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Keywords:

  • Lymphatic filariasis;
  • economic burden;
  • rural areas;
  • India

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Study area
  5. Material and methods
  6. Results
  7. Discussion
  8. Acknowledgment
  9. References

Summary This study examined the direct and indirect costs due to acute form of lymphatic filariasis caused by Wuchereria bancrofti to the households in rural communities in Tamil Nadu state in south India. For nearly one-third of the acute adenolymphangitis (ADL) episodes the affected did not seek treatment and for 27% of the episodes they consulted health personnel, underwent treatment and paid for it. On average, the ADL patients spent Rupees (Rs.) 2.35 (US $ 0.07) per episode on treatment, but expenditure was as high as Rs. 32.11 (US $ 0.92) among those who paid. Doctor's fees and medicines constituted 83% of the total treatment costs. Patients with multiple and longer duration episodes and with better living conditions spent relatively more on treatment. The proportion of patients who spent money on treatment was smaller in poorer households, but their treatment costs formed a relatively higher proportion of their income than those of middle and high-income households. The ADL episodes curtailed economic and domestic activities. In 87% of the episodes, the affected were not able to attend any economic activity compared to 37% of the episodes in the case of controls. Patients spent only 0.68 ± 1.91 hours on economic activity compared to 4.40 ± 3.74 hours by the control individuals during the ADL episodes. The sign rank test showed that the mean difference of 3.73 ± 3.81 and 2.14 ± 1.83 hours in the time spent on economic and domestic activity respectively between cases and controls was highly significant (P 0.01). Regression analysis demonstrated that the difference in the time spent on activities is only due to ADL and no socio-economic variable had any effect on it. The cost of treatment and loss in economic activities combined with high incidence in the study communities indicate the extent of the economic burden imposed by the hitherto neglected acute form of lymphatic filariasis and the necessity to control it.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Study area
  5. Material and methods
  6. Results
  7. Discussion
  8. Acknowledgment
  9. References

About 119 million people are estimated to be infected with lymphatic filariasis in the world and 48 million of them live in India alone (WHO 1994). These estimates, though disturbing, failed to attract the funds or attention of the planners for the control of the disease. Evans et al. (1993) emphasized the need to quantify the economic costs of filariasis to set priorities within the health system and attract resources to control the disease. Evidence of serious economic loss due to onchocerciasis in parts of West Africa (Remme & Zongo 1989) attracted the world's attention, leading to planning and successful implementation of effective control measures. Similar evidence is lacking for lymphatic filariasis (Andreano & Helminiak 1988), which may be one of the reasons for neglecting the control of the disease.

The clinical course of lymphatic filariasis is often initially asymptomatic, with subsequent episodes of acute adenolymphangitis (ADL) characterized by fever and painful swelling of inguinal lymphatic nodes, and finally the development of chronic lymphatic obstruction. The important chronic disease manifestations include lymphoedema/elephantiasis of the lower limbs in males and females and hydrocele in males. It is now established that the acute form of the disease causes severe functional impairment (Ramaiah et al. 1997) and incapacitation (Gyapong et al. 1996) and is a major cause of concern for patients (Vector Control Research Centre (VCRC), unpublished data). But, the economic impact of these acute ADL episodes has not been quantified so far. Hence, the direct costs (expenditure incurred by patients on treatment) and indirect costs (loss of economic and domestic activity) of ADL episodes, caused by infection with Wuchereria bancrofti, were investigated in a year-round study in two villages of Tamil Nadu state in south India and the results are presented in this paper.

