfaat kayu manis

Manfaat kayu manis:

1. Mengatur gula darah

2. Mengurangi kadar kolesterol LDL/kolesterol berbahaya. mengurangi resiko penyakit kardiovaskular.

3. Memiliki senyawa anti infeksi alami. Kayu manis efektif terhadap H. pylori yaitu bakteri penyebab borok atau bisul dan patogen lainnya.

4. Mengurangi rasa sakit terkait dengan arthritis,

5. Mengurangi sitokin terkait dengan nyeri rematik.

6. Mengurangi proliferasi sel kanker, pencegahan kanker.

7. Mengandung serat, kalsium, zat besi, dan mangan

8. Zat kimia alami cinnamaldehyde, meningkatkan hormon progesteron dan menurunkan produksi testosteron pada wanita, menyeimbangkan hormon kesuburan.

9. Perawatan penyakit neurodegenerative (Alzheimer, Parkinson, multiple sclerosis, tumor otak, dan meningitis,

10. Mengurangi peradangan kronisn gangguan neurologis

11. Berpotensi efektif terhadap HIV4, sama dgn Cardiospermum helicacabum.

12. Mencegah penyakit jantung.

13. Menyehatkan pembuluh darah.

14. Mengurangi peradangan kronis

15. Mencegah Parkinson

16. Mengobati alzheimer

17. Mengobati tumor otak

18. Mengobati meningitis

Pertolongan Pertama Pada Patah Tulang

Pertolongan Pertama Pada Kecelakaan (P3K) Patah Tulang – Pertolongan pertama perlu dilakukan pada korban yang mengalami patah tulang, sebelum ia mendapatkan perawatan medis yang lebih intensif. Namun sebelum melakukan pertolongan pertama ini ada beberapa tindakan yang harus dilakukan yakni; terlebih dulu menghangatkan tubuh korban. Jika dirasa perlu boleh untuk diberikan perawatan shock. Setelah itu taruhlah kantong es pada bagian yang mengalami patah tulang.



Selanjutnya lakukan pemeriksaan seksama pada korban. Jika tulang yang patah itu menembus pada permukaan kulit dan menimbulkan pendarahan berat, untuk menghentikan pendarahan ini, jangan melakukan tindakan menekan tulang kembali ke tempat semula atau biarkan dengan apa adanya dulu. Selain itu jangan melakukan pencucian pada luka.



Selanjutnya panggil ambulans untuk membawa korban ke rumah sakit atau bawalah ke dokter terdekat.



Jika korban harus diangkat untuk mendapatkan pertolongan medis lebih lanjut, sebaiknya pada bagian tulang yang patah itu diikat atau dijepit dengan potongan kayu (splint) untuk mengantispasi atau mencegah kemungkinan terjadinya kerusakan susulan pada tulang. Pengikat atau penjepit dapat dibuat dan bahan apa saja yang penting dapat mem buat tulang yang patah tersebut tidak bergerak.



Bahan untuk membuat jepitan itu bisa majalah, tangkai sapu, papan atau bahan-bahan lain yang mendukung. Penjepit dibuat secara memanjang sehingga melewati sendi di atas dan bawah dan bagian tulang yang patah itu.



Jika patah tulang ini dialami dalam sebuah kecelakaan mobil:



1. maka jepitlah kaki dan tangan korban yang mengalami patah tulang ketika masih di dalam mobil.

2. Gunakan pembalut atau bahan-bahan lain untuk mengikat kaki atau tangan yang mengalami patah tulang itu ke bagain kaki atau tangan satunya yang masih baik.

3. Ikat bagian atas dan bawah dan organ yang patah itu dengan kencang dan baik sehingga tidak memungkinkannya untuk bergerak lagi.



Namun jika pengikatan itu tidak mungkin untuk dilakukan di dalam mobil dan badan korban harus ditarik keluar maka langkah-langkahnya adalah;



1. Badan korban dikeluarkan dengan cara ditarik. Tujuannya agar tidak ada pergeseran pada organ yang mengalami patah tulang sehingga pengikatan yang akan dilakukan berlangsung dengan baik.



