Filariasis Report

A FINAL REPORT
ON
EPIDEMIOLOGICAL SURVEILANCE OF LYMPHATIC
FILARIASIS IN MAKWANPUR, CHITWAN, RUPENDEHI
AND NAWALPARASI DISTRICTS OF NEPAL
Submitted by
MAHENDRA MAHARJAN
LECTURER
CENTRAL DEPARTMENT OF ZOOLOGY (PARASITOLOGY)
TRIBHUVAN UNIVERSITY
KIRTIPUR KATHMANDU
Submitted to
WHO Filariasis Elimination Program
Epidemiology and Disease Control Division / HMG, Nepal
Submitted through
KIRTIPUR KATHMANDU
NEPAL
2005
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TEAM MEMBERS IMPLEMENTING THE PROJECT :
Project Team members
Principal investigator
Mahendra Maharjan
Central Department of Zoology
Tribhuvan University
Kirtipur
Co-Investigator
Satish Chandra Jha
Tri- Chandra Multiple Collage
Kathmandu
Parasitologists
Maheshwer Khanal
Bhoj Bdr. Bhat Chhetri
Ashok Bahadur Bam
Dina Nath Dhakal
Budhan Chaudhari
Yam Bahadur Pokhrel
Rakhi G. Jha
Advisors
Dr. Margarita Ronders
WHO Technical Officer
Dr. Shankar Bahadur Shrestha
Sr. Medical officer
EDCD, Teku
NAME OF THE INSTITUTE IMPLEMENTING THE PROJECT:

KIRTIPUR, KATHMANDU
Correspondence: Mahendra Maharjan (mahendra_maharjan@yahoo.ca)
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ACKNOLEDGMENTS
Lymphatic filariasis has been identified as the second leading cause of permanent and
long-term disability and is one of six tropical diseases targeted by WHO/TDR. Because
of public health importance of this disease in the national context, Nepal government has
committed to eliminate filariasis by 2015. The present study is the situation analysis stage
of the continuation of LF elimination programme under the WHO collaborative project
run by EDCD, Teku.
Due to nocturnal periodicity of the microfilaria, collection of the blood samples from the
community people is not easy without the support of the health personels, social workers
and community people. The dedication shown by the Epidemiology and Disease Control
Division towards the success of this programme is exceptional. So that we are heartly
grateful to Dr. Mahendra Bahadur Bista, Director, EDCD, Teku for moral support,
financial arrangement, quick administrative process throughout the study period. We are
equally grateful to the technical advisors Dr. Margarita Ronders, WHO Technical Officer
and Dr. Shankar Bahadur Shrestha, filariasis elimination programme co-ordinator for
their continuous monitoring and moral inspiration to assure the quality of the
epidemiological survey from beginning to end.
Directors of District Public Health Office, Rupandehi, Nawalparasi, Makwanpur and

Chitwan are extremely thankful for their whole hearted support and arrangement of the
community health personnel to involve in the field survey. We have really a sweet
remembrance of working with the health post and sub-health post encharges, health
workers, community leaders, social workers of the eight sentinel sites. Working together,
eating together with sharing happy and sorrow moments of working day and night was
really a marvelous. It was unexpected that in spite of uncomfortable political situation
also community people never allow us to feel discomfort our stay and work. Their warm
welcome, support, co-operation and inspiration boosted up all the team members working
capacity up to the success.
Its my privileged to be grateful with my project team members. I wish but don’t want to
express other words to acknowledge them which never could represent their friendship
spirit of working with keen interest in each and every steps. I would simply say “HI” to
all team members particularly co-investigator and all parasitologists, who had sacrificed
their several times warm beddings for the success of the work.
It would be almost injustice not to write anything to the EDCD staffs particularly Mr.
Narendra Tandukar, Dr. Ashok sharma and others. Their co-operative nature inspired us a
lot to tackle various administrative difficulties easily. Ms Meena kumari Maharjan and
Mr. Rabindra Maharjan, whose direct and indirect contribution in the project is
remarkable. I owe my gratitude to both of them.
Mahendra Maharjan
Principal investigator
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Introduction
Lymphatic filariasis is a parasitic disease caused by nematodes inhabiting the lymphatic

system. Filariasis, is one of six tropical diseases targeted by WHO/TDR The disease is
widespread throughout the tropical and subtropical areas of Asia. Africa, the western
pacific and some parts of the Americas(Michael et al.,1996)).Where it is a major cause of
acute and chronic morbidity affecting persons of all ages and both sexes. Lymphatic
filariasis is a dramatically disabling, disfiguring disease usually affecting one or both
limbs, causing hydrocele and equally grotesque enlargement of male scrotum. Infection
also causes acute fever, inflammation of the lymphatic system and the bronchial
asthmatic condition known as tropical pulmonary eosinophilia (WHO, 1995). Not only
does it lead to great personal suffering from its disabling and disfiguring lesions. But it is
also a significant impediment to socioeconomic advancement, both locally and nationally
(WHO, 1995).
Lymphatic filariasis has been identified as the second leading cause of permanent and
long-term disability (WHO, 1995). But the true amount of disability it causes is only
beginning to be quantified accurately (Evans et al., 1993, Ramu et al., 1996). A total of
44 million persons currently suffer from one or more of the overt manifestations of the
infection: lymhoedema and elephantiasis of the limbs or genitals. Hydrocele, chyluria,
pneumonitis or recurrent infections associated with damaged lymphatics. The remainder
of the 120 million infected have preclinical hidden damage of their lymphatic and renal
systems (Otteson, 1994) and to this burden of disease must also be added the serious
psychosocial consequences that these profoundly disabling lesions often have, including
the seldom mentioned sexual/social dysfunction of men of all ages affected with
hydroceles or other genital abnormalities and of young women with lymphoedema of the
breasts or genitals(Dreyer et al., 1997). Other complication may include chyluria and
chronic pulmonary fibrosis. The most prevalent of the chronic manifestations are
hydrocele- grossly enlarged and hanging scrotum- and lymphoedema of the arms and
legs, including the most advanced and feared stage, elephantiasis, other complications
may include chyluria (milky urine), which is painless but results in weight loss and
lethargy, and tropical Pulmonary eosinophilia (asthma and cough) which results in
chronic pulmonary fibrosis, more than 30 million people suffer from chronic filarial
disease and over one million with elephantiasis. The rest are infected, but symptomless
(TDR report, 91-92). Little is known about the social and economic impact of lymphatic
filariasis, which makes it difficult to assess what the above figures mean in terms of
human suffering. Clearly, people with gross elephantiasis are severely impaired, both
physically and socially, and the prevalence of elephantiasis alone makes lymphatic
filariasis an important public health problem
The highest number of infected persons is in the South-East Asia Region with India alone
accounting for 45.5 million. In sub Saharan Africa the estimate of 41 million cases is less
precise and there is a particular need to determine more accurately the distribution of
infection and diseases in affected countries. Several countries in Asia have large
numbers of cases and infection and disease are very prevalent in many of the pacific
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islands as well.( Michael et al.,1996WHO, 1995Evans et al., 1993, Ramu et al.,
1996Otteson, 1994Dreyer et al., 1997TDR report, 91-92Ottesen et al., 1997)
The infection of lymphatic filariasis in Nepal is one of the most neglected and hidden
public health and socio-economic problem(WHO,2000). The first report on elephantiasis
was given by Jung (1973) from Central-Nepal. He reported more prevalence of lymphatic
filariasis in rural and semi urban areas in compared to the urban areas. In Gokarna VDC
of KTM valley reported 24.6% endemicity rate with average mf density per person blood
sample was recorded to be 22.40. (Pradhan et al. 1997). Bhusal et al., (2000) reported
5.8% microfilaremia and 13% crude disease rate and density of mf was to be 3/20 micro
liter and 16/20 micro liter of blood in Tokha-Chandeshwari VDC. Bista et al. (2000)
reported the existence of the filariasis in different parts of Nepal. Serially Michael et
al.,1996WHO, 1995Evans et al., 1993, Ramu et al., 1996Otteson, 1994Dreyer et al.,
1997TDR report, 91-92Ottesen et al., 1997Jung (1973) WHO,2000Pradhan et al. 1997).
Bhusal et al., (2000) Bista et al. (2000) Manandhar (2001) reported large percentage of
crude disease from Sipwa, Dovan and Bhaktapur. Sherchand et al. (2002) reported 13%
of microfilaria from 37 districts. Jha et al.,(2003) reported that the overall endemicity
rate of LF of 8 districts was 16.08%. The highest endemicity rate was found in Bhaktapur
(28.36%) and the least in Saptari district (7.69%). Similarly crude disease rate was found
to be the highest in Bhaktapur while the least in Rauthat. Still nation wise figure for the
lymphatic filariasis is lacking.
The climatic condition, temperature and rainfall in hills, mid terai and terai geographical
regions of Nepal are much favorable for the breading of the mosquito vectors. The
existence of the high prevalence of microfilaria disease rate in the country from the
reported cases indicated that large number of the population are at the risk of getting
infection. Hence now the disease had been considered as one of the major public health
problem in the country and had been targeted to eliminate by the year 2015 with the
financial support of WHO.
Administratively Nepal is divided into five development region, fourteen zones and 75
districts. The district is further divided into several municipalities, sub municipalities and
Village Development committees(VDCs). Makwanpur, Chitwan, Nawalparasi and
Rupandehi are the adjoining districts extending from central mid terai regions to mid
western terai region.
The first phase of study and control programme had already been completed in Parsa
district. In second phase of the filariasis elimination programme two more districts
Chitwan and Makwanpur added. Just prior to the present phase of filariasis elimination
programme, epidemiological survey had been carried out to figure out the exact situation
of filariasis in four districts of the country, Rupandehi, Nawalparasi, Makwanpur and
Chitwan applying the sentinel survey method. So that same population can be easily
traced out throughout the elimination programme till the district is considered to be free
of the disease.
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Objective
General objective:
Ø To determine the prevalence and density of microfilariaemia in selected sentinel
areas of Makwanpur, Chitwan, Rupendehi and Nawalparasi districts
Specific objectives:
Ø To determine the prevalence of lymphatic filariasis in four districts.
Ø To determine the microfilariaemia mean density in the study area.

