| The disability
problem due to Lmphatic Filariasis (LF) disease
has been reported in 80 countries Ottesan
EA (2000). Globally, the 1.1 billion people
are exposed to risk of LF and the estimated
LF affected population is 120 million Ottesan
EA (2000), Michael E et al. (1996). Our recent
estimation showed that there are 21 million
diseased individuals in India alone Sabesan
S et al. (2000) contributing approximately
40 per cent of global burden. A progressive
lymphadema with increasing episodic attack
adenolymphngistis (ADL) is the most important
cause of physical suffering, permanent disability
Pani SP and Lall R (1998) and the economic
loss of the affected individuals and the community
Ramaiah KD et al. (1998, 1999, 2000). Apart
from these LF is also responsible for social
problems including sexual disability and discomfort
of marital life Dreyer G et al (1997).
The disease “Lymphatic Filariasis” mainly
affect the lymphatic system of a man and it
manifest itself in the form of lymphangistis,
filarial fever, funiculitis, epididymo-orchitis
during acute stages and the chronic phase
includes elephantiasis, hydrocele and chronic
oedema Pani SP and Lall R (1998). Though the
mortality due to filariasis is negligible,
regular treatment and management of limb swelling
from becoming worse is high degree of attention
in view of its disability and disease burden
during the entire lifetime of the individual
and the community Pani SP and Lall R (1998),
Ramaiah KD et al. (1998) and Dreyer G et al
(1997).
Lymphatic filariasis is recognized as one
of the potential eradicable diseases CDC (1993).
The Global Alliance for Elimination of Lymphatic
Filariasis (GAELF) has recommended that the
transmission control and morbidity management
are two important pillars in the global elimination
strategy for Lymphatic Filariasis (LF) Das
PK. and Pani SP (2000). For transmission control,
annual single dose mass administration of
anti-parasitic drugs Das PK. and Pani SP (2000)
is being implemented in several countries
including India.
The study aimed to provide aids and guidance
or a manual massage to diseaseaffected community
through self-help groups (SHG) for filariasis
morbidity management and control by self-help
measures Dreyer G et al (2000), which is recognized
as need, based current strategy in the Global
Elimination of Lymphatic Filariasis Programme.
Materials and
Methods
Study Site
The study site, Pondicherry is the capital
of Pondicherry Union Territory, which is located
in the East coast of South India about 160
Km south of Chennai (formerly Madras), it
geographically extends between 11o 53’ 45”
N and 11o 58’ 55” N, 79o 46’ 15” E and 79o
50’ 50” E. It has the geographical area measured
to 48.06 Sq. Km. Monsoon is experienced from
October to December in every year. Total urban
population is 516,985, (Males 260,482 and
Females 256,503) and the total number of households
is 101,481 (Census of India 2001).
Study
Design
The study was designed for the selection of
appropriate service locations for morbidity
management for filariasis disease, mainly
considering the patients convenience, using
GIS decision support tool. It provides to
capture the filariasis disease data in electronic
mode and attach the same to the digital map
of the study area for the spatial analysis
on GIS Platform. The study was carried in
three stages. In the initial stage, field
data was collected through reconnaissance
survey, which was conducted in every doorstep
in every street of the study site. In the
second stage, a geo-database was created and
which was linked to the GIS spatial database
engine for depicting the attributes on the
digital map of the study site for preparation
of distribution map and further spatial analysis.
Finally, to develop a decision support tool,
spatial analysis was carried out for determining
the appropriate locations and allocating optimum
patients to each self-help morbidity management
centre considering distance and other basic
facilities (i.e. roads, transports, electricity,
water, accommodations, and SHG).
|
| Figure 1.
(a) The occurrence of lymphodema cases
in different age group, and (b) lymphodema
cases with different grade in Pondicherry
Urban. |
The data is pooled into a single GIS platform
to achieve the objectives. Mapping the existing
health facilities and identifying the new
locations for opening self-help health centres
in the center of every disease cluster (community)
with minimum distance coverage for local treatment,
was consider as main factor for the decision
support tool. This was based on the understanding
of people’s intricacy for traveling long distance
i.e. more than half a kilo metre for local
treatment and the huge expenditure for periodical
traveling for morbidity management are the
background key factors of the spatial ring
buffering analysis, and thus, the study was
framed with a hypothesis that no lymphodema
patient would prefer to travel beyond 1 Km
distance for seeking treatment.
|
| Figure2. Study
area of Pondicherry Urban showing the
filariasis lymphodema disease with different
grades |
The self-help Health Service Centres
The self-help groups included voluntary organizations,
youth club, NGOs, youth welfare association
and community movements. The distance of each
distance ring buffer was measured from the
center of each disease clusters to the peripherals
of each lymphodema case household location.