2. Dukunglah anggota badan korban dengan tangan pada kedua sisi dan bagian tubuh yang patah, sementara itu teman Anda dapat menariknya dengan hati-hati sampai sebisa mungkin mendekati pada posisi semula.



Untuk jepitan akan lebih baik jika dilapisi dengan kapas atau kain. Kemudian ikatlah sedemikian rupa dengan ikatan yang tidak terlalu kencang. Ikatan itu bisa dan kain pembalut, ikat pinggang, dasi atau kain panjang. Ikatan pada tangan atau kaki ditujukan agar bagian tulang yang patah itu tidak bergerak-gerak. Untuk selanjutnya serahkan penanganan tulang agar dapat kembali ke posisi yang sebenarnya kepada dokter.



Bila tulang yang patah itu terdapat di organ punggung, leher atau tengkorak maka jangan melakukan pengangkatan terhadap korban.

10 Langkah Tindakan Resusitasi Jantung Paru (RJP)

Resusitasi jantung paru-paru atau CPR adalah tindakan pertolongan pertama pada orang yang mengalami henti napas karena sebab-sebab tertentu.

CPR bertujuan untuk membuka kembali jalan napas yang menyempit atau tertutup sama sekali. CPR sangat dibutuhkan bagi orang tenggelam, terkena serangan jantung, sesak napas karena syok akibat kecelakaan, terjatuh, dan sebagainya.

Namun yang perlu diperhatikan khusus untuk korban pingsan karena kecelakaan, tidak boleh langsung dipindahkan karena dikhawatirkan ada tulang yang patah. Biarkan di tempatnya sampai petugas medis datang. Berbeda dengan korban orang tenggelam dan serangan jantung yang harus segera dilakukan CPR.

Tahap untuk mendapatkan Resusitasi yang efektif adalah dengan memeriksa Airway, Breathing, Circulation (ABC)

Tahap-Tahap RJP :
1. Periksa Kesadaran Penderita
·   Menepuk bahu/ menggoyangkan badan penderita
·   Jika belum merespon, panggil dengan suara keras
·   Jika tidak merespon lakukan tahap ke-2
2. Call For Help
·   Berteriak minta tolong dengan orang sekitar
·    Aktifkan EMS (Emergency Medical Service) dengan menelpon 911 atau Panggilan petugas kesehatan terdekat
·  Saat menghubungi petugas kesehatan, informasikan tentang kejadian, jarak terdekat menuju kejadian, nama tempat kejadian, lantai, kamar, dengan lengkap
·  Jelaskan nama anda yang menghubungi, apa yang terjadi, jumlah korban, kondisi korban, dan pertolongan yang sudah diberikan.
·  Sementara menunggu petugas kesehatan datang lakukan tahap ke-3
3. Atur Posisi Korban
·   Posisi baring telentang (agar efektif dalam melakukan pemeriksaan napas dan nadi
·   Baringkan ditempat datar dan  keras
4. Ekstensikan Kepala Korban
·   Tehnik mengangkat dengan cara 1 tangan di dahi korban dan tangan lainnya di bawah dagu korban
5.  Periksa Mulut Korban
·   Kaji adanya benda asing/ material muntahan dimulut korban. Jika terlihat ambil benda asing tersebut. Pengambilan material cair dengan kain, pengambilan material padat dengan jari
·   JANGAN MEMBUANG WAKTU UNTUK TINDAKAN INI SAJA, lakukan tahap 6
6.  Periksa Napas
·   Lihat dada penderita apakah  normal (normalnya turun naik)
·   Dengar suara napas dengan merasakan hembusan napas di pipi
·   Jika tidak ada tanda-tanda napas, lanjut ke tahap-7
7.    Beri 2x napas buatan
·  Pencet hidung korban, lingkari mulut korban dengan mulut anda secara ketat
·  Hembuskan napas pelan dan dalam  sampai melihat dada penderita naik
·  Batas waktu antara napas kedua 1,5 detik
8. Periksa nadi korban
·   Pada orang dewasa terletak di arteri karotis (leher)
·   Angkat dagu seperti tahap 4, tekan dan  rasakan nadi carotis, tahan 5-10 detik
·   Jika nadi ADA dan napas TIDAK ADA, beri napas buatan sebanyak 10-12x/menit
·   Jika nadi dan napas TIDAK ADA, mulai gunakan KOMPRESI DADA
9.  Kompresi Dada
·   Tekan teratur pada dinding dada. Diharapkan darah akan mengalir ke organ vital dan organ vital masih tetap berfungsi hingga EMS datang
·  Lokasi penekanan pada area, dua jari di atas proxesus xifoideus.
·  Penekanan dilakukan dengan menggunakan pangkal telapak tangan. Dengan posisi satu tangan diatas tangan yang lain.
· Tekanan pada tulang dada dilakukan sedemikian rupa sehingga masuk 3-4 cm (pada orang dewasa).
·  Jaga lengan penolong agar tetap lurus, sehingga yang menekan adalah bahu (atau lebih tepat tubuh bagian atas) dan bukan tangan atau siku
·  Pastikan tekanan lurus ke bawah pada tulang dada karena jika tidak, tubuh dapat tergelincir dan tekanan untuk mendorong akan hilang
·  Gunakan berat badan saat kita berikan tekanan
·  Dorongan yang terlalu besar akan mematahkan tulang dada
·  Waktu untuk menekan dan waktu untuk melepas harus sama waktunya
·  Berikan kompresi 30x dengan kecepatan 80-100x/menit
·  Setiap 30 kali kompresi harus dikombinasikan dengan napas buatan
10.  Kordinasikan Antara Kompresi dengan napas buatan
·  Setiap akhir 30x kompresi diselingi dengan 1-1,5 detik napas buatan
·  Rangkaian 30 kali kompresi dan 2 kali napas buatan diulang selama 5 kali siklus baru lakukan evaluasi nadi(tahap ke-8)
·  Lanjutkan resusitasi hingga petugas kesehatan datang