Study area

  1. Top of page
  2. Abstract
  3. Introduction
  4. Study area
  5. Material and methods
  6. Results
  7. Discussion
  8. Acknowledgment
  9. References

The study has been carried out in two villages – Chinna Thatchur (CHT) and Avvayarkuppam (AVK) – in Villupuram-Ramasamy Padayatchiar (VRP) district, located about 150 kms south of the city of Madras, in Tamil Nadu state in south India. The region is endemic for bancroftian filariasis (Sharma et al. 1987; Ramaiah et al. 1986). Parasitological and clinical surveys showed a microfilaria (Mf) prevalence of 12.8% and 13.1% and a chronic disease rate of 20.3% and 18.2% in CHT and AVK respectively (VCRC unpublished data). No anti-filaria measures have ever been undertaken in these villages. The other major health problems in the study population were nutritional disorders and intestinal helminth infection.

A village health worker is responsible for the day-to-day health needs of the people. However, his visits to the villages are not regular. For some ailments, people in the study villages do consult local healers, who mostly use herbal and traditional medicines for treatment. For minor problems such as headaches, body aches and fevers, people resort to self-medication and use analgesics available in the local shops. In CHT a Registered Medical Practitioner (RMP), who is not a qualified doctor, is an important source of treatment for minor ailments. Primary Health centres (PHCs) in the neighbouring villages (about 2–4 kms away) are the nearest health facility and source of treatment. For major ailments, people consult private health practitioners (in the nearby towns), who charge Rs. 20 to 50 (US $ 0.6 to 1.4) per consultation. However, the ability of the villages to pay for visits to the major hospitals in cities like Madras is extremely limited.

Material and methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Study area
  5. Material and methods
  6. Results
  7. Discussion
  8. Acknowledgment
  9. References

The study was conducted from June 1993 to May 1994. Initially, its purpose was explained to the village leaders and their cooperation sought. Then a census was carried out in both study villages: a team of three members visited every household and collected the important demographic and socio-economic characteristics of the study population. The number of family members, their sex and age, and occupation details etc. for each member of the household, presence or absence of assets (cycle, radio or TV) and the type of house (thatched/tiled/concrete) were recorded. Those with at least primary education were classified as literate. For the purpose of the data analysis, the population was divided into two broad categories – farmers and non-farmers – and the year into two seasons – summer (February–June) and rainy/winter (July–January). Details on the cropping pattern, employment opportunities and wage rates in the study villages were collected by interviewing key-informants (Pelto & Pelto 1978). Data on the size of land holding and household's annual income were also gathered from the heads of families. The annual income was computed based on the income generated from occupation (farming, weaving etc.) and through wages.

A population of 1,414 in CHT and 1,373 in AVK (total 2787; males 1419 and females 1368) was monitored for one year to study the incidence of ADL and to estimate the direct and indirect costs to the ADL patients. In order to detect the people affected with acute episodes of ADL, two experienced health workers surveyed all households (n= 581) at fortnightly intervals for one year. An acute ADL episode was defined by the presence of local signs and symptoms such as pain, tenderness, local swelling and warmth in the groin with or without associated constitutional symptoms such as fever, nausea or vomiting. The health workers explained to members of each household in the local language (Tamil) the symptoms of ADL, known locally as nerikatti juram (Ramaiah et al. 1996a), with which the people were very familiar due to its high incidence (Ramaiah et al. 1996b), and enquired if anyone in the household suffered from them. For those individuals who suffered from ADL episodes during the preceding fortnight, clinical symptoms and their duration were recorded by questioning the affected individuals and their family members. Those who had acute episodes during the visit (on-going) of the health workers were visited daily until the clinical symptoms had completely resolved and they had resumed their normal activities, to collect data on their activity pattern. Subsequently, a physician visited and questioned and examined the patients to confirm whether the ADL was of filarial origin or otherwise. Then the direct costs for all the ADL episodes and indirect costs for on-going episodes were compiled. For those affected by ADL, the presence or absence of chronic clinical manifestations – lymphoedema or hydrocele or both – was also noted.

Direct costs

These included expenditure on consultation, medicines, travel and escort or patient's companion and also on self-medication and local healers. For the on-going episodes these costs were estimated on a day-to-day basis by visiting the patients until the ADL resolved. For those who suffered the episodes during the fortnight prior to the visit of the survey team, the costs were compiled by recall and examining prescriptions and medical bills. Data were collected separately for different direct costs by eliciting information on the doctor, hospital and town visited by the patient for treatment, the amount of fees paid and expenditure on travel and escort, if any.