Ø To determine the potential risk factors in relation to filariasis transmission.
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Methodology
Study areas:
Four districts of country
Ø Makwanpur
Ø Chitwan
Ø Rupandehi and
Ø Nawalparasi
In each of the district two sentinel sites were identified with the help of filariasis
elimination program, Nepal, EDCD/HNG, Teku and District Public Health officers of
respective districts. Among these districts, Makwanpur district lies in the Mid-terai
region where as rest of three districts Chitwan, Nawalparasi and Rupandehi lies in the
Terai region.
Study design:
Epidemiological descriptive study.
Sampling Design:
Under the epidemiological descriptive study, Sentinel surveillance method was applied
which is the appropriate method to measure the chronic disease burden, sign and
symptoms and asymptomatic microfilaria carrier in the community. Furthermore the
study design is applicable to conduct the filariasis elimination program because of the
focal nature of LF distribution.
For the sentinel survey two VDCs were selected that is one from urban areas and one
from rural areas. It was targeted to conduct the survey among 500 community people
from each of the sentinel sites for the questionnaire survey and blood sample collection.
Sentinel sites from each district was selected on the basis of identified factors like the
presence of the visible sign and symptoms among the community people (elephantiasis
or hydroceole) that were expected to increase the difficulty of eliminating transmission,
such as area of high prevalence, with high vector densities. In each of the sentinel sites
with the help of the community health workers wards having population of more than
1000 were identified to carry out the detail survey. In selected wards total households
were marked where each and every family members above the age group of two were
identified as the targeted study sample. So that same population can be traced out for the
monitoring of the success of the treatment programme till the districts are considered as
free from filariasis.
Sample size :
A total of 4084 community people were interviewed and night blood samples were
collected. A total of 1019 from Makwanpur, 1006 from Chitwan, 1019 from Nawalparasi
and 1040 from Rupandehi districts with the target of 500 blood samples in each of two
sentinel sites from two districts.
Criteria of inclusion and exclusion:

Children below two years of age was excluded in the survey. Rest of the household
members from each identified household were included in the study.
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Community awareness/ mobilization:
One day community awareness and mobilization programme was organized in each of
the sentinel sites just before the survey started. Community people were informed about
the awareness programme through the community volunteers, heathworkers, political
leaders. The tools used in for that purpose were, hand miking in some sentinel sites like
Bairghat of Rupandehi district, Postering etc. Community people were gathered at a
common community places of each sentinel sites, briefed about the aims and objectives
of the programme, briefed on the disease transmission, pathogenecity and need of
control programme, views expressed from community leaders, local health workers and
social workers. As well as common consent taken to conduct the survey from the
community people. Since the survey was done during the evening and night, it was
essential to introduce the working team in front of the community people and requested
to co-operate with the working team.
Training:
The training programme of one day each was organized in each of the district at four
consecutive time interval for all the staffs involved in the project, prior to commencement
of the survey. During the day time of the training all the field members were instructed to
apply the technique precisely, well acquainted according to the survey methodology.
Standard methods for the administration of the questionnaire in the field condition as well
as easy and convincing techniques for the collection of the blood sample from the ear
lobe was instructed with the help of theoretical and practical approach. The questionnaire
was pre- tested among the participants and piloted during the practical session. All the
participants was examined their practical knowledge of proper blood collection by means
of pilot survey during the same night. Among the total of sixteen participants excellent
eight of them were selected for the following days survey as the project staffs. The same
methodology were applied for the rest of the three districts.
Diagnostic tools:
Consent from the sample population

A set of written consent was given to sign mainly from the household head of each
sentinel site before questionnaire administration and blood sample collection.
Questionnaires administration
A set of structured questionnaire was developed in order to determine the potential risk
factors for filarial transmission. The survey team visited in each of the household and
administered structured questionnaire from the household head (if not- one of the elder
member of the household) during the day time.
Blood sample collection

Detection of microfilariaemia (mf) in the night blood is the only reliable method
available for the diagnosis of filarial infection due to nocturnally periodic nature of
Wuchereria bancrofti. The survey team visited the house holds in between 22.00 p.m. to
2.00 a.m. for the sample collection. The research assistant collected six drops of blood i.e.
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about 20 micro litter from each of the household members by pricking ear lobe with the
sterilized lancet on thorough supervision of parasitologist. Blood smear was prepared in
a slide from each sample individual keeping two drops of blood in each spot of the three
side of the microslide (two drops at the center of the slide and two drops each on the sides
of the slide). The drops of blood in the slides were spread with the help of the toothpick
to prepare the thick smear and reduce the chances of breaking the microfilaria during the
smear preparation. The thick smear were air dried, stickered with the detailed
identification numbers written in the questionnaire form. Microfilaria is nocturnally
periodic, reaching pick density in blood between 10.00 p.m. to 4.00 a.m. and slowly
declining in density , during the day time (David T. Dennis, 1991).
Fixing and staining of the slides

All the blood samples collected along with the questionnaire administration were
properly marked with sticker each set in questionnaire and slides and brought to the
laboratory. The blood smears were fixed dipping the slide for 10 seconds in methanol and
air dried. The dehaemoglobinization was done keeping distilled water sufficient enough
to cover the thick smear and keep for approximately 30 minutes till complete
dehaemoglobinization. The slides were air dried and staining of the slides were
performed dipping the dehaemoglobinized slides in the Giemsa stain for 25 to 30
minutes. The stain was washed and packed in the slide rack for the examination purpose.
Microscopical Examination of the slides

The examination of slides were done using binocular microscope with 5X, 10X, 40X and
100X objectives. Each and every field of the smear was thoroughly examined first in low
power for the screening and high power for the confirmation. The slides checked by the
parasitologists were rechecked and final conclusion for microfilaria positivity and density
were drown.
Result enterpretation
The questionnaire along with the slide examined result were tabulated in the special
format and analysed.
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Results
The present epidemiological surveillance study result of lymphatic filariasis in four
district of the country is divided into three parts (A) community mobilization/ awareness
programme and training to the community health personnel. (B)questionnaire survey and
parasitological examination
I-part: Community awareness/mobilization and Training

A-1: District- Rupandehi
Sentinel site I : Bairghat VDC

Community awareness programme: The field Assistants of the project staffs were
mobilized to inform community people to attend the awareness programme. Hand miking
tool was used for this purpose. The community mobilization / awareness programme was
conducted at training hall of the Sub-health post. The programme was participated by
more than 40 adults and large number of children, which was very much encouraging.
Programme schedule
Date : 24 May, 2005

Venue: Training hall , Bairghat VDC.
Facilitator: Mr. Ramesh Nepal.
Raporteur: Mr. Maheshor Khanal.
11:00- 11:30 – introduction, objective and project plan by Mahendra Maharjan (PI)
11:30 – 11:45 – few words on the programme – Ramesh Nepal (healthpost encharge)
11:45 – 12:15 – Information about the disease – Satish Chandra Jha (CI)
12:15 – 12:20 – Few words - Ram brij Chaudhari (Ex- ward chairman)
12:20 – 12:25 – Few words – Kamalawati Mishra ( community health volunteer)
12:25 – 12:30 – Survey plan – Maheshor Khanal (parasitologist, team leader)
12:30 – 1:00 – Tea and snacks
This awareness programme played very important role to introduce the importance of the
present survey, The disease, transmission pattern, pathology and importance of the night
blood sample collection. The most important positive aspect of the awareness programme
was to make familiar the team members in front of the community people, which was
essential in this present political situation of the particular locality. Besides these, the
awareness programme was intended to take common consent from the community
leaders, social workers and health personnel to conduct the survey. In this sense, the
outcome of the programme seemed extremely fruitful.
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Training programme:
Date : 24 May, 2005