Tanda-tanda keberhasilan RJP :
1.     Dada harus naik dan turun dengan setiap tiupan (ventilasi)
2.     Pupil bereaksi atau tampak berubah normal (pupil harus mengecil saat diberikan cahaya)
3.     Denyut jantung kembali terdengar Reflek pernapasan spontan
4.     Dapat terlihat Kulit penderita pucat berkurang atau kembali normal
5.     Penderita dapat menggerakkan tangan atau kakinya
6.     Penderita berusaha untuk menelan
7.     Penderita menggeliat atau memberontak

Langkah - Langkah CPR/RJP Atau Cara Melakukan CPR/RJP

Resusitasi jantung paru-paru atau CPR adalah tindakan pertolongan pertama pada orang yang mengalami henti napas karena sebab-sebab tertentu. CPR bertujuan untuk membuka kembali jalan napas yang menyempit atau tertutup sama sekali. CPR sangat dibutuhkan bagi orang tenggelam, terkena serangan jantung, sesak napas karena syok akibat kecelakaan, terjatuh, dan sebagainya.

Proses Menstruasi Wanita.mp4

Oral Manifestations of HIV: Case Studies

Filariasis

Filariasis adalah sejumlah infeksi yang disebabkan oleh cacing filaria. Penyakit ini dapat menyerang hewan maupun manusia. Parasit filaria memiliki ratusan jenis, tapi hanya delapan spesies yang dapat menyebabkan infeksi pada manusia.

Pengelompokan filariasis umumnya dikategorikan menurut lokasi habitat cacing dewasa dalam tubuh manusia, yaitu filariasis kulit, limfatik, dan rongga tubuh. Di sini akan dibahas lebih detail mengenai filariasis limfatik. Di Indonesia, penyakit ini lebih dikenal dengan istilah kaki gajah atau elefantiasis.

Penyebab dan Penularan Filariasis
Gejala-gejala Filariasis
Diagnosis dan Pengobatan Filariasis

• Operasi.

• Melakukan olahraga ringan untuk bagian tubuh yang mengalami penumpukan cairan untuk memicu pengalirannya.

• Membersihkan bagian yang bengkak dengan seksama tiap hari untuk mencegah infeksi.

• Mensterilkan luka jika ada.