Indirect costs

These were estimated only for patients with on-going ADL episodes (n= 62) and neighbourhood controls matched by age, sex and occupation, but without the history of acute or chronic disease. Details on the activity pattern and time spent on each activity on the day (24 h) prior to the day of the visit of the surveillance team were collected for individual pairs of cases and controls. The daily activities were divided into eight categories: economic, domestic, personal, leisure, educational, travel, health-seeking and social customs. However, this paper presents the results on only the economic and domestic activities, which are the most productive ones. The domestic activity pattern was analyzed only for females since the domestic chores such as cooking, washing and cleaning the house etc. are exclusively performed by them.

The data on direct and indirect costs were collected uniformly for all cases and controls using the standard proforma. Data on treatment seeking behaviour of patients were also collected by administering a questionnaire to 40 randomly selected patients with a history of ADL. The patients were asked whether they had done anything to seek relief; what kind of help they had sought so far and what kind of help they had sought most recently.

Statistical analysis

The difference in the incidence of ADL between males and females was examined using the standard normal Z test. As the amount of money spent on treatment varied widely, the mean expenditure is expressed in terms of geometric mean, which was derived by transforming the costs into log (y + 1) values and changing their means into the original scale. The difference in the time spent on economic and domestic activity by the affected and controls was examined by using the sign rank test. The impact of independent variables such as age, literacy status, asset and household type on the difference in the time spent on economic and domestic activities was analyzed through multiple regression analyse, using the SPSS package.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Study area
  5. Material and methods
  6. Results
  7. Discussion
  8. Acknowledgment
  9. References

The local economy

Weaving (59%) and agriculture (21%) in CHT and agriculture (74%) in AVK were the predominant economic/occupational activities. Nearly 79% of the study population live in thatched houses. About 69% of the families in CHT and 35% in AVK do not own cultivable land and those who do are either marginal or small farmers. Dry land constitutes nearly 90% of the total cultivable area and the crops (ground-nut, sesame, cotton and paddy) are rain-dependent. Hence, cultivation lasts only 6 months (during monsoon and post-monsoon seasons) in a year and only limited work is available during the other six months. However, weaving continues throughout the year. The wages for male and female agricultural labourers were Rs. 25.00 (US $ 0.7) and Rs. 8.00 (US $ 0.2) respectively per day. The wages for weaving labourers were Rs. 24.00 (US $ 0.7) a day. The average household size was 4.64 ± 1.87 and the average number of working persons per family was 2.64 ± 1.22. About 73.7% of the families have an annual income of less than Rs. 5,000 (US $ 143) and only 10% have more than Rs. 10,000 (US $ 286).

Incidence, age and sex distribution of ADL episodes

Of the 2787 study population, 96 males and 52 females (total 148 or 5.31%) were affected with 269 ADL episodes during the one year surveillance period (annual incidence rate 269/2787*1000; 96.52/1000 population). Males had a higher incidence (108.53/1000) than females (84.06/1000) (P= 0.05). The incidence was strongly age-dependent with a maximum level (238.74/1000) in the 51–60 age group. Of the 148 affected individuals, 94 (63.5%) had only one episode, 26 (17.6%) had two, 13 (8.8%) had three and 15 (10.1%) had more than three. The mean duration of each episode was 3.58±1.95 days (range 1–17 days). The majority of episodes (99/269, 36.8%) occurred in agricultural labourers, followed by weavers (59/269, 22.0%) and cultivators (43/269*100, 16.0%). 17.1% of the episodes occurred in people without any chronic clinical symptoms, the rest in chronic patients. More details on the epidemiology of ADL are given in a recent paper (Ramaiah et al. 1996b).

