BackgroundFollowing the World Health Assembly resolution on Elimination of lymphatic filariasis (ELF) as a public health problem by the year 2020, a Global Program (GPELF) was launched in 1997 to help endemic countries to initiate national programs. The current strategy to interrupt transmission of LF, is administration of once-yearly, single-dose, two-drug regimen (Albendazole with Diethylcarbamazine (DEC) to be used in endemic areas with the goal of reaching 65% epidemiological coverage for 4–6 years. We report findings of independent assessment from year 2010 to 2015 for last six rounds, after initial five rounds of Mass Drug Administration (MDA) since 2005 for ELF in endemic area of Gujarat.MethodsIndependent assessment of MDA was performed to find coverage and compliance indicators, reasons for non-coverage and non-compliance in five Implementation Units (IUs). Pre, during and post MDA evaluations were done in three phases. The impact of MDA was measured by microfilaraemia survey. A total of eight sites, four random and four fixed sentinel sites were selected to calculate microfilaria rate (MF) per IUs per year. In years 2010 to 2015, we report results from 125,936 nocturnal blood smears and 17551 population in 120 selected clusters. Four clusters were selected per year in each of the five IUs for assessment of MDA round.ResultPost MDA survey showed drug coverage between 81%-88% and epidemiological coverage 77%-89% across years. Main reasons for non-coverage were drug administrator related (the team did not visit or missed people) while non-compliance was population related (fear of side effects, sickness, people forgot or absent). During MDA findings show that the directly observed consumption is considerably improved from 58% in 2010 to 82% in 2015. The knowledge about benefits of drug provided also increased from 59% to 90% over the years. The current MF rate is less than one in all IUs with an overall 68% percent decrease from baseline year 2005 to year 2015. The average MF rate of Gujarat is 0.44 for year 2015.ConclusionsThe findings show that achieving adequate epidemiological and drug coverage is possible by actual field level operation of the program in large endemic areas. The results and feedback from independent assessment, performed regularly, could guide the policymakers and program managers for mid-term corrections and to frame strategies to enhance program. Monitoring of coverage and impact indicator together informs decisions for reaching end-point of MDA. The impact indicator- microfilaria rate in all IUs of South Gujarat Region has reached and remained less than one percent signaling end-points of MDA. Post MDA stringent monitoring in form of TAS is recommended to keep vigil on maintenance of elimination achieved.

Background: Government of India has lunched the frame work for eliminating malaria from the country by 2030 [1] [2]. But progressive States like Gujarat has to achieve the target by 2024. The first step in this direction is to bring down the Annual Parasitic Incidence less than 1.0. Under National Vector Borne Disease Control Programme (NVBDCP) various activities for Vector control coupled with complete treatment to confirm malaria cases within 24 hours were given more focus and implemented diligently and effectively. Aim: To evaluate the progress of the efforts being undertaken for malaria elimination in Gandhinagar district. Design: Impact of malaria control efforts in Gandhinagar district covering all areas were studied in detail. Setting: Malaria prone villages of Gandhinagar district where preventive actions were undertaken in an integrated manner during the period of 2005 to 2015. Exploratory: Data pertaining to rural and urban areas of the district covering all PHCs, UHCs and Towns were analyzed and interpreted. Outcome: Reduction in malaria incidence and scaling up of non chemical methods for control of malaria. Analysis: Percentage and proportions. Results: Area specific approach adopted in rural areas of Gandhinagar district by putting more emphasis on good surveillance, ensuring complete treatment to malaria cases within 24 hours and effective strategy for vector control mainly non chemical methods resulted in reducing Annual Parasitic Incidence (API) from 1.96 in 2005 to 0.17 in 2015 in Gandhinagar district. 226 villages (74.83%) out of 302 in the district are malaria free and only 9 villages are having API > 1.0. The district aims to achieve malaria elimination in the next five years. Conclusion: Gandhinagar district has made rapid stride towards malaria elimination in a

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