Langkah Pencegahan Filariasis

• Mengenakan baju atau celana panjang.

• Mengoleskan losion antinyamuk.

• Tidur di dalam kelambu.

• Membersihkan genangan air di sekitar lingkungan.

Menurut WHO, terdapat sekitar 120 juta orang di dunia yang menderita filariasis limfatik dan sepertiga di antaranya mengidap infeksi yang parah. Parasit yang dapat menyebabkan jenis filariasis ini meliputi Wuchereria bancrofti, Brugia malayi, dan Brugia timori.

W. bancrofti merupakan parasit yang paling sering menyerang manusia. Diperkirakan ada 9 dari 10 pengidap yang menderita filariasis limfatik akibat parasit ini.

Parasit filaria masuk ke tubuh manusia melalui gigitan nyamuk yang sudah terinfeksi. Cacing tersebut akan tumbuh dewasa, bertahan hidup selama enam hingga delapan tahun, dan terus berkembang biak dalam jaringan limfa manusia.

Infeksi ini umumnya dialami sejak masa kanak-kanak dan menyebabkan kerusakan pada sistem limfatik yang tidak disadari sampai akhirnya terjadi pembengkakan yang parah dan menyakitkan. Pembengkakan tersebut kemudian dapat menyebabkan cacat permanen.

Berdasarkan gejalanya, filariasis limfatik terbagi dalam tiga kategori yang meliputi kondisi tanpa gejala, akut, dan kronis.

Sebagian besar infeksi filariasis limfatik terjadi tanpa menunjukkan gejala apa pun. Meski demikian, infeksi ini tetap menyebabkan kerusakan pada jaringan limfa dan ginjal sekaligus memengaruhi sistem kekebalan tubuh.

Filariasis limfatik akut terbagi lagi dalam dua jenis, yaitu adenolimfangitis akut (ADL) dan limfangitis filaria akut (AFL).

Jika mengidap ADL, pasien akan mengalami gejala demam, pembengkakan noda limfa atau kelenjar getah bening (limfadenopati), serta bagian tubuh yang terinfeksi akan terasa sakit, memerah, dan membengkak. ADL dapat kambuh lebih dari satu kali dalam setahun. Cairan yang menumpuk dapat memicu infeksi jamur pada kulit yang merusak kulit. Semakin sering kambuh, pembengkakan bisa semakin parah.

Sedangkan AFL yang disebabkan oleh cacing-cacing dewasa yang sekarat akan memicu gejala yang sedikit berbeda dengan ADL karena umumnya tidak disertai demam atau infeksi lain. Di samping itu, AFL dapat memicu gejala yang meliputi munculnya benjolan-benjolan kecil pada bagian tubuh, tempat cacing-cacing sekarat terkumpul (misalnya pada sistem getah bening atau dalam skrotum).

Sementara jenis ketiga, yaitu kondisi kronis, akan menyebabkan limfedema atau penumpukan cairan yang menyebabkan pembengkakan pada kaki dan lengan. Penumpukan cairan dan infeksi-infeksi yang terjadi akibat lemahnya kekebalan tubuh akhirnya akan berujung pada kerusakan dan ketebalan lapisan kulit. Kondisi ini disebut sebagai elefantiasis. Selain itu, penumpukan cairan juga bisa berdampak pada rongga perut, testis pada penderita laki-laki dan payudara pada penderita wanita.

Proses diagnosis filariasis limfatik dapat dilakukan melalui tes darah dan tes urine. Kedua tes ini akan mendeteksi keberadaan parasit filaria dalam tubuh pasien. Tes darah akan dilakukan pada malam hari saat parasit aktif.