Venue: Training hall , Bairghat VDC.
Experts/trainers: Mr. Mahendra Maharjan
Mr. Satish Chandra Jha
Participants : All the team members
Time schedule:
1:00 – 2:30 – Training on Questionnaire survey
2:30 – 4:00 – Training on blood sample collection and smear preparation.
In the first phase of the training, trainer translated the questions in Nepali language then
explained in detail about the meaning of each and every question. Oriented towards the
pattern of asking questions and expected answer from the respondents.
Participants were informed about some basic DO ‘s’ and NOT to DO ‘s”
DO ‘s’
- When entered the house, start with greetings, informal discussion to bring him/her
normal answering environment.
- Formally introduce yourself, who are you, purpose, what is your expectation of
this visit.
- Take oral consent to participant in this survey most probably from household head
otherwise from elder person.
- Write clearly the serial Number, your group identification alphabet, household
number and sentinel site identification number which most be same with the slide
number collected from the same individual.
- Then ask about the family size- identify who among them are or will be present
during survey period, where the rest family members are? etc.
- Use their own language, use simple informal words so those respondents feel
comfortable with your questions.
- Fill all the known demographic information like district, VDC, ward, etc before
entering the questions.
- Cover each and every questions in sequence, start from household head followed
by elderly persons.
- Fill the questionnaire on behalf of the children with their parents or guardiants.
- Be careful with the link questions.
- Take consent from the respondent if he is above 15 if not take consent from the
guardiants or the parents.
- Inform each of them to remain in full relaxation or sleep and will visit about
approximate time and don’t hesist to give blood samples.
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NOT to DO ‘s’
- Don’t lead the question
- Don’t repeat the questions once you have got the answer i.e. if the answer of the
question no. 11 is ‘No’ leave the question 12 and 13.
-
After these information participants were asked questions as they are the household
members. They were informed to behave as the community members of the different
nature. The trainees were practically taught how to tackle with the different situation.
Then the questions were practiced among themselves.
Refreshment break
In second phase of the training the participants were practiced to collect the blood
samples
The participants were oriented to the materials needed to bring with them during the field
visit/ preparation before field visit. They are as follows:
- Wear apron and gloves for safety and also keep their identity card with them
- Arrange the slide collection packet i.e appropriate number of slide box, cotton
swab, lancet, glass slides, wooden sticks. Besides these field bag including the
torch light etc.
- Arrange the questionnaire according to the household number.
- Prepare the appropriate number of the spirit cotton swab.
- Prepare the appropriate number of the glass slides(clean) and keep sticker label on
the one side of the slide. Arrange the sticker labeled slides in the slide box.
- Arrange the questionnaire set of the particular household, keep serial number,
group identification number, household number and sentinel site identification
number on the label of the individual to whom you are going to collect the blood
samples.
Blood collection methods:

- Clean the lower ear lobe with the cotton swab, in case of ladies, be sure that
request her or her gaurdiants to take out the ear rings and other ornaments from
the ear lobes.
- Prick the ear lobe with the sterilized lancet, don’t touch the tip of the lancet with
your hand or don’t keep the lancet opened. Take out just prior to the pricking.
- Squeez the ear lobe slowly so that a big drop of blood comes out.
- Drop the two drops of blood in the centre of the slide, spread spherically but
blood should not touch the margin of the slide.
- Squeez second time the ear lobe , drop again the two drops of blood on the one
side and spread as previously, similarly repeat for the third time and keep on the
another end but don’t touch the labeling sticker.
- Clean the ear lobe with the spirit cotton swab.
- Make the slide air dry.
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- Arrange the slide in sequencing manner in the slide box.
- Repeat the same method of the blood collection and slide preparation from the
another family member.
After these information, the trainer had shown practically the preparation of the field bag
and arrangement method of the materials needed during night blood sampling. When
every thing is ready. Each and every participants were allowed to write their serial
number one each of the questionnaire set, supposing that each of the participants are of
the same family members. Trainer had requested to take the blood sample from one of the
participants. He had shown practically how to collect blood samples and how to make
the thick blood film in the slide and then to arrange in the slide box. The method was
practiced among each other by the participants. The trainer pointed out their wrong
methods and repeatedly practiced to make them perfect.
The participants were divided into two groups each of the two members guided by
parasitologist, and expert, group A and B respectively.
Field questionnaire survey
After 4:00 PM, each of the group selected their household and became ready for the
questionnaire survey upto 8:00 PM.
Arrangement for blood collection

Came back from the field and took dinner
After dinner each of the group arranged their survey bag for the blood collection.
Arranged necessary materials i.e. spirit swab preparation, labeling stickers on glass slides
etc.
Night blood collection
Since the community people sleep late during these days, blood collection was started
only after 12:00 mid night. As in questionnaire survey, during the night blood collection
also the twogroups were guided by the parasitologist and expert. Each of the team moved
towards the same household from where they have administered the questionnaire. The
groups started to collect the blood samples using the appropriate techniques. They were
guided by the experts in each and every steps.
After the training programme, each of the project staffs were informed their
responsibility during the survey period. Inform them to use the same methodology, not to
compromise with the quality of the survey.
Same methodology was applied in rest of all the sentinel sites for the community
awareness/mobilization programme and the training to the community health workers.
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(See the preliminary report submitted to the lymphatic filariasis programme,
EDCD/HMG, Teku) Briefly
Sentinel site II
Mangal pur, Bishnu Pura VDC-4, Rupandehi district.
Date: 15th jesth 2062
Team formation: The field working team was formed before the survey was started. The
team composition was as follows:
Parasitologist: Mr. Bhoj Bahadur Bhat Chhetri (Team leader)

Research assistant Mr. Ram Prasad Gautam (HA, health-post encharg)
Mr. Bishnu Prasad Upadyaya (CMA)
Field assistant Mrs.Rashika Gautam (AHW)
Mr. Ahamad Husain(VHW)
mobilized to inform community people to attend the awareness programme. The
community mobilization / awareness programme was conducted at training hall of the
Sub-health post. The programme was participated by large number of community people.
The awareness programme was addressed by the investigators, team leader, healthpost
encharge, community leaders and social workers of the community.
Similar training method was applied as described above in this site too
District: Nawalparasi
Sentinel site I
Rani nagar, Triveni VDC- 6, Nawalparasi district.
Date: 12th jesth 2062.
Parasitologist: Mr. Ashok Bahadur Bam (Team leader)

Research assistant Mr. Indra Mahato (CMA, sub-health-post encharg)
Mr. Sunil Gautam (Lab-assistant)
Field assistant Mr.Brij Bihari Chaudhari (VHW)
Mrs. Indira Joshi(CMA)
Sentinel site: Ward no 6 of the triveni VDC
mobilized to inform community people to attend the awareness programme. Hand miking
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tool was used for this purpose. The community mobilization / awareness programme was
conducted at training hall of the Sub-health post. The programme was participated by
more than 60 adults and large number of children, which was very much encouraging.
encharge, community leaders and social workers of the community.
Similar training method was applied as described above
Sentinel site II
Tharu gaun, Kudia VDC- 7, Nawalparasi district.
Date: 13th jesth 2062
Parasitologist: Mr. Yam Bahadur pokhrel (Team leader)

Research assistant Mr. Rishi Kafle (CMA, sub-health-post encharg)
Mr. Padam Bahadur Chettri (Lab-assistant)
Field assistant Mr.Ram Prasad Panjiyar (VHW)
Mrs. Goma Pandey(CHV)
Sub-health post. The programme was participated by large number of community people
which was very much encouraging.
encharge, community leaders and health and social workers of the community.

District: Makawanpur
Sentinel site I
Patkeri-7, Hatia VDC,
Date: 5th, Ashad 2062
Parasitologist: Mr. Yam Bahadur pokhrel (Team leader)

Research assistant Mr. Pushpa Ram Gallu (health-post encharg)
Mr Uttam Aryal (Lab-assistant)
Field assistant Ms.Kamala Subedi (ANM)
Ms. Basu Subedi (ANM)
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District: Makawanpur
Sentinel site II
Gopali gaun, Palung Daman VDC,
Parasitologist: Mr. Ashok Bahadur Bam (Team leader)

Research assistant Mr. Kedar lama (CMA)
Mr Durga Dhakal (ANM)
Field assistant Ms.Pabita K.C (CHW)
Ms. Kanchan K.C (CHW)

District: Chitwan
Sentinel site I
Beldiha, Bhandara VDC-7,
Parasitologist: Mr. Budhan Chaudhari (Team leader)

Research assistant Mr. Deepak Paudel (CMA)
Mr Indra Prasad Silwal (Lab assistant)
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Field assistant Mr .Agni Prasad Silwal (CHW)
Ms. Santosi Silwal (CHW)
District: Chitwan
Sentinel site I
Tandi, Ratna nagar municipality-8,
Date: 3rd, Ashad 2062
Parasitologist: Mr. Dina Nath Dhakal (Team leader)

Research assistant Ms. Rekha Shrestha (CMA)
Ms Shanti Paudel (Lab assistant)
Field assistant Ms .Sudha Bohara (CHW)
Ms. Shalik Ram Adhikari (CHW)
(B) Questionnaire survey and parasitological examination
All together 4084 community people permanently inhabiting the eight sentinel sites of
four districts of Nepal were interviewed (with themselves or with their gradients) using
structural questionnaire and night blood samples were collected and examined for
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analysis of the filariasis situation from all those volunteers prior to the control
programme.
DEMOGRAPHIC CHARACTERISTIC
1. DISTRICT-WISE SAMPLE COLLECTION
In all the four districts, questionnaire survey and night blood samples were collected from
two each sentinel sites: sentinel sites were as follows
Rupandehi:
Sentinel site I – Bairghat
Sentinel site II – Bishnupura
Nawalparasi:
Sentinel site I – Raninagar,Triveni
Sentinel site II – Kudiya
Chitwan
Sentinel site I – Bhandara
Sentinel site II – Ratnanagar
Makwanpur
Sentinel site I – Hatiya
Sentinel site II – Palung
Districts Sentinel Sites Total Male(%) Female(%)

1. Rupendehi 1a, Bairghat 510 282(55.3) 228(44.7)
1b, Bishnupura 530 246(46.4) 284( 53.6)
Total 1040 528(50.8) 512(49.2)
2, Nawalparasi 2a, Raninagar 508 233(45.9) 275(54.1)
2b, Kudiya 511 252 (49.1) 259(50.7)
Total 1019 485(47.5) 534(52.4)
3, Chitwan 3a,Bhandara 504 246(48.8) 258(51.2)
3b,Ratnanagar 502 247(49.2) 255(50.8)
Total 1006 493(49) 513(51)
4, Makwanput 4a, Hatiya 512 226(51.9) 246(48.1)
4b, Palung 507 235(46.4) 272(53.6)
Total 1019 501(49.1) 518(50.9)
TOTAL 4084 2007(49.15) 2077(50.85)
Table no. 1 : Total no. of blood samples collected from four districts.
collected from two each sentinel sites of the four districts. Among them males were 2007
(49.15%) male and 2077(50.85%) female. From each of the sentinel sites more than 500
community people were involved in the survey.
18 | P a g e
2, AGE AND SEX-WISE SAMPLE COLLECTION:
Each and every household members above the age group two in the identified sentinel
sites were included.
Table no. 2 age and sex wise collection of blood samples

Age Total Male Female
group
Yrs No. of % No. of % No. of %
samples samples samples
Under 762 18.66 391 19.48 371 17.86
10
11-20 958 23.46 469 23.37 489 23.54
21-30 712 17.43 308 15.35 404 19.45
31-40 543 13.30 242 12.06 301 14.49
41-50 445 10.90 206 10.26 239 11.51
51-60 273 6.68 154 7.67 119 5.73
61-70 210 5.14 123 6.13 87 4.19
> 70 181 4.43 114 5.68 67 3.23
Total 4084 100.00 2007 100.00 2077 100.00
The maximum study population belongs to age group 11-20 i.e. 23.54% and least above
70 i.e. 3.23%
3,EDUCATION AND DISTRICT WISE SAMPLE COLLECTION
Table no. 3 education and district wise distribution of study population.