Sources of treatment

The various sources of treatment for the patients are summarized in Figure 1. The quantitative interview data revealed that while 82% of the ADL patients had ever tried to seek relief (Figure 1), 49% tried recently, i.e. during the last 6 months. The majority of patients preferred private practitioners (24% any time and 8% recently) followed by government hospital (9% and 1%), traditional healers (6% and 1%), National Filaria Control Programme office (3% and 0%) in a nearby town and local PHC (4% and 1%).

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Figure 1. Sources of treatment for ADL patients.

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Expenditure on treatment

Of 269 ADL episodes observed during the one-year study, the patients did not seek treatment for 85 (31.6%) episodes; and for 46 (17.1%) they underwent treatment but spent nothing. Although, for the remaining 138 (51.3%) episodes patients did spend something, for 66 (24.5%) episodes they were content with self-treatment and for the other 72 (26.8%) episodes they consulted either health personnel (PHC worker) or a Registered Medical Practitioner (RMP) within the village, the PHC doctor in the neighbouring village, or a doctor in a nearby town and paid for treatment. The geometric mean spent on each of the 269 ADL episodes was Rs. 2.35. (US $ 0.07) (range RS. 0.00–1000) per episode. The average expenditure on self-treatment (n= 66 episodes) was Rs. 2.02 (US $ 0.06) (range Rs. 0.60–15.00) per episode. The patients who consulted a doctor and paid for treatment (n= 72 episodes) incurred an expenditure of Rs. 32.11 (US $ 0.91) (Rs. 5.00–1000.00) per episode. Among the patients affected with these 72 episodes, males (n= 45 episodes) incurred a mean expenditure of Rs. 35.39 (US $ 1.0) (Range Rs. 9–1000) and females (n= 27) Rs. 27.12 (US $ 0.77) (Range Rs. 5.00–720.00) per episode. The individuals (n= 25) who suffered multiple episodes (2–4) spent more per episode than those (n= 30) with only one episode. The two individuals who suffered five or more episodes spent surprisingly little (Table 1). The episodes that lasted 4 days and above (n= 39) incurred more expenditure (Rs. 35.06; US $ 1.0) than shorter ones (n= 33) (Rs. 28.85; US $ 0.82)). Patients living in tiled or concrete houses spent Rs. 46.86 (US $ 1.3) (Range Rs. 500–720.00) per episode compared to Rs. 26.73 (US $ 0.8) (Range Rs. 5.00–1000.00) by those living in thatched houses. Distribution of costs showed that about 83% of the total costs were the doctor's fee and medicines (Table 2).

Table 1.  Cost (in rupees) of treatment per ADL episode in relation to frequency in patients who paid for treatment during the study period of 1993–1994 Thumbnail image of
Table 2.  Distribution of treatment costs (in rupees) per ADL episode with respect to input during the study period of 193–1994 Thumbnail image of

While the treatment costs of ADL episodes (n= 269) constituted about 0.60%, 0.32% and 0.16% of the household income of the low (Rs. 1–5000), middle (Rs. 5001–10,000) and high (> Rs. 10,000) income groups, they constituted about 2.81%, 1.04% and 0.47% respectively of those households from where the patients paid (n= 72 episodes) for treatment (Table 3). The proportion of patients seeking treatment was less in the lower income group (Table 3).

Table 3.  Proportion of episodes for which treatment sought and treatment costs in relation to household income during 1993–1994 Thumbnail image of

Characteristics of the patients and controls observed for activity patterns

The activity pattern was studied for 62 on-going ADL episodes. To study the effect of ADL on time spent on various activities, paired data were collected for patients and controls. The average age of the cases (n= 62) and controls (n= 62) was 46.15 ± 16.79 and 45.50 ± 14.78 respectively. About 44% and 47% of the cases and controls respectively possessed assets. About 79% of the cases and 87% of the controls lived in thatched houses. The average household size of the former was 4.51 ± 1.79 and of the latter 4.15 ± 1.63. The number of working adults in the families of the cases and controls was 2.44 ± 1.16 and 2.87 ± 1.23 respectively.