Jika positif terdiagnosis, dokter akan memberikan obat-obatan anti-filaria untuk menangani filariasis limfatik. Contoh obat yang umumnya digunakan adalah diethylcarbamazine (DEC). Kondisi kronis juga terkadang harus disertai dengan langkah penanganan lain yang meliputi:

Langkah utama dalam untuk mencegah tertular filariasis adalah dengan menghindari gigitan nyamuk sebisa mungkin. Hal ini sangat penting, terutama di negara-negara tropis, seperti Indonesia. Untuk memaksimalisasi perlindungan terhadap gigitan nyamuk, kita dapat mengambil langkah-langkah sederhana yang meliputi:

Filariasis

From Wikipedia, the free encyclopedia

Filariasis
Life cycle of Wuchereria bancrofti, a parasite that causes filariasis
Classification and external resources
Specialty	Infectious disease
ICD-10	B74
ICD-9-CM	125.0-125.9
Patient UK	Filariasis
MeSH	D005368
[edit on Wikidata]

Filariasis (or philariasis) is a parasitic disease caused by an infection withroundworms of the Filarioidea type.^[1] These are spread by blood-feeding black flies and mosquitoes. This disease belongs to the group of diseases called helminthiasis.

Eight known filarial nematodes use humans as their definitive hosts. These are divided into 3 groups according to the niche within the body they occupy:

• Lymphatic filariasis is caused by the worms Wuchereria bancrofti, Brugia malayi, and Brugia timori. These worms occupy the lymphatic system, including the lymph nodes; in chronic cases, these worms lead to the disease elephantiasis.
• Subcutaneous filariasis is caused by Loa loa (the eye worm), Mansonella streptocerca, and Onchocerca volvulus. These worms occupy thesubcutaneous layer of the skin, in the fat layer. L. loa causes Loa loafilariasis, while O. volvulus causes river blindness.
• Serous cavity filariasis is caused by the worms Mansonella perstans andMansonella ozzardi, which occupy the serous cavity of the abdomen.

The adult worms, which usually stay in one tissue, release early larval forms known as microfilariae into the host's bloodstream. These circulating microfilariae can be taken up with a blood meal by the arthropod vector; in the vector, they develop into infective larvae that can be transmitted to a new host.

Individuals infected by filarial worms may be described as either "microfilaraemic" or "amicrofilaraemic", depending on whether microfilariae can be found in their peripheral blood. Filariasis is diagnosed in microfilaraemic cases primarily through direct observation of microfilariae in the peripheral blood. Occult filariasis is diagnosed in amicrofilaraemic cases based on clinical observations and, in some cases, by finding a circulating antigen in the blood.

Signs and symptoms

The most spectacular symptom of lymphatic filariasis is elephantiasis—edema with thickening of the skin and underlying tissues—which was the first disease discovered to be transmitted by mosquito bites.^[2] Elephantiasis results when the parasites lodge in the lymphatic system.

Elephantiasis affects mainly the lower extremities, while the ears, mucous membranes, and amputation stumps are affected less frequently. However, different species of filarial worms tend to affect different parts of the body; Wuchereria bancroftican affect the legs, arms, vulva, breasts, and scrotum (causing hydrocele formation), while Brugia timori rarely affects the genitals.^{[citation needed]} Those who develop the chronic stages of elephantiasis are usually amicrofilaraemic, and often have adverse immunological reactions to the microfilariae, as well as the adult worms.^[2]

The subcutaneous worms present with rashes, urticarial papules, and arthritis, as well as hyper- and hypopigmentationmacules. Onchocerca volvulus manifests itself in the eyes, causing "river blindness" (onchocerciasis), one of the leading causes of blindness in the world.^{[citation needed]} Serous cavity filariasis presents with symptoms similar to subcutaneous filariasis, in addition to abdominal pain, because these worms are also deep-tissue dwellers.

Cause

Human filarial nematode worms have complicated lifecycles, which primarily consists of five stages. After the male and female worms mate, the female gives birth to live microfilariae by the thousands. The microfilariae are taken up by thevector insect (intermediate host) during a blood meal. In the intermediate host, the microfilariae molt and develop into third-stage (infective) larvae. Upon taking another blood meal, the vector insect injects the infectious larvae into the dermis layer of the skin. After about one year, the larvae molt through two more stages, maturing into the adult worms.