Based on the distance and other basic facilities
and in the patient’s convenience, the existing
PHC, GH in and around the study areas are
plotted for optimum allocation of the patients
to the existing facilities and identified
appropriate new locations for opening Self
Help health Centres.
|
| Figure 3. Filariasis
lymphodema Cases classified in to different
age group (based on spatial cluster
analysis), major roads (line showing
red colour) are overlaid on the urban
map |
Results and Discussions
Totally, 482 cases (both males and females)
were identified and these were recorded properly,
using GARMIN GPS 12XL. The preliminary analysis
shows that < 15 years we have no record on
lymphodema case, working adult age group 15
to 35 years is potentially having problem
of 18 per cent, and steadily increased 30.3
per cent in the 35 to 55 years age group (working
middle age group), in the later age group
of > 55 to 75 years having record of 35.3
per cent (170 cases), and finally, 16.4 per
cent (79 cases) were recorded in the age group
of < 75 years. It shows that the potential
working age group is affected severely. In
the over all view, grade II is highest record
of 36.7 per cent and followed by grade-I 31.2
per cent, grade III 23.2 percent and grade
IV 8.9 per cent are recorded. Disease time
duration of having lymphodema problem is assessed
by questionnaire method. Based on this questionnaire,
228 (47%) cases were identified with disease
for the past 1 year, 108 (22%) cases were
assessed having problem of disease for 1-10
years, 73 (15.1%) cases were recorded with
disease problem for 10-20 years, 20 (4.1%)
cases were having disease problem for the
period of 20 to 30 years and finally, the
disease cases recorded to 53 (10.9%) with
more than 30 years (Fig.1a and 1b).
| Required number of SHGC with different
distant rule for optimum allocation
of patients to each SHGC for filariasis
morbidity management: |
|
The Digital map of Pondicherry urban was prepared
Map Info 4.5 GIS platform. The digital data
was captured in to GIS platform for plotting
the locations of the disease cases. These
disease cases were further classified with
filariasis lymphodema grade wise and age wise
distribution (fig2. and fig.3).
The function of spatial analysis shows that
the accomplishing the disease density, which
gives an average of 1.89 km in all direction.
It has the ribbon like spatial pattern of
disease distribution mainly due to the major
settlements are developed along the both side
of roads are fueled to atypical spatial pattern
of disease distribution.
Selection of self-help Health
Service centres
Spatial ring buffering, spatial clustering,
and nearest neighbourhood analysis was performed
for easy understanding of spatial pattern
and disease clustering. The distributions
of the disease cases are found two major linear
patterns and one ring cluster (fig.2). Though
the lymphodema cases proportionally high in
the 56 -75 years of age group and the presents
of lymphodema grade II cases is high in percentage
it has found in all over the human settlements
(fig.3). The list of existing PHC/ GH is depicted
on the Pondicherry urban boundary map. The
different distance rule of 0.2KM, 0.3KM, 0.4KM
0.5 KM, 0.6, 0.7 KM, 0.8 and 0.9 KM were created
over the disease distribution map, using spatial
ring buffering technique at GIS platform.
The minimum, maximum and the mean distances
of each disease cluster are calculated against
to each distance rule/ ring buffering. Since,
the K-mean patients density 1.89 Km, the spatial
ring buffering performance started from 0.2KM,
and it is increased by 0.1KM and which is
extended up to 1KM.
|
| Figure 4. Optimum
allocation of patients to the existing
health centres and the proposed new
location for opening SHG health centres:
rule fixed 0.4 Km ring buffer only
|
Number of existing centers and the required
centers against each distance rule (0.2KM,
0.3KM, 0.4KM, 0.5KM, 0.6KM, 0.7Km, 0.8KM,
0.9Km & 1.0KM) were calculated and tabulated
for the optimum coverage of the patients with
in the specified distance coverage. Ring buffering
of 0.2KM, 0.3Km and 0.4Km are overlaid on
lymphodema distribution map and derived the
output of 0.4 Km ring buffer (Fig.4). The
results of 0.5Km and 0.6Km ring buffers are
giving the same results of 0.4Km distance
ring buffer, therefore, next analysis, the
distance of 0.7Km, 0.8Km, and 0.9Km ring buffers
are overlaid on lymphodema cases and obtained
0.7Km as the output of second analysis (Fig.5).
Conclusion
The distributions of the disease cases are
found to be linear pattern of spatial distribution
associated with major roads system. The lymphodema
cases proportionally high in the 56 -75 years
of age group and the presents of lymphodema
grade II and lymphodema grade III cases are
high in percentage. The study gives result
that with 0.7 KM ring buffering distance is
having optimum service coverage. The present
study hypothesis is that the aged patients
could travel less than 1KM distance from their
residence to the health centres for morbidity
management is care fully examined. The study
area required 15 centres with 0.7KM distance
ring buffer or coverage area, out of 15, 10
centres are already existed, and 5 more new
centres only required covering all the patients.
We suggest that opening self-help health service
centres with coverage of less than 1-kilometer
distance in urban like Pondicherry is ideal.
|
| Figure 5 Optimum
allocations of patients to the existing
health centres and the proposed new
location for opening SHG health centres:
rule fixed by 0.7Km, ring buffer only
|
Acknowledgement
The author is grateful to the Director, Vector
Control Research Centre, Puducherry- 60506,
India, for permitting to carryout this study,
providing facilities and clinical staff support
for collecting data.
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