Activity patterns of ADL patients and controls

Economic activities. During 87% (54/62) of the episodes, the patients were not able to do any work, leading to complete loss of labour compared to 37% (23/62) of the episodes in the case of controls. This disability was found to be still higher in males (Figure 2). On average, the affected individuals could spend only 0.68 ± 1.91 hours per day on their economic activity compared to 4.40 ± 3.74 hours by the control individuals and the sign rank test showed that the mean difference of 3.74 ± 3.81 hours was highly significant (P > 0.01). Both male and female patients spent significantly less time than the respective controls on economic activities, and the mean difference of 4.42 ± 3.88 in males (n = 33) and of 2.93 ± 3.62 in females was also highly significant (P > 0.01). The difference persisted and was significant (P > 0.01) in farmers (4.39 ± 3.68; n = 36) and non-farmers (2.81 ± 3.89; n = 26) and during both the summer (3.96 ± 3.73; n = 27) and winter/rainy seasons (3.54 ± 3.92; n = 35) between cases and controls. During only 2 of the 269 episodes (0.7%), the households reported that hired labourers substituted the patient's lost labour.

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Figure 2. Proportion of ADL patients and controls with complete loss of labour, ▪ ADL patients; □ Controls.

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Domestic activities. The affected women were not able to perform any domestic activity during about half of the episodes (Figure 2). The time spent on domestic activity by the affected females was also less than that spent by control females (n = 29) and the mean difference of 2.14 ± 1.83 hours per day was highly significant (P > 0.01). The mean difference was significant (P > 0.05) in summer (mean = 1.60 ± 1.50; n = 10) as well as the winter and rainy (mean 2.42 ± 1.93; n = 19) seasons.

Multiple regression analysis showed that socio-economic variables such as age, literacy status, asset and household type have no influence on the difference in the time spent on economic activity and domestic activity by cases and controls (P > 0.05).

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Study area
  5. Material and methods
  6. Results
  7. Discussion
  8. Acknowledgment
  9. References

The economic impact of some infectious diseases such as malaria (Sinton 1935; Shepard 1991; Picard & Mills 1992; Mills 1994), onchocerciasis (Remme & Zongo 1989) and schistosomiasis (Yixin Huang & Manderson 1992) has been documented, at least to some extent. However, such information is very scanty for filariasis (Evans et al. 1993), the second most widely prevalent vector-borne disease. This is even more so for the acute disease, the epidemiological (Ramaiah et al. 1996b) and socio-economical (Ramaiah et al. 1997; Gyapong et al. 1996) importance of which has been documented recently. While this study provides some insight into the treatment costs to ADL patients and impact of acute disease on number of hours worked on economic and domestic activities, which are very important constituents of the overall economic burden of a disease, similar information is being compiled in another study on chronic disease. The combined costs of acute and chronic filariasis will be useful and more appropriately compared with the costs of other diseases commonly prevalent in the region to determine the relative public health importance and priority for control of filariasis.

The only report on treatment for ADL mentions that patients in Tahiti, on learning the beneficial effects of the drug in preventing the further attacks of ADL, obtain Diethylcarbamazine (DEC), the widely used anti-filarial drug, from the local mass chemotherapy programme (March et al. 1960). Chronic filarial symptoms such as elephantiasis and hydrocele are irreversible, whereas the ADL episodes are transient and characterized by fever and painful swelling of lymphatics in the groin region of the body. People with or without chronic symptoms suffering from ADL tend to seek treatment, the cost of which may constitute a significant proportion of the total costs incurred due to filariasis by the patients.