Diagnosis

Filariasis is usually diagnosed by identifying microfilariae on Giemsa stained, thin and thick blood film smears, using the "gold standard" known as the finger prick test. The finger prick test draws blood from the capillaries of the finger tip; larger veins can be used for blood extraction, but strict windows of the time of day must be observed. Blood must be drawn at appropriate times, which reflect the feeding activities of the vector insects. Examples are W. bancrofti, whose vector is a mosquito; night is the preferred time for blood collection. Loa loa's vector is the deer fly; daytime collection is preferred. This method of diagnosis is only relevant to microfilariae that use the blood as transport from the lungs to the skin. Some filarial worms, such as M. streptocerca and O. volvulus, produce microfilarae that do not use the blood; they reside in the skin only. For these worms, diagnosis relies upon skin snips, and can be carried out at any time.

Concentration methods

Polymerase chain reaction (PCR) and antigenic assays, which detect circulating filarial antigens, are also available for making the diagnosis. The latter are particularly useful in amicrofilaraemic cases. Spot tests for antigen^[3] are far more sensitive, and allow the test to be done any time, rather in the late hours.Various concentration methods are applied: membrane filter, Knott's concentration method, and sedimentation technique.

Lymph node aspirate and chylus fluid may also yield microfilariae. Medical imaging, such as CT or MRI, may reveal "filarial dance sign" in chylus fluid; X-ray tests can show calcified adult worms in lymphatics. The DEC provocation test is performed to obtain satisfying numbers of parasites in daytime samples. Xenodiagnosis is now obsolete, and eosinophilia is a nonspecific primary sign.

Treatment

The recommended treatment for people outside the United States is albendazole (a broad-spectrum anthelmintic) combined with ivermectin. A combination of diethylcarbamazine and albendazole is also effective.^[4] All of these treatments are microfilaricides; they have no effect on the adult worms. Different trials were made to use the known drug at its maximum capacity in absence of new drugs. In a study from India, it was shown that a formulation of albendazole had better anti-filarial efficacy than albendazole itself.^[6]

In 2003, the common antibiotic doxycycline was suggested for treating elephantiasis.^[7] Filarial parasites have symbiotic bacteria in the genus Wolbachia, which live inside the worm and seem to play a major role in both its reproduction and the development of the disease. Clinical trials in June 2005 by the Liverpool School of Tropical Medicine reported an eight-week course almost completely eliminated microfilaraemia

Transmission assessment surveys

Transmission Assessment Survey (TAS): A survey designed to measure whether evaluation units have lowered the prevalence of infection to a level where recrudescence is unlikely to occur, even in the absence of MDA interventions.

Evaluation is necessary to determine whether the programme has achieved its objective of reducing levels of microfi lariae in endemic populations to an extent where transmission is likely no longer sustainable. Programmes must be able to assess whether MDA has succeeded in lowering the prevalence of infection to a level where recrudescence is unlikely to occur.

Transmission Assessment Surveys (TAS) are designed to help programme managers determine whether areas have reached this critical threshold of infection can be used to automate the calculations for determining the appropriate survey strategy. Th e design of the TAS is fl exible in
order to best fit the local situation; it depends upon factors such as the net primary school enrolment ratio, the population size, the number of schools or enumeration areas and the feasibility of different survey methods.

While the TAS provides helpful evidence to national programmes regarding the decision to stop MDA, programme managers must thoughtfully consider the decision about whether to stop or to continue MDA.

Lymphatic Filariasis Elimination Goal

Strategy for Elimination of Lymphatic Filariasis 

• Annual Mass Drug Administration (MDA) of single dose of DEC (Diethylcarbamazine citrate) and Albendazole for 5 years or more to the eligible population (except pregnant women, children below 2 years of age and seriously ill persons) to interrupt transmission of the disease.

• Home based management of lymphoedema cases and up-scaling of hydrocele operations in identified CHCs/ District hospitals /medical colleges.