Education Chitwan Rupandehi Nawalparasi Makawanpur Total
Bhandara Rathanagar Bairghat Bishnupur Raninagar Kudiya Hatiya Palung
Illiterate 289(17.31) 72(4.31) 360(12.57) 365(21.87) 113(6.77) 143(8.57) 145(8.69) 182(10.90) 1669(40.87)
Literate 45(16.54) 56(20.59) 22(8.09) 19(6.99) 26(9.56) 26(9.56) 38(13.97) 40(14.74) 272(6.66)
Primary 72(8.65) 86(10.34) 97(11.66) 103(12.380 138(16.59) 69(8.29) 130(15.63) 137(16.47) 832(20.37)
Secondary 98(7.48) 288(20.97) 31(3.66) 43(3.28) 231(17.62) 273(20.82) 199(15.18) 148(11.29) 1311(32.10)
Distribution of educational level of the study population showed that maximum samples
were collected from the illiterate groups in Bhandara just reverse in Ratnanagar in case
of Chitwan, while in Rupandehi, maximum samples were collected from illiterate group
in both sentinel sites. In Nawalparasi, maximum samples were collected from literate
groups but in Makwanpur, maximum smples were collected from theliterates in palung
and least form the Hetaunda.
19 | P a g e
4) OCCUPATION AND DISTRICTWISE SAMPLE COLLECTION
Table no. 4, Occupation and district wise collection of blood sample

occupation Chitwan Rupandehi Nawalparasi Makawanpur Total
Bhandara Rathanagar Bairghat Bishnupur Rohinagar Kudiya Hatiya Palung
Farmer 229 43 276 330 53 282 237 205 1655(40.56)
Student 146 248 117 79 225 4 146 165 1130(27.70)
Labour 11 19 18 9 14 2 11 3 87(2.13)
Housewife 85 72 38 20 62 185 85 55 602(14.75)
Businessman 4 65 8 6 88 12 4 43 230(5.64)
Unemployed 1 9 4 10 8 12 1 12 57(1.40)
Teacher 5 9 1 2 10 3 5 0 35(0.86)
Other 8 21 11 35 33 3 8 8 127(3.11)
Child 15 16 37 39 35 8 15 16 161(4.03)
Total 500 500 500 500 500 500 500 500 4000
The table indicated that large number of people in the study area engaged in
agriculture(40.55%) than other occupation.
KNOWLEDGE AND PRECAUTION OF FILARIASIS AMONG DIFFERENT

EDUCTIONAL STATUS
Educational level of the community people are categorized illiterate, who cann’t read and
write, literate- who had taken adult education courses and remaining according to the
schoolings. Knowledge determines the people who had seen elephantiasis or hydrocele
people either around their community or somewhere else. Precaution determines the
community people’s practice of using bednets, ointments or some other measures against
mosquito bite.
Table 5 : Distribution of knowledge and precaution of filariasis among peoples

belonging to different economic status.
Education Total No Of person Knowledge(%) Precaution(%)
Illiterate 1669 222 (13.30) 41 (2.46)
Literate 272 79 (29.04) 27 ( 9.93)
Primary 832 95 (11.42) 29 (3.49)
Secondary + higher 1311 540 (41.19) 288(21.97)
studies
The highest knowledge about elephantiasis was found among secondary educational
status population in which highest number of precaution was also found to be taken by
same status population it was found that there is statically significant difference of
knowledge and precaution among different educational status
20 | P a g e
PREVALANCE OF MICROFILARIA
GENERAL PREVALANCE : A total of 4084 individual were examined from four

district of Nepal of which overall crude disease rate was 67 ( 1.68%) and individuals
103(2.58%) had microfilaria, 14(0.35%) had microfilaria with sign and symptoms of LF .
Hence endemicity rate was found to be 4.6% of 184 samples
DISTRICT – WISE DISTRIBUTION OF LYMPHATIC FILERIASIS
Table:6(I):- Distrist wise distribution of Sign and Symptom of Lymphatic filariasis
Total
Sign and Symptoms
Sentinal site Total Sample E H B C L T CDR%
Bairghat 510 1 2 0 3 1 0 7
Rupendehi Bishnupura 530 5 15 0 4 0 0 24
Raninagar 508 3 3 1 0 1 0 8
Nawalparasi Kudia 511 1 10 0 2 0 1 14
Bhandara 504 1 2 0 1 0 0 4
Chitwan Ratnanagar 502 1 0 0 1 0 0 2
Hatiya 512 0 0 0 0 1 0 1
Makwanpur Palung 507 5 1 0 0 1 0 7
Total 4084 17 33 1 11 4 1 67
Table:6(II):- Distrist wise and sexwise distribution of Sign and Symptom of Lymphatic filariasis
Male Female
Total Total
Sentinal site Sample E H C L CDR% Sample E C L T B CDR%
Bairghat 282 1 2 1 0 4 228 0 2 1 0 0 3
Rupendehi Bishnupura 246 0 15 0 0 15 284 5 4 0 0 0 9
Raninagar 233 2 3 0 0 5 275 1 0 1 0 1 3
Nawalparasi Kudia 252 0 10 0 0 10 259 1 2 0 1 0 4
Bhandara 246 0 2 0 0 2 258 1 1 0 0 0 2
Chitwan Ratnanagar 247 0 0 0 0 0 255 1 1 0 0 0 2
Hatiya 266 0 0 0 0 0 246 0 0 1 0 0 1
Makwanpur Palung 235 1 1 0 0 2 272 4 0 1 0 0 5
Total 2007 4 33 1 0 38 2077 13 10 4 1 1 29
21 | P a g e
Rupandehi
A total of 1040 night blood samples were collected from the two sentinel sites of the
Rupandehi district, Bairghat and Bishnupura respectively.
Table 7. Prevalence of microfilaria in Rupendehi district

Sentinel site Total sample Total positive Percentage
Bairghat 510 14 2.74%
Bishnupura 530 40 7.55%
Total 1040 54 5.19%
Among the total 1040 night blood sample, microfilaria prevalence was found to be 5.19%
(54/1040) in Rupandehi district. Among them highest prevalence was recorded in the
Bishnupura sentinel site i.e 7.55%(40/530).
Table 8. Endemicity rate of Lymphatic filariasis in Rupandehi district

Sential site Total MF CDR MF + ER(%)
sample CDR Sentitialsite
Bairghat 510 14 7 21(4.1%)
Bishnupur 530 37 24 3 64 (12.1%)
Total 1040 51 31 3 85 (8.2%)

mosquito bite.
22 | P a g e
70 i.e. 3.23%
Table 9. Endemicity rate of Lymphatic filariasis in Rupendehi district

Bairghat 510 14 7 21(4.1%)
Bishnupur 530 37 24 3 64 (12.1%)
Total 1040 51 31 3 85 (8.2%)

mosquito bite.
23 | P a g e
70 i.e. 3.23%
Endemicity rate of the lymphatic filariasis includes the microfilaria positive cases with or
without sign and symptoms as well as the crude disease rate (CDR) which includes
chronic elephantiasis, limbs swelling, breast swelling, chyluria, skin thickness,
lymphoedema etc too. Overall endemicity rate of lymphatic filariasis also showed very
high in the Rupandehi district i.e. 8.2%(85/1040).
Endemicity rate of the lymphatic filariasis includes the microfilaria positive cases with or
without sign and symptoms as well as the crude disease rate (CDR) which includes
chronic elephantiasis, limbs swelling, breast swelling, chyluria, skin thickness,
lymphoedema etc too. Overall endemicity rate of lymphatic filariasis also showed very
high in the Rupandehi district i.e. 8.2%(85/1040).
Table 10. Sexwise prevalence of microfilaria

Sex Bairghat Bishnupura
Total Mf percentage Total Mf percentage

sample positive sample positive
Male 282 7 2.48% 246 19 7.7%
Female 228 7 3.07% 284 21 7.4%
Total 510 14 2.74% 530 40 7.5%
Sex wise prevalence of the microfilaria positivity and endemicity rate in the Bairghat and
Bishnupura sentinel sites of the Rupandehi district revealed no significant difference.
Table 11. Sex wise endemicity rate of lymphatic filariasis in Rupandehi district
Sex Bairghat Bishnupura Rupandehi
MF CDR MF ER(%) MF CDR MF ER(%) Total
+ + ER(%)
CDR CDR
Male 7 4 0 11 17 15 2 34 48(9.35%)
Female 7 3 0 10 20 9 1 30 37(7.44%)
Total 14 7 0 21(4.1%) 37 24 3 64(12.8%) 85(8.4%)
24 | P a g e
Night blood samples were collected from each and every family members above the age
group two of the identified households in the sentinel sites.
Table 12. Age wise prevalence of microfilaria in Rupandehi district.