Neither anti-filarial measures nor filaria clinics exist in rural India (Rao & Sharma 1986) and hence patients seek other sources, particularly the private practitioners, for treatment. Affected people willing to consult the doctor and undergo treatment incurred an expenditure of Rs. 32.11 (US $ 0.9) per ADL episode. This is a significant amount in rural areas, particularly in poorer households during lean work season, and equivalent to four days' wages of women and about two days' wages of men. The fact that treatment-seeking is less common in poorer households and the mean expenditure of treatment constituted about 2.81% of the average family income of these households compared to 0.47% in high income groups (Table 3), suggests that poor people are more at risk to lymphatic filariasis and the disease burden is relatively higher in this segment of the population in the endemic communities. Besides, as people from low-income groups mainly depend on wages, loss of labour during ADL episodes deprives them of immediate cash availability, which causes a great deal of hardship to the affected families. The cost of treatment, the necessity to travel to reach the PHCs in the neighbouring villages or to nearby towns to consult private practitioners, inability per se to travel due to severity of ADL episodes, and loss of faith in treatment due to recurrence of episodes, are the reasons why nearly half of the affected individuals do not undergo or do not spend money on treatment and why about one-third resorts to self-treatment. Besides, the aetiology of the ADL is not well understood and hence there is no definite treatment practice. Negligence in treating the ADL form of the disease may lead to the chronic form of disease, which is irreversible and inflicts a socio-psychological burden on the affected individuals: life-long functional impairment (Ramaiah et al. 1997) and reduced productivity (Ramu et al. 1996). The burden is likely to be proportional to the prevalence of chronic disease. Many communities report a chronic disease prevalence as high as 10–25%. In an endemic community in Ghana, where the prevalence of hydrocele and elephantiasis of legs was 19.3% and 4.1% respectively, the burden caused by chronic disease was found to be much higher than the acute disease, with an incidence rate of 96/1000 people/year (Gyapong et al. 1996). Thus, if the consequences of ADL form of disease (the disease progression) are taken into account, the costs of the acute form of the disease will be much higher than those described here. In addition to the household expenditure, the costs borne by the PHCs for the treatment of filariasis patients and the expenditure incurred by the National Filaria Control Programme will further increase the costs of prevention and/or treatment of filariasis.

The average expenditure on treatment per episode increased with the frequency of episodes to a maximum of Rs. 95.00 (US $ 2.71) in patients with 4 episodes (Table 1). Surprisingly, patients with more than 4 episodes spent much less. This suggests that while people with multiple episodes try hard and spend considerably to get the ADLs cured, those with very frequent episodes neglect treatment for the reasons cited above, and therefore incur less expenditure. Since the ADL episodes are often severe and render the affected bedridden, the suffering would be proportional to the number of episodes suffered by an individual and their duration. Understandably, patients with more episodes of longer duration spent relatively more on treatment, apparently to get relieved from the effects of ADL. People with better economic status, as evident from living in tiled or concrete houses, spent more on treatment than people with a lower economic status (living in thatched houses).

In another parallel study, as many as 85% of the ADL patients said, during structured interviews, that the episodes severely impaired their economic activities (Ramaiah et al. 1997). During our study, patients were not able to participate in the economic activity during 87% of the episodes. During ADL episodes, male patients spent only about 15% of the total time spent by controls on economic activity. Similarly, the domestic activities of female patients were also severely hampered. Note that the study included only those ADL episodes occurred in chronic patients and a proportion of loss in the activities of the ADL patients could also be due to chronic disease. However, the reduced activities of the patients could be mainly attributed to the acute episodes, as during about 87% of the episodes people were not able to do any work and the chronic patients generally develop coping mechanisms (Gyapong et al. 1996; VCRC unpublished data) and become able to work almost daily (VCRC, unpublished data), although their productivity was less than normal (Ramu et al. 1996).

Sabesan et al. (1992) showed that ADL causes a loss of 26.52 man-days per patient and as a result loses Rs. 636 (US $ 20) per year. Kessel (1957) reported a loss of 450 working days to 600 rubber tappers as a result of 150 acute episodes. These data and the above results clearly show that the acute form of lymphatic filariasis impairs the earnings of the victims.