Progress and AchievementIn pursuit of the goals, the Government of India launched nationwide MDA in 2004 in endemic areas as well as home based morbidity management, scaling up hydrocelectomies in hospitals and CHCs. During the year 2004, only 202 districts could be covered with coverage rate of 72.6%. The number of districts was upscaled and in 2007 all the 250 known LF endemic districts were brought under MDA. The policy decision to implement global strategy of co-administration of DEC with Albendazole during MDA was approved by National Task Force on Elimination of Lymphatic Filariasis under the Chairmanship of DGHS. The population coverage during MDA has improved from 73% in 2004 to 83% in 2013 (Prov.) which has resulted in the overall reduction of microfilaria rate from 1.24% in 2004 to 0.29% in 2013 (Prov.).Capacity building has improved the performance of various functionaries. The initiative was taken to involve senior faculties from various medical colleges during 2005-2007. A total of 544 faculty members belonging to medicine, community medicine, pharmacology, microbiology and paediatrics were trained from 79 medical colleges. Subsequently trainings were imparted in state and approximately about 1 million health personnels including Medical Officers, Paramedics, Drug Distributors, Lab. Technicians, etc are trained annually on MDA and Morbidity management.Intensive social mobilization during MDA, have been carried out by various states/ UTs involving political/ opinion leaders, decision makers, local leaders and community. 
Validation through Transmission Assessment Survey (TAS)

All the districts have completed more than 5 rounds of MDA by the end of 2014, and are required to be evaluated to decide whether to stop or continue MDA. As per WHO guidelines-2011, the districts having observed minimum five rounds of MDA with more than 65% coverage against total population at risk in implementation unit (population of district covered under MDA) are to be subjected for Transmission Assessment Survey (TAS) using Immuno-chromatographic test (ICT) for presence of circulating antigenaemia in children born after initiation of MDA to know the current infection. During July 2012, WHO conducted a Regional Workshop on Capacity Building on TAS at Puducherry (India) for all Member countries of SEAR.

• Afterwards four National level Trainer’s Training Workshops have been organized for which financial support was provided by WHO. Workshops were conducted at Pune, Bhubaneswar, Chennai and Bangalore. ICMR, NCDC and WHO Officers were also involved during the training. In these workshops, a total of 139 state and district level officials as a result of which the capacity of district level officials were improved and till May, 2015, 49 districts with 66 evaluation units (approv. 2 million population each) have been successfully cleared through TAS. The details of the 49 districts are (5 of Assam, 2 of Goa, 5 of Gujarat, 3 of Karnataka, 4 of Kerala, 4 of Maharashtra, 16 of Tamilnadu, 4 of Odisha, 4 of West Bengal and 1 each of Daman & Diu and Puducherry) have successfully completed TAS exercise and qualified for MDA stoppage.

• During 2015-16, TAS is expected to be carried out in 68 districts (6 of Andhra Pradesh, 2 of Telangana, 2 of Assam, 10 of Bihar, 3 of Chattisgarh, 1 of Gujarat, 3 of Jharkhand, 1 of Karnataka, 4 of Kerala, 2 of Madhya Pradesh, 2 of Maharashtra, 5 of Odisha, 4 of Tamil Nadu, 18 of Uttar Pradesh, 2 of West Bengal, 1 each of A&N Island, Dadra & Nagar Haveli and Lakshadweep). Majority districts are waiting for procurement and supply of ICT cards which is manufactured by only one company i.e. Allere (Binax), USA. In July, 2015, a National level trainer’s training workshop on TAS with demonstration of ICT and FST (Filaria Strip Test) was organized at VCRC, ICMR, Puducherry with the support of WHO for 30 officials from different states, NVBDCP headquarter, Regional offices for health & F.W. and medical college. Five more such workshops at state level for district level officers are proposed. The list of participants trained in 2013 and 2015 on TAS may be seen.

Morbidity Management and Disability Alleviation

• Morbidity Management is another pillar of strategy for ELF and states/UTs were advised on up-scaling home based morbidity management of Lymphoedema cases and Hydrocele operations. The process involved updating the line-listing of Lymphoedema & Hydrocele cases in the districts. Demonstration and training on simple foot hygiene to affected persons and motivate them for self practice. Motivate for surgical intervention to hydrocele cases. The updated report from LF endemic states/UTs indicated 8.27 lakh Lymphoedema and 3.76 lakh hydrocele cases.

• Since 2004, the states/UTs have reported 129572 hydrocele operations. Different states have initiated management of Lymphodema cases through demonstrating home based foot hygiene method to patients at local levels.