Age Bairghat Bishnupura
group Total Mf Percentage Total Mf Percentage
<10 118 0 0 178 5 2.80
11-20 139 3 2.15 115 11 9.56
21-30 64 5 7.81 84 7 8.33
31-40 67 1 1.49 58 4 6.89
41-50 64 2 3.12 29 4 13.79
51-60 26 3 11.53 30 2 6.66
61-70 20 0 0 25 4 16
>70 12 0 0 11 0 0
Maximum prevalence of the microfilaria in case of Bairghat revealed among the age
group 51-60 years while in Bishnupura sentinel site revealed maximum in age group 41-
50 i.e 11.53% and 13.79% respectively. Prevalence of microfilaria was found to be
minimum among the age group of below 10 and above 70.
Table 13. Age wise endemicity rate of Lymphatic filariasis in Rupandehi district
Age Total Bairghat Bishnupura
group
Total Total Total Total Mf CDR Mf + ER ER Total Mf CDR Mf + ER ER(%)
Sample ER ER(%) sample CDR (%) sample CDR
<10 296 6 2.03 118 0 0 0 0 0.00 178 5 1 0 6 3.37

11-20 254 18 7.09 139 3 0 0 3 2.16 115 11 3 1 15 13.04
21-30 148 17 11.49 64 5 0 0 5 7.81 84 7 5 0 12 14.29
31-40 125 14 11.20 67 1 3 0 4 5.97 58 4 5 1 10 17.24
41-50 93 14 15.05 64 2 3 0 5 7.81 29 4 5 0 9 31.03
51-60 56 7 12.50 26 3 0 0 3 11.54 30 2 2 0 4 13.33
61-70 45 5 11.11 20 0 0 0 0 0.00 25 4 1 0 5 20.00
>70 23 4 17.39 12 0 1 0 1 8.33 11 0 2 1 3 27.27
1040 85 87.86 510 14 7 0 21 43.63 530 37 24 3 64 39.58
But endemicity rate of the lymphatic filariasis was found to be higher in the age group
above 70 i.e. 17.39% that is due to the presence of the sign and symptoms, Crude Disease
Rate (CDR). Most of the chronic elephantiasis cases are found among the elderly age
group people while hydrocele cases were revealed maximum among the young age group
people.
25 | P a g e
Nawalparasi
Nawalparasi district. Prevalence of microfilaria in this district is also found to be very
high 4.9%(50/1019). Among the two sentinel sites higher prevalence of microfilaria in
the blood samples was found in Tharu gaun of the Kudia VDC than Rani nagar of the
Triveni VDC. The crude disease rate also found maximum in Kudia VDC. Due to the
large no. of the crude diseases rate particularly hydrocele and elephantiasis and chyluria
the endemicity rate of the lymphatic filariasis increased upto the 7.06%.
Table 14. Prevalence of microfilaria in Nawalparasi district

Rani nagar 508 19 3.74%
Kudia 511 31 6.06%
Total 1019 50 4.9%
Table 15. Endemicity rate of Lymphatic filariasis in Rupendehi district

Rani nagar 508 18 8 1 27(5.31%)
Kudia 511 28 14 3 45(8.8%)
Total 1019 46 22 4 72(7.06%)
Analysis of the distribution of the microfilaria and lymphatic endemicity rate in

Nawalparasi district revealed reverse result i.e. the higher prevalence revealed among the
males in Rani nagar of the Triveni VDC and minimum in Kudia. But overall endemicity
rate of lymphatic filariasis indicated similar distribution among both sex groups.
Table 16. Sexwise prevalence rate of microfilaria
Sex Raninagar Kudia

Male 233 13 5.57% 252 8 3.18
Female 275 6 2.18 259 23 8.88
Total 508 19 3.74 511 31 6.06%
26 | P a g e
Table 17. Sex wise endemicity rate of lymphatic filariasis in Nawalparasi district
Sex Rani nagar Kudia Nawalparasi
MF CDR MF ER(%) MF CDR MF ER(%) Total
+ + ER(%)
CDR CDR
Male 12 5 1 18 6 10 2 18 36(7.43%)
Female 6 3 0 9 22 4 1 27 36(6.74%)
Total 18 8 1 27 28 14 3 45 72(7.06%)
In Nawalparasi district, agewise distribution of microfilaria in community people with or

without crude disease as well as the sign and symptoms indicated maximum prevalence
in age group21-23 and 51-60 in case of Triveni VDC while similar result revealed among
the elderly age group people in Kudia VDC too. The result is also similar with the
endemicity rate in both of the sentinel sites of the Nawalparasi district. There were 8
cases of only crude disease rate found in Triveni while 14 cases of crude disease rate
observed in Kudia. Regarding CDR maximum elephantiasis cases as well as hydrocele
cases found in both of this sentinel sites. Most interestingly in both of these sites large
numbers of young men and boys came to consult about their hydrocele problems. Some
of them had removed water with the help of physicians not only in Nepal but also in India
but the problem is still existing and suffering. These people had clearly presented their
views regarding their psychological and social problem because of hydrocele problem
and its negative impact in their marriage life.
Table 18. Age wise prevalence of microfilaria in Nawalparasi district.

Age Rani nagar Kudia
<10 125 0 0.00 90 3 3.33
20-Nov 148 6 4.05 181 4 2.21
21-30 48 5 10.42 55 5 9.09
31-40 56 1 1.79 60 3 5.00
41-50 70 3 4.29 60 8 13.33
51-60 24 3 12.50 30 1 3.33
61-70 17 1 5.88 15 5 33.33
>70 20 0 0.00 20 2 10.00
508 19 511 31
27 | P a g e
Table 19. Age wise endemicity rate of Lymphatic filariasis in Nawalparasi district
Age Total Rani Nagar Kudia
group
<10 3 125 0 0 0 0 0.00 90 3 0 0 3 3.33
215 1.40
11-20 17 148 6 2 0 8 5.41 181 3 5 1 9 4.97
329 5.17
21-30 15 48 4 1 1 6 12.50 55 5 4 0 9 16.36
103 14.56
31-40 9 56 1 3 0 4 7.14 60 2 2 1 5 8.33
116 7.76
41-50 13 70 3 0 0 3 4.29 60 8 2 0 10 16.67
130 10.00
51-60 5 24 3 1 0 4 16.67 30 1 0 0 1 3.33
54 9.26
61-70 8 17 1 1 0 2 11.76 15 4 1 1 6 40.00
32 25.00
>70 2 20 0 0 0 0 0.00 20 2 0 0 2 10.00
40 5.00
1019 72 508 18 8 1 27 511 28 14 3 45
Chitwan
Chitwan district, Bhandra and Ratna nagar. In comparision to the Rupandehi and Ratna
nagar municipality microfilaria prevalence rate is found to be very less. Only one each
samples found to be positive for the microfilaria in the night blood samples. But the rate
of the crude disease is not less. In most of the cases community people don’t wish to
explain there secrete problems, although it is evident that a total of six people had
mentioned their secret problems and some of them talked about their elephantiasis
problem. Hence the total lymphatic filariasis endemicity rate is about one percent. It is
remarkable that those community people had already received first phase treatment
against the lymphatic filariasis before more than one year and going to receive second
phase of the treatment after the survey.
Table 20. Prevalence of microfilariaemia in Chitwan district

Bhandra 504 1 0.19%
RatnaNagar 502 1 0.19%
Total 1006 2 0.19%
Table 21. Endemicity rate of Lymphatic filariasis in Chitwan district.

Bhandra 504 1 4 0 5(0.99%)
RatnaNagar 502 1 2 0 3(0.59%)
Total 1006 2 6 0 8(0.79%)
28 | P a g e
Each case of the microfilaria infection in both of the sentinel sites showed only in the
males. None of the cases in the females observed. Large numbers of crude disease rate
observed in both of the sentinel sites compared to the microfilaria infection rate. Among
CDR most cases were of chronic elephantiasis.
Table 22. Sex-wise prevalence rate of microfilaria

Sex Bhandara RatnaNagar

Male 246 1 0.4% 247 1 0.40%
Female 258 0 0% 255 0 0%
Total 504 1 0.19% 502 1 0.19%
Table 23. Sex wise endemicity rate of lymphatic filariasis in Chitwan district
Sex Bhandara RatnaNagar Chitwan
Mf CDR MF ER(%) MF CDR MF ER(%) Total
+ + ER(%)
CDR CDR
Male 1 2 0 3(1.21%) 1 0 0 1(0.4%) 4(0.81%)
Female 0 2 0 2(0.77%) 0 2 0 2(0.78%) 4(0.77%)
Total 1 4 0 5(0.99%) 1 2 0 3(0.59%) 8(0.79%)
Each cases of microfilaria found among the age group 51-60 in Bhandara and 31-40 in
Ratnanagar. CDR was observed in all age groups in case of Bhandara. Hence overall
endemicity rate of the lymphatic filariasis was about one percent.
Table 24. Age wise prevalence of microfilaria in Chitwan district.