The substitution by hired labourers for the time lost due to ADL was negligible in the present study. It was shown elsewhere that the activities of the malaria-affected family members were taken over by other family members (Bonilla & Rodriguez 1993; Nur & Mahran 1988), sometimes at the cost of leisure of other family members (Bonilla 1985). In our study villages, the households are reasonably large and depending upon necessity, other family members may substitute the intermittent absence of the patients from the economic activity, particularly in agriculture sector.

Recent estimates showed that lymphatic filariasis causes loss of 850 000 Disability adjusted life years (DALYs). However, this is generally considered an underestimate because the estimates depend mainly on chronic disease and the acute disease is not given adequate importance. The disability observed due to ADL in the present and other studies will be useful to estimate lost DALYs. This information and the information on the cost of various treatment strategies could be used to estimate the cost benefit and cost effectiveness of various strategies.

While a number of studies have been conducted on patent infection and the chronic form of filariasis, very few studies have ever been carried out on the acute form, and its aetiology is not well understood. In the study villages, the incidence of acute episodes was 96.52 per annum per 1000 population (Ramaiah et al. 1996b). Such high incidence and severe functional impairment (Ramaiah et al. 1997) combined with considerable direct and indirect cost of the acute disease observed in our study suggests the seriousness of the problem of acute form of lymphatic filariasis. The annual economic losses caused by lymphatic filariasis in India have been conservatively estimated at US $ 1.5 billion (WHO 1997). With the new control strategy of annual single dose mass chemotherapy with DEC, the per capita treatment cost per annum has been worked out to be only about Rs. 1.00 (US $ 0.02) (WHO 1997; VCRC unpublished data) and the required 4–5 rounds of annual mass treatment cost about US $ 12 million per annum (WHO 1997). Thus the cost-benefit ratio of lymphatic filariasis control appears to be very high.

Acknowledgment

  1. Top of page
  2. Abstract
  3. Introduction
  4. Study area
  5. Material and methods
  6. Results
  7. Discussion
  8. Acknowledgment
  9. References

