Observation Report on Mass Drug Administration of DEC Tablets in Bangladesh

I have been in charge of overseeing the project to provide tablets of DEC (diethylcarbamazine, one of the treatment drugs for lymphatic filariasis (LF), manufactured by Eisai to the World Health Organization (WHO) free of charge. Before Eisai began providing DEC tablets to WHO, we had to firmly grasp the reality of mass drug administration (MDA) as it is currently being implemented by WHO and governments in countries endemic for the disease. What follows is my report on the site of a current MDA program that I was given an opportunity to observe firsthand.

In November 2012, I visited Chapai Nawabganj District in Bangladesh, which is about 300 km west of the capital, Dhaka, or about seven hours drive by car. Villagers there live in poor living conditions with inadequate sewage system. Local health workers and Japan International Cooperation Agency (JICA) volunteers visit about 100 homes per day in this district delivering and providing guidance on treatment drugs for LF. However, the practice of taking medicine is still highly unusual for many of the local villagers, with some children even running away from us right when we were attempting to administer the drugs.

Given these circumstances, I came to realize that it would be far more difficult than I had originally thought to promote understanding in the local community, specifically in regard to the serious effects of this disease and the importance of taking the medicine, which was necessary if we were to gain their cooperation in taking the correct medicine at the proper dosage each year without fail. Nevertheless, it was a very important task for us since our failure to gain their understanding would erase all of our efforts to provide them with a treatment.

One of the major problems that I found with the MDA program during my visit was that even when LF is eliminated in one district as the result of administration of correct doses of the right medicine, the district may still be plagued with the same disease again if that disease remains endemic in adjacent districts from which there are no physical barriers. Further, while it remains a basic principle for national governments to instruct and to varying degrees control local governments, I have learned from this visit that alone may not be enough. This firsthand experience also showed me how important it is to strengthen communications and cooperation along the national borders, which are freely traversed by the mosquitoes that spread the disease, and to plan and implement MDA on a more coordinated, global scale.

Going forward in our efforts to eliminate LF, Eisai will not only provide its DEC tablets to targeted countries endemic for the disease but also strive to identify what can be done for existing patients and how to provide assistance with tasks other than merely providing drugs. This is what we believe is necessary to make the elimination of LF a real possibility.

Reporter