Age Bhandara RatnaNagar
<10 90 0 0.00 72 0 0.00
20-Nov 149 0 0.00 125 0 0.00
21-30 85 0 0.00 100 0 0.00
31-40 62 0 0.00 88 1 1.14
41-50 49 0 0.00 54 0 0.00
51-60 31 1 3.23 24 0 0.00
61-70 25 0 0.00 27 0 0.00
>70 13 0 0.00 12 0 0.00
504 1 502 1
29 | P a g e
Table 25. Agewise endemicity rate of Lymphatic filariasis in Chitwan district.
Age Total Bhandara RatnaNagar
group
<10 0 90 0 0 0 0 0.00 72 0 0 0 0 0.00
162 0.00
11-20 1 149 0 0 0 0 0.00 125 0 1 0 1 0.80
274 0.36
21-30 2 85 0 2 0 2 2.35 100 0 0 0 0 0.00
185 1.08
31-40 2 62 0 0 0 0 0.00 88 1 1 0 2 2.27
150 1.33
41-50 0 49 0 0 0 0 0.00 54 0 0 0 0 0.00
103 0.00
51-60 2 31 1 1 0 2 6.45 24 0 0 0 0 0.00
55 3.64
61-70 1 25 0 1 0 1 4.00 27 0 0 0 0 0.00
52 1.92
>70 0 13 0 0 0 0 0.00 12 0 0 0 0 0.00
25 0.00
1006 8 8.34 504 1 4 0 5 12.80 502 1 2 0 3 3.07
Makwanpur
Makwanpur district, Hatiya and Palung respectively. Microfilaria prevalence was found
only in Hatiya i.e. 2.14% but nil in Daman VDC palung. Makwanpur district is also one
of the district where first phase of control programme had already been conducted before
more than one year along with the Chitwan. Overall microfilaria prevalence in
Makwanpur district is 1.07% while the lymphatic filariasis endemicity rate was 1.86%
since large number of crude disease rate in both of the sentinel sites of this district. In
Hatiya VDC, maximum 7 cases of the CDR including with the microfilaria was recorded.
Table 26. Prevalence of microfilariaemia in Makwanpur district

Hatiya 512 11 2.14%
Palung 507 0 0%
Total 1019 11 1.07%
Table 27. Endemicity rate of Lymphatic filariasis in Makwanpur district.

sample CDR Sentitial
site
Hatiya 512 4 1 7 12(2.34%)
Palung 507 0 7 0 7(1.38%)
Total 1019 4 8 7 19(1.86%)
Sexwise prevalence rate of the microfilaria result revealed that the cases were equally
distributed in both of the sex. But maximum CDR found to be distributed among the
30 | P a g e
females than that of the males i.e. due to the chronic elephantiasis among the females
more than that of the males.
Table 28. Sex-wise prevalence rate of microfilaria

Sex Hatiya Palung

Male 266 6 2.25% 235 0 0
Female 246 5 2.03% 272 0 0
Total 512 11 2.14% 507 0 0
Table 29. Sex wise endemicity rate of lymphatic filariasis in Makwanpur district
Sex Hatiya Palung Makwanpur
M CD MF ER(%) M CD MF ER(%) Total
f R + F R + ER(%)
CD CD
R R
Male 3 0 3 6(2.25%) 0 2 0 2(0.85%) 8(1.59%)
Female 1 1 4 6(2.43%) 0 5 0 5(1.83%) 11(2.12%)
Total 4 1 7 12(2.34%) 0 7 0 7(1.38%) 19(1.86%)
Regarding agewise distribution of the microfilaria infection in Makwanpur district,

maximum cases were observed in the younger age groups while sign and symptom cases
were found to be higher in elderly age group people.
Table 30. Age wise prevalence of microfilaria in Makwanpur district.

Age Hatiya Palung
<10 44 2 4.55 45 0 0.00
11-20 49 4 8.16 52 0 0.00
21-30 127 2 1.57 149 0 0.00
31-40 79 2 2.53 73 0 0.00
41-50 62 0 0.00 57 0 0.00
51-60 53 1 1.89 55 0 0.00
61-70 60 0 0.00 21 0 0.00
>70 38 0 0.00 55 0 0.00
512 11 507 0
31 | P a g e
Table 31. Agewise endemicity rate of Lymphatic filariasis in Makwanpur district.
Age Total Bhandara RatnaNagar
group
<10 3 44 0 0 2 2 4.55 45 0 1 0 1 2.22
89 3.37
11-20 5 49 1 1 3 5 10.20 52 0 0 0 0 0.00
101 4.95
21-30 3 127 2 0 0 2 1.57 149 0 1 0 1 0.67
276 1.09
31-40 2 79 1 0 1 2 2.53 73 0 0 0 0 0.00
152 1.32
41-50 1 62 0 0 0 0 0.00 57 0 1 0 1 1.75
119 0.84
51-60 4 53 0 0 1 1 1.89 55 0 3 0 3 5.45
108 3.70
61-70 0 60 0 0 0 0 0.00 21 0 0 0 0 0.00
81 0.00
>70 1 38 0 0 0 0 0.00 55 0 1 0 1 1.82
93 1.08
1019 19 16.34 512 4 1 7 12 20.74 507 0 7 0 7 11.92
DISTRIBUTION OF SIGN AND SYMPTOM CASES IN FOUR DISTRICTS
Chitwan: Out Of 1006 Examined persons, 6 (0.6%) showed signs and symptoms of
lymphatic filariasis in which 2 had elephantiasis, 2 has hydrocoele and 2 had chyluria.
Rupandehi: The overall crude disease rate in this district was found to be 3.26% of 34
persons in which 5 had elephantiasis, 17 had hydroecoele 9 had chiluria 1 had
lymphoedema, 1 had elephansitiasis whith chyluria and 1 had swelling of lymphnode
with chyluria.
Nawalparasi: In this discrict the crude disease rate was 2.6% of 26 samples in which 3
had elephantiasis, 16 had hydroecoele, 1 had chyluria, 1 had lymphnode, 1 had thick skin
1 had elephantiasis with breast swelling 1 had elephantiasis with thick skin and 1 had
chyluria with thick skin
Makawanpur: The crude disease rate was found to be 1.07% (15 individuals ) in which 5
had elephantiasis, 1 had hydrocoele, 1 had chyluria, 7 had swelling of lymphnode and 1
had thick skin
32 | P a g e
LYMPHATIC FILARIASIS IN STUDY AREA
Microfilaria prevalence showed increasing trend from the eastern part of mid terai
geographical region, Makwanpur to the western terai region. In this present study
comparatively least prevalence found in the Chitwan(0.19%) and miximum in Rupandehi
district(5.19%). But the prevalence of the microfilaria infection in two sentinel sites of
the same districts also showed marked variation.
Microfilariemia prevalence in four districts of Nepal
8
7.55%
7
6 6.06%
p e r c e n ta g e
5 4.9% 5.19% Sentinel I

4 3.74% Sentinel II
3 2.74% Total
2 2.14%
1
0 0
0.01% 0.19
0.19%
Makwanpur Chitwan Nawalparasi Rupandehi
Districts
Figure 1: Prevalence of microfilaria in four districts of Nepal
The distribution pattern of the endemicity rate of the lymphatic filariasis in four districts
also showed the similar to that of the microfilaria distribution.
33 | P a g e
Endemicity rate(ER) of Lymphatic filariasis in four
districts of Nepal
10
8.2%
8 7.06%
percentage
6
4
1.86%
2 0.79%
0
Districts
Figure2. : Lymphatic filariasis endemicity in four districts of Nepal
Sex wise comparative endemicity rate of lymphatic filariasis showed more cases in the
male than female in all three districts besides the Makwanpur district. But distribution
pattern in male and females were not significant. Both male and female were found to be
more or less equally infected either with the microfilaria in their blood or with the
chronic elephantiasis or with the hydroceole or chyluria.
Sex wise endemicity rate of lympatic filariasis in

four districts of Nepal
10 9.35%
7.43% 7.44%
8 6.74%
Percentage
6 Male
4 2.12% Female
1.59%
2 0.81%0.77%
0
Districts
Figure 3. : Sex wise endemicity rate of lymphatic filariasis in four districts of Nepal
Agewise endemicity rate showed markedly variation in four districts. In Nawal parasi and
Rupandehi where maximum microfilaria as well as CDR was recorded showed maximum
in 61-70 age group in Nawalparasi district while situation in Rupandehi showed
increasing number of cases from the younger age group to the elderly age group.
34 | P a g e
Age wise endemicity Rate of Lymphatic filariasis in
four districts of Nepal
30
Percentage ( % )
25
Makwanpur
20
Chitwan
15
Nawalparashi
10
Rupandehi
5
0
<10 .11-20 21-30 31-40 41-50 51-60 61-70 >70
Age Group
Figure. 4: Agewise endemicity rate of lymphatic filariasis in four districts of Nepal.
Table 32 Lymphatic filariasis endemicity rate in four districts of Nepal

District Sential MF CDR MF + ER(%) ER(%)
CDR Sentitialsite District
Chitwan Bhandara 1 4 5 8(0.8)
Ratnanager 1 2 3
Rupandehi Bairghat 14 7 21 85(8.5)
Bishnupur 37 24 3 64
NawalParasi Raninager 18 8 1 27 72(7.2)
Kudiya 28 14 3 45
Makwanpur Hatiya 4 1 7 12 19(1.9)
palung 7 7
103 67 14 184(4.6) 184(4.6)
Overall endemicity rate of lymphatic filariasis in four districts of Nepal was found to be
4.6% of Rupandehi was recorded to be highly prevalent district and Chitwan as the least
prevalent district. Possible sign and symptoms of the lymphatic filariasis like chronic
elephantiasis, hydroceole or chyluria cases were common in all the districts.
35 | P a g e
AGE AND SEX-WISE ENDEMICITY RATE
The overall study showed that the highest endemicity rate was found in the age group 40-
49. Sex wise endemicity rate highest in age group 30-39 in male and age group 60 -69
in females.The ratio of microfilariaemia, crude disease amd microfilariaemia with clinical
symptom in both sexes was found almost same
OCCUPATION-WISE ENDEMICITY RATE
Represents the distribution of endemicity rate in different occupation. The highest

infection was found in labour 10.34%(9/87) of a samples followed by farmers and others
6.94% (115/1657).
Table 33. Occupational Distribution of endemicity rate of lymphatic filariasis in

four districts of Nepal.
Occupation Total No of Infected Person %
Person
Farmer 1657 115 6.94