The study received financial support from WHO/TDR/UNDP/World Bank. The authors express their gratitude to the late Dr. Vijai Dhanda, former Director, VCRC, for his encouragement and support and to Dr. K.N. Panicker, Deputy Director, VCRC, for giving valuable suggestions. They thank Dr. Marcel Tanner, Swiss Tropical Institute, Dr. David Evans and Dr. Carol Vlassoff of the WHO/TDR for their help in designing and keen interest in the study. Thanks are also due to Mr. P. Vanamail, VCRC, for his help in statistical analysis of data and Dr. Shobha Rao, Agharkar Research Institute, Pune, India, for her comments and suggestions on the study. H. L. Guyatt gratefully acknowledges the financial support of the Wellcome Trust.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Study area
  5. Material and methods
  6. Results
  7. Discussion
  8. Acknowledgment
  9. References
  • 1
    Andreano R & Helminiak T (1988). Economics, health and tropical diseases: A review. In Economics, Health and Tropical Diseases (eds P Rosefield & AN Herrin). University of the Philippines, pp 19–22.
  • 2
    Bonilla E (1985). Development of research training project in socio-economics of malaria eradication in Columbia: Executive Summary (Unpublished report to Special Programme for Research and Training in Tropical Diseases), WHO, Geneva.
  • 3
    Bonilla, E Rodriguez, A (1993). Determining malaria effects in rural Columbia. Social Science and Medicine 37, 11091114.
  • 4
    Evans, DB Gelband, H Vlassoff, C (1993). Social and economic factors and the control of lymphatic filariasis: a review. Acta Tropica 53, 126.
  • 5
    Gyapong, JO Gyapong, M Evans, DB, et al (1996). The economic burden of lymphatic filariasis in northern Ghana. Annals of Tropical Medicine and Parasitology 90, 3948.
  • 6
    Kessel, JF (1957). Disabling effects and control of filariasis. American Journal of Tropical Medicine and Hygiene 6, 402414.
  • 7
    March, HN Laigret, J Kessel, JF Bambridge, B (1960). Reduction in the prevalence of clinical filariasis in Tahiti following adoption of a control programme. American Journal of Tropical Medicine and Hygiene 9, 180184.
  • 8
    Mills, A (1994). The economic consequences of malaria for households: a case study. Health Policy 29, 209227.
  • 9
    Nur, ETM & Mahran HA (1988). The effect of health on agricultural labour supply: a theoretical and empirical investigation. In Economics, Health and Tropical Diseases (eds AN Herrin and PN Rosenfield) University of the Philippines.
  • 10
    Pelto PJ and Pelto GH (1978). Anthropological Research. The Structure of Inquiry. Cambridge University Press, Cambridge.
  • 11
    Picard J and Mills, A (1992). The effect of malaria on work time: analysis of data from two Nepali districts. Journal of Tropical Medicine and Hygiene 95, 382389.
  • 12
    Ramaiah, KD Pani, SP Balakrishnan, N Sadanandane, C Das, LK Mariappan, T Rajavel, AR Vanamail, P Subramanian, S (1986). Prevalence of bancroftian filariasis and its control by single course of diethylcarbamazine in a rural area in Tamil Nadu. Indian Journal of Medical Research 89, 184191.
  • 13
    Ramaiah, KD Ramu, K Vijay Kumar, KN (1996a). Knowledge and beliefs about transmission, prevention and control of lymphatic filariasis in rural areas of South India. Tropical Medicine and International Health 1, 433438.
  • 14
    Ramaiah, KD Ramu, K Vijay Kumar, KN Guyatt, H (1996b). Epidemiology of acute filarial episodes caused by Wuchereria bancrofti infection in two rural villages of Tamil Nadu, South India. Transactions of the Royal Society of Tropical Medicine and Hygiene 90, 639643.
  • 15
    Ramaiah, KD Vijay Kumar, KN Ramu, K Pani, SP Das, PK (1997). Functional impairment caused by lymphatic filariasis in rural areas of South India. Tropical Medicine and International Health 2, 832838.
  • 16
    Ramu, K Ramaiah, KD Guyatt, H Evans, D (1996). Impact of lymphatic filariasis on the productivity of male weavers in a south India village. Transactions of the Royal Society of Tropical Medicine and Hygiene 90, 669670.
  • 17
    Rao, CK Sharma, SP (1986). Control of filariasis in India. Journal of Communicable Diseases 18, 276282.
  • 18
    Remme J & Zongo JB (1989). Demographic aspects of the epidemiology and control of onchocerciasis in West Africa. In Demography and Vector Borne Diseases (ed MW Service). CRC Press, Florida, pp 367–386.
  • 19
    Sabesan, A Krishnamoorthy, K Pani, SP Panicker, KN (1992). Man-days lost due to repeated acute attacks of lymphatic filariasis. Trends in Life Sciences (India) 7, 57.
  • 20
    Sharma, RVSN Vallishayee, RS Mayurnath, S Narayanan, PR Radhamani, MP Tripathy, SP (1987). Prevalence survey of filariasis in two villages in Chingleput district of Tamil Nadu. Indian Journal of Medical Research 85, 522530.
  • 21
    Shepard, DS (1991). Economic impact of malaria in Africa. Tropical Medicine and Parasitology 42, 197223.
  • 22
    Sinton, A (1935). What malaria costs India nationally, socially and economically. Reports of the Malaria Survey of India 5, 223264.
  • 23
    World Health Organization (1994). Lymphatic Filariasis Infection and Disease: Control Strategies. Report of a Consultative Meeting held at the Univirsiti Sains Malaysia, Penang, Malaysia. WHO, Geneva.
  • 24
    World Health Organization (1997). Lymphatic Filariasis: Reasons for Hope. WHO/CTD/FIL/97.4, WHO, Geneva.
  • 25
    Yixin Huang, Manderson, L (1992). Schistosomiasis and social patterning of infection. Acta Tropica 51, 175194.