Clinicians’ practices related to management of filarial adenolymphangitis and lymphoedema in Orissa, India

The Global Programme to Eliminate Lymphatic Filariasis (GPELF), which includes alleviation of disability and suffering of patients, is implemented primarily in India by primary health care system. The present study assesses the current practices related to lymphoedema care among clinicians of primary healthcare system in three filarial endemic districts of Orissa, India. The results are based on the data obtained through in-depth interviews with 50 clinicians from primary health centres (PHCs) and private clinics located in 22 PHCs sampled from three districts. All clinicians are aware of common as well as atypical manifestations of LF and offered treatment to them. The most commonly dealt complaints are lymphoedema of chronic LF and acute lymphangitis. All the clinicians reported that they prescribed diethylcarbamazine (DEC) for the treatment of patients with acute episodes, and only 50% of them prescribed antibiotics along with DEC. However, there is no uniform pattern either in the dosage of DEC or in the use of antibiotics. In this study, all the clinicians are aware that repeated acute episodes leads to lymphoedema. Majority of clinicians (94%) prescribed DEC to prevent this progression. For reduction of oedema, they offered a variety of treatments and more than half of the clinicians prescribed DEC. The study districts have been covered by the mass drug administration (MDA) of DEC under the GPELF. In order for the GPELF as a whole to prove successful and sustainable, those persons who are already suffering from LF need to be cared for and their suffering is to be relieved. Current practices of clinicians, both at government and private health institutions should be improved. With the revised knowledge that bacterial infections play a key role in the progression of disease, the attitude of clinicians towards the treatment of LF has to be changed.