Student 1130 24 2.12
Labour 87 9 10.34
Housewife 602 13 2.16
Busnessman 230 10 4.35
Unemployed 57 3 5.26
Teaching 35
Other 125 8 6.29
Child 161 2 0.012
Total 4084 184 37.472
36 | P a g e
MEAN MICROFILARIA DENSITY IN STUDY AREA
The youngest person found infected with microfilaria was 6 yrs old girl with mean
density of 0.33 per 20µlt blood and the oldest person was 75 yrs old man with mean
density of 26.66 per 20µlt blood. The highest microfilaria density of 47 per 20 blood.
Table 34. District – wise, microfilaria density

District Sential Average Average Average Mean Mf
sites mf mf mf density/ 20
density density density in µl blood
in 1st in 2nd 3rd 20 µl
20µl 20 µl blood
blood blood
Chitwan Bhandara 1 0 0 0.33/20µl
Ratnanager 0 3 0 1/20µl
Rupandehi Bairghat 2.43 1.21 1.28 1.64 /20µl
Bishnupura 5.41 4.72 5.41 5.18/20µl
NawalParasi Raninagar 4.53 3.63 4.79 4.32/20µl

Kudiya 2.73 2.13 2.53 2.47/20µl
Makwanpur Hatiya 1.09 0.00 0.64 0.58/20µl
palung 0 0 0 0/20µl
The survey result revealed that maximum microfilaria density was found in Bishnupura
sentinel site of the Rupandehi district i.e. 5.18/µlt blood sample. While least density
found only one per 20µlt blood in chitwan.
CLUSTERING IN FAMILY
The ratio of the positive families was 5.16% (23/446) with an average of 2.6 cases per
family.
37 | P a g e
Discussion and Conclusion
Community awareness and mobilization of the community people play a key role in the
success of the community based health programme. Participation of the community
people including with the social and community leaders, community health workers were
much encouraging during the study period in all the eight sentinel sites of the four
districts. These awareness programme played very important role to introduce the
importance of the present survey, The disease, transmission pattern, pathology and
importance of the night blood sample collection. The most important positive aspect of
the awareness programme was to make familiar the team members in front of the
community people, which was essential in this present political situation of the particular
locality. Besides these, the awareness programme was intended to take common consent
from the community leaders, social workers and health personnel to conduct the survey.
In this sense, the outcome of the programme seemed extremely fruitful. Focusing to the
community health workers filariasis survey training programme was organized which
boosted up the night blood sampling programme upto the success.
During the survey a total of 4084 community people were interviewed and night blood
samples were collected from two each sentinel sites of the four districts. Among them
males were 2007 (49.15%) male and 2077(50.85%) female. Overall microfilaria
prevalence revealed 2.86% in four district. District wise distribution of microfilaria was
varied, highest prevalence was observed in Bishnupura VDC of the Rupandehi district
i.e. 5.19% (54/1040). Among them highest prevalence was recorded in the Bishnupura
sentinel site i.e 7.55%(40/530). Endemicity rate of the lymphatic filariasis includes the
microfilaria positive cases with or without sign and symptoms as well as the crude
disease rate (CDR) which includes chronic elephantiasis, limbs swelling, breast swelling,
chyluria, skin thickness, lymphoedema etc too. Overall endemicity rate of lymphatic
filariasis also showed very high in the Rupandehi district i.e. 8.2%(85/1040) followed by
Nawalparasi and Makwanpur district while least in Chitwan district. Although the
endemicity rate revealed in the present study also indicated higher than the microfilaria
infection in all the district, still the endemicity data might not be the clear picture. Since
most of the cases during the questionnaire survey don’t wish to expose their internal
health problems. Earlier reports on microfilaria infection and disease endemicity rate in
various districts of the country indicated 7.1-9.16% mf among urban population, 10.03-
11.3% in semi urban and 0.8-17.69% mf in rural population (Jung 1973). While in
Gokarna VDC of the kathmandu valley reported 22.4% mf in blood samples of
community people (Pradhan et al., 1997). Bhusal et al., (2000) reported 5.8%
microfilaremia in Tokha-Chandeshwari VDC of kathmandu. Sherchand et al. (2002)
reported 13% of microfilaria from 37 districts of the country. In present study, out of
4084 study population 24 had the elephantiasis, maximum 36 hydroceole, 13 chyluria
cases in eight sentinel sites of the four districts of the country.
38 | P a g e
Microfilaria infection rate and endemicity rate of lymphatic filariasis is low in
Makwanpur and Chitwan compared to Nawalparasi and Rupandehi district. The reason
behind the low prevalence of the disease might be the treatment of the community people
against the lymphatic filariasis in the first phase of the elimination programme about one
year before.
The analysis of these various data on microfilaria infection and endemicity rate in
different districts revealed wide variation but the ultimate conclusion is that the disease is
most prevalent in all the hilly and terai districts of the country. Still large numbers of the
chronic elephantiasis cases can be observed in most of the hilly and terai regions.
Hydroceole another hidden public health problem existing in the society creating not only
individuals health problems but also psychosocial disturbance among the married
couples. During the field observation and interaction with the hydroceole patient both
young unmarried and married men revealed piteous and pessimistic thinking regarding
sexual and marriage life. This still needs to study in detail to explore the sociological
problems and psychological problem along with the public health problem particularly in
the countries like Nepal.
The survey result revealed that maximum microfilaria density was found in Bishnupura
sentinel site of the Rupandehi district i.e. 5.18 mf/20µlt blood sample. While least density
found only one per 20µlt blood in Chitwan. The youngest person found infected with
microfilaria was 6 yrs old girl with mean density of 0.33 per 20µlt blood and the oldest
person was 75 yrs old man with mean density of 26.66 per 20µlt blood. The highest
microfilaria density of 47 per 20µlt blood revealed from Rupandehi district. In rest of the
districts Nawalparasi, Makwanpur and Chitwan showed mean microfilaria density of 0-
5/20µlt blood. In some cases microfilaria density was found very high showing direct
relationship with the risk group of that community.
The earlier reports sex wise infection with microfilaria showed higher in males than
females. In present study there is no marked difference between both sexes was observed
in all the sentinel sites of the four districts. But age wise infection rate showed gradual
increment with increase in age while gradually decreases with further increase in age i.e
after 50 years. This might be due to fact that positive rate of MF in children as well as old
age people are less due to less exposed to mosquito biting because because of their
nature of the responsibility. The LF can be acquired in younger age group, can remain
hidden for a long period of time without showing any clinical symptoms. In this study
also CDR was also increasing with increase in age group 30-39 years to 50-59 years age
groups. Sherchand et al., (2002 ) also showed insignificant distribution of the microfilaria
antigenaemia in relation to the sex but regarding the age group highest positivity rate was
shown in 46-50 age group.
same status population it was found that there is statistically significant difference of
knowledge and precaution among different educational status people. In this case
knowledge indicates the people who had either seen or heard regarding the elephantiasis
39 | P a g e
or the hydroceole around their community or somewhere else. Precaution refers the
measures taken by the community people against mosquito biting such as the use of the
bednets, ointments, mosquito mats, chemical spray etc. It has been observed that in terai
region due to the hot temperature during nights, most of the community people belonging
to the low economic conditions use to sleep outside the house without sleeved cloths
which increases the chances of getting mosquito bite and transmission of the filariasis
very much easily.
groups but in Makwanpur, maximum samples were collected from the literates in palung
and least form the Hetaunda. Although the distribution of the filariasis is not significantly
related to the educational level, it was clear that it has direct impact on the knowledge of
the vector borne diseases and practices towards the preventive measures taken against it.
Distribution of endemicity rate in different occupational groups showed highest infection

among the labour 10.34%(9/87) followed by farmers 6.94% (115/1657). Comparatively
low endemicity rate observed among the other occupational groups directly related to the
higher economic conditioned occupational groups like businessmen, teachers etc. In this
report indicated that the educational level, occupation as well as the application of the
preventive measures were considered as the potential risk factors of getting the filarial
infection among the community people of the study area.
Ninety percent of filarial infections are caused by Wuchereria bancrofti, and most of the
remainder by Brugia malayi, for Wuchereria bancrofti humans are the exclusive host,
and even though certain strain of B. malayi can also infect some feline and monkey
species, life cycle in human and other animals generally remain epidemiologically
distinct (Bista et al., 2000). But still filarial infections due to the Wuchereria bancrofti
and Brugia malayi is not quantified. None of the taxonomic report exist yet in the context
of Nepal. In this survey we have collected microfilaria with varied density range from
184 individuals from four districts of the country. During the microscopic examination of
the microfilaria we have reported two distinct morphological structures of the
microfilaria basically regarding the shape, size and extension of the nucleus. Some of the
structures are more or less identical with the Brugia malayi {The photograph is attached
with the report). The result indicates that filarial infection in Nepal is not only due to the
Wuchereria bancrofti but also due to the Brugia malayi. But the result still needs to be
verified with the molecular taxonomic methods.
40 | P a g e
Recommendations
v The mass drug administration, control programme must be regularized along with
the monitoring of the same study population of the sentinel area throughout the
elimination programme in order to assess the success of programme
v Sentinel survey result can’t be generalized or representative of the whole district
situation so that to figure out exact filariasis prevalence in the potentially risk
district, wide and large scale randomized should be carried out.
v Not only the treatment of the human beings but also needs to control the vectors
side by side throughout the elimination programme.
v Still the major cause of the filarial infection in the country has not been
quantified, hence taxonomic research should be carried out which may help a lop
in the elimination programme.
41 | P a g e
References
Bhusal, K. P., Joshi, A. B., Mishra, P. N. and Bhushal, K. (2000). Prevalence of
Wuchereria bancrofti Infections of Tokha – Chandeshwori VDC Kathmandu
Vallley, Nepal. J Inst Med; 22: 204-211.
Bista, M. B., Banerjee, M.K., Thakur, G.D. and Shrestha, S.B. (2000). Lymphatic
filariasis: Review of literature and Epidemiological analysis of the situation in Nepal
1994-1999. Epidemiology and Disease control division, Department of Health
Service,Ministry of Health , HMG –Nepal.
David T. Dennis, 1991. Lymphatic filariasis. VBC Tropical disease paper No. 9
Dreyer G, Noroes J, Addiss D. (1997).The silent burden of sexual disability

associated with lymphatic filariasis. Acta tropica 63:57-60
Evans D, B., Gelband H, Vlassoff C. (1993). Social and economic factors and the
control of lymphatic filariasis a review. Acta tropica,53:1-26.
Jha S. C. (2003). An epidemiological study of microfilarial infection in eight districts

of Nepal. Dissertation presented to CDZ (Parasitology).
Jung, R. K. (1973). A brief study on the epidemiology of filariasis in Nepal. J Nep

Med Ass; 11: 155-168.
Manandhar, R. (2000). Epidemiological Study of Microfilariasis in three different

geographical Region of Nepal. Dept Micro IOM; 112: 1-10.
Michael, E., Bundy, D.A.P, Grenfel B.T., (1996). Re –assessing the global prevalence
and distribution of lymphatic filariasis. Parasitology,112:409-428.
Otteson, E.A (1994). The human filariasis, new understanding, new theurapeutic
strategies. Current opinion in infectious diseases. 7:550-558.
Ottesen, E.A., Duke B. O. L, Karam, M and Behbenhani, K. (1997). Strategies and

tools for the control/elimination of lymphatic filariasis. Bulletin of the World Health
Organization. 75:491-503
Pradhan, S.P., Shrestha, I., Palikhey, N. and Uppretty,R.P. (1998). Epidemiological

study of lymphatic filariasis in Gokarna VDC of Kathmandu Valley during august
and September, 1997. J. NHRC; 2 (1): 13-17.
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Ramu et al., (1996). Impact of lymphatic filariasis on the productivity of male
weavers in a south Indian village. Transaction of the Royal Society of Tropical
Medicine and Hygiene 90:669-670.
Sherchand, J.B., Obsomer, V., Thakur, G.D. and Hommel, M. (
2002). Mapping of lymphatic
filariasis in Nepal; Filaria J.WHO;www.filariajournal.com/content/2/1/7 .
Thakur,G.D.(2000). Epidemiological Situation of Lymphatic filariasisin Nepal,

Report submitted to Ministry of Health, Vector born Disease,Reaearch and Training
Centre, Hetauda Nepal.
Weerasooriya, M.V., Weerasooriya, T.R., Gunawardeha, N.K., Samarawickrema,

W.A. and Kimura, E. (2001). Epidemiology of bancroftian filariasis in three sub-
urban areas of Matara, Sri-Lanka, Ann Trop Med Parasitol; 95: 263-273.
Witt, C. and Ottesen, E.A. (2001). Lymphatic Filariasis : An infection in Childhood.

Trop Med and International Health ; 6: 582-606.
World Health Organization. (1995). Lymphatic. filariasis and Onchocerociasis. TDR

Twelfth Programme Report; 10532: 87-100.
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4: 1-20.
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5: 1-35.
43 | P a g e
Photographs of Community awareness/mobilization programme
Bairghat: Rupandehi Triveni: Nawalparasi
Bhandara: Chitwan
Triveni: Nawalparasi
Bhandara: Chitwan Kudia: Nawalparasi
44 | P a g e
Photographs of Training Programme
Training on questionnaire fillup

Demons. Of blood collection from ear lobe
Reseach asst. -blood collection practice Demons. Of three drops of blood
45 |Demons.
P a g e Of thick blood film Pricking ear lobe with lancet
Photographs of questionnaire survey
Questionnaire Survey in Bairghat of Rupendehi Questionnaire Survey in Bishnupura of Rupendehi
Questionnaire Survey in Kudia of Nabalparasi Questionnaire Survey in Bhandara of Chitwan
Questionnaire Survey in Ratnanagar of Chitwan Questionnaire Survey in Hatiya VDC of Makwanpur
46 | P a g e
Photographs Of Night Blood Sample Collection
Blood Sample in Bairghat of Rupandehi Blood Sample in Bishnupura of Rupandehi
Blood Sample in Raninagar of Nawalparasi Blood Sample in Ratnanagar of Chitwan
Blood Sample in Palung of Makwanpur

Blood Sample in Bhandara of Chitwan
47 | P a g e
Photographs Of Clinical Symptoms
Brest Swelling in 52 yrs old Woman Right Hand Swelling in 52 yrs old Woman
Swelling in Hydrocoel Swelling in Hydrocoel
48 | P a Hand
g e swelling in young age girl Swelling in left lage
Photographs Of Slide Staining And Examinations
Dehaemolisation Prosses of blood flim Adding the Giemsa Stain on blood flim
Cleaning the stained blood flim with distilled water Drying the Blood flim in laboratory
Examination of thick blood flim Under light Microscope Verifying the microfilaria under Phase Contrast Microscope
49 | P a g e
Photographs of microfilaria
50 | P a g e

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A FINAL REPORT

Project Team members

NAME OF THE INSTITUTE IMPLEMENTING THE PROJECT:

Correspondence: Mahendra Maharjan (mahendra_maharjan@yahoo.ca)

Directors of District Public Health Office, Rupandehi, Nawalparasi, Makwanpur and

Lymphatic filariasis is a parasitic disease caused by nematodes inhabiting the lymphatic

Ø To determine the microfilariaemia mean density in the study area.

Criteria of inclusion and exclusion:

Consent from the sample population

Blood sample collection

Fixing and staining of the slides

Microscopical Examination of the slides

I-part: Community awareness/mobilization and Training

Sentinel site I : Bairghat VDC

Date : 24 May, 2005

12:30 – 1:00 – Tea and snacks

Date : 24 May, 2005

Blood collection methods:

Field questionnaire survey

Arrangement for blood collection

Date: 15th jesth 2062

Parasitologist: Mr. Bhoj Bahadur Bhat Chhetri (Team leader)

Parasitologist: Mr. Ashok Bahadur Bam (Team leader)

Sentinel site: Ward no 6 of the triveni VDC

Similar training method was applied as described above

Date: 13th jesth 2062

Parasitologist: Mr. Yam Bahadur pokhrel (Team leader)

Similar training method was applied as described above

Parasitologist: Mr. Yam Bahadur pokhrel (Team leader)

Similar training method was applied as described above

Gopali gaun, Palung Daman VDC,

Date: 8th, Ashad 2062

Parasitologist: Mr. Ashok Bahadur Bam (Team leader)

Similar training method was applied as described above

Parasitologist: Mr. Budhan Chaudhari (Team leader)

Similar training method was applied as described above

Tandi, Ratna nagar municipality-8,

Date: 3rd, Ashad 2062

Parasitologist: Mr. Dina Nath Dhakal (Team leader)

Similar training method was applied as described above

(B) Questionnaire survey and parasitological examination

1. DISTRICT-WISE SAMPLE COLLECTION

Districts Sentinel Sites Total Male(%) Female(%)

Table no. 2 age and sex wise collection of blood samples

3,EDUCATION AND DISTRICT WISE SAMPLE COLLECTION

Table no. 3 education and district wise distribution of study population.

Table no. 4, Occupation and district wise collection of blood sample

KNOWLEDGE AND PRECAUTION OF FILARIASIS AMONG DIFFERENT

Table 5 : Distribution of knowledge and precaution of filariasis among peoples

GENERAL PREVALANCE : A total of 4084 individual were examined from four

DISTRICT – WISE DISTRIBUTION OF LYMPHATIC FILERIASIS

Table:6(I):- Distrist wise distribution of Sign and Symptom of Lymphatic filariasis

Table 7. Prevalence of microfilaria in Rupendehi district

Table 8. Endemicity rate of Lymphatic filariasis in Rupandehi district

GENERAL PREVALANCE : A total of 4084 individual were examined from four

Table 9. Endemicity rate of Lymphatic filariasis in Rupendehi district

GENERAL PREVALANCE : A total of 4084 individual were examined from four

Table 10. Sexwise prevalence of microfilaria

Total Mf percentage Total Mf percentage

Table 12. Age wise prevalence of microfilaria in Rupandehi district.

<10 296 6 2.03 118 0 0 0 0 0.00 178 5 1 0 6 3.37

Table 14. Prevalence of microfilaria in Nawalparasi district

Table 15. Endemicity rate of Lymphatic filariasis in Rupendehi district

Analysis of the distribution of the microfilaria and lymphatic endemicity rate in