SPATIAL DIMENSIONS OF FILARIASIS IN KUMBAKONAM CONTROL UNIT, TAMIL NADU, INDIA: A GIS APPROACH Thesis submitted to the Bharathidasan University for the award of degree of Doctor of Philosophy in Geography Submitted by S. Vadivel Assistant Professor and Part – time Research Scholar, Research Supervisor Dr.P.H.Anand, M.Sc.,M.Phil.,Ph.D. Associate Professor and Head Post Graduate and Research Department of Geography, Government Arts College (Autonomous), Kumbakonam – 612 001, Tamil Nadu, India May - 2012 DECLARATION I do hereby declare that the thesis entitled “SPATIAL DIMENSIONS OF FILARIASIS IN KUMBAKONAM CONTROL UNIT, TAMIL NADU, INDIA: A GIS APPROACH”, which I am submitting for the award of Degree of Doctor of Philosophy in Geography, to the Bharathidasan University, is the original work carried out by me, in the Post Graduate and Research Department of Geography, Government Arts College (Autonomous), Kumbakonam 612 001, Tamil Nadu, India, under the guidance and supervision of Dr. P.H. Anand, Associate Professor and Head, PG and Research Department of Geography, Government Arts College (Autonomous), Kumbakonam. I further declare that this work has not been submitted earlier in this or any other University and does not form the basis for the award of any other degree or diploma. Kumbakonam S. Vadivel 4th May 2012 Part-time Research Scholar PG and Research Department of Geography (DST-FIST Recognized) Government Arts College (Autonomous), (Accredited by NAAC // AICTE and Affiliated to Bharathidasan University)) Kumbakonam, 612 001, Tamil Nadu Dr.P.H.Anand,M.Sc.,M.Phil.,Ph.D. 04-05-2012 Associate Professor and Head, CERTIFICATE This is to certify that the thesis entitled “SPATIAL DIMENSIONS OF FILARIASIS IN KUMBAKONAM CONTROL UNIT, TAMIL NADU, INDIA: A GIS APPROACH”, submitted by Mr. S. Vadivel, for the award of Doctor of Philosophy in Geography, in the Bharathidasan University was carried out at the Post Graduate and Research Department of Geography, Government Arts College (Autonomous), Kumbakonam, 612001 under my guidance and supervision after fulfilling the basic requirements specified by the University. (P.H. ANAND) Research Advisor ACKNOWLEDGEMENT More than 1.3 billion people in 72 countries worldwide are threatened by lymphatic filariasis, commonly known as elephantiasis. Over 120 million people are currently infected, with about 40 million disfigured and incapacitated by the disease. Lymphatic filariasis can result in an altered lymphatic system and the abnormal enlargement of body parts, causing pain and severe disability. Acute episodes of local inflammation involving the skin, lymph nodes and lymphatic vessels often accompany chronic lymphoedema. To interrupt transmission WHO recommends an annual mass drug administration of single doses of two medicines to all eligible people in endemic areas. Lymphatic filariasis, commonly known as elephantiasis, is a neglected tropical disease. Infection occurs when filarial parasites are transmitted to humans through mosquitoes. When a mosquito with infective stage larvae bites a person, the parasites are deposited on the person's skin from where they enter the body. The larvae then migrate to the lymphatic vessels where they develop into adult worms in the human lymphatic system. Infection is usually acquired in childhood, but the painful and profoundly disfiguring visible manifestations of the disease occur later in life. Whereas acute episodes of the disease cause temporary disability, lymphatic filariasis leads to permanent disability. Currently, more than 1.3 billion people in 72 countries are at risk. Approximately 65 per cent of those infected live in the WHO South-East Asia Region, per cent in the African Region, and the remainder in other tropical areas. Lymphatic filariasis afflicts over 25 million men with genital disease and over 15 million people with lymphoedema. Since the prevalence and intensity of infection are linked to poverty, its elimination can contribute to achieving the United Nations Millennium Development Goals. World Health Assembly Resolution 50.29 encourages Member States to eliminate lymphatic filariasis as a public-health problem. In response, WHO launched its Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000. The goal of the GPELF is to eliminate lymphatic filariasis as a public-health problem by 2020. The strategy is based on two key components: interrupting transmission through annual large-scale treatment programmes, known as mass drug administration, implemented to cover the entire at-risk population; alleviating the suffering caused by lymphatic filariasis through morbidity management and disability prevention. The present research is focused upon taking all the parameters concerned are the latest technological development to identify and analyze the problem by using GIS and GPS technology. The research would help the administration to plan for the future and the scientists to continue in the Filarial related research. For the successful completion of the work several people have extended their assistance and help. I mention few of them here and keep the rest in my mind. At the outset I thank our Principal i/c Dr. J. Govindadoss, for extending moral and administrative support for the successful completion of this work. I remember the similar support, which was extended to me by the then Principals, of this college. I thank all the staff members of the Filiarial Contol unit, which is under the control of Director of Public Health and Preventive Medicine, Chennai and Kumbakonam Filarial Control Unit. I convey my sincere thanks to Prof. I.C. Kamaraj and Prof. V. Kumaraswamy, former Heads of the Department of Geography, for consistent encouragement and critical suggestions as and when I approach them. I wish to express my deepest gratitude to Dr. P.H. Anand, Associate Professor and Head, P.G and Research Department of Geography, Government Arts College (Autonomous), Kumbakonam for his unencumbered, exemplary guidance, indefatigable efforts to steer in the right direction, bountiful scholarly advice, undiminished zeal for extracting fruitful information and for his painstaking efforts and deepest understanding of my needs in this research. I extend my sincere thanks to Dr. P. Thirumalai, Assistant Professor of Geography, P.G and Research Department of Geography, government arts college (Autonomous) Kumbakonam for giving a good shape to this project. I also convey my deep sense of gratitude to my colleagues, Dr. P. Arul, Dr. B. Gobu, Dr. R. Maniyosai, Thiru. K.K. Jayakumar, Thiru. A. Senthilvelan and Thiru. R. Thulasiraman. I appreciate the students of M.Sc., Geography, of this college for the assistance during research work. The present work will be incomplete but for the perfect tolerance, sacrifice, boundless love and ceaseless prayers of my parents, wife Mrs. Anbarasivadivel and childrenV. Sivabalan, V. Sivakrishnan and relatives for providing calm atmosphere during the research work. Last but not the least I am very much thankful to my colleague Dr. J. Senthil Assistant Professor for his wholehearted support and assistance provided during the GPS data collection. S. Vadivel CONTENTS Chapter One PROBLEM STATEMENT AND PROCEDURES Page # 1.1 Filariasis: Definition and Meaning 1 1.2 History of Lymphatic Filariasis: 2000BC-500AD 3 1.2.1 Discovery of Symptoms: 1588-1592 3 1.2.2 Discovery of Microfilariae: 1863 and 1866 4 1.2.3 Discovery of the Adult Worm: 1876 4 1.2.4 Discovery of the Life Cycle: 1877 4 1.2.5 Discovery of Transmission: 1900 5 1.2.6 Current Discoveries 5 1.3 Identification Methods: Filariasis 5 1.3.1 Infections Agents 6 1.3.2 Mode of Transmission 6 1.3.3 Incubation period 7 1.3.4 Period of communicability 7 1.3.5 Vector Aspects 7 1.3.6 Aedes vectors 8 1.3.7 Mansonia vectors 8 1.3.8 Anopheles vectors 8 1.4 Types of filariasis 9 1.5 Worms that cause filariasis 9 1.6 Lymphatic filarial diseases 10 1.7 Geographical Distribution of Filariasis in Select Countries 11 1.8 Geographical variation in transmission 14 1.9 Filariasis in Asia 16 1.10 Filariasis in India 16 1.11 Filariasis in Tamil Nadu 17 1.12 National Control Strategies in select countries 19 1.13 Review of Literature 22 1.13.1 Socio cultural literature 25 1.14 Impact on infected individuals 27 1.14.1 Current knowledge about LF’s sociocultural burden 27 1.14.2 Impact upon lifestyle and economic opportunities 29 1.15 Impacts on the LF elimination programme 30 1.15.1 Paucity of LF-related sociocultural research 30 1.15.2 Beliefs about disease causality and transmission 31 1.15.3 Community ownership of treatment programmes 32 1.15.4 The value of increasing our sociocultural understanding 33 1.16 Problem Statement 36 1.17 Objectives 36 1.18 Methodology 37 Chapter Two PROFILE OF THE STUDY AREA 2.1 Introduction 39 2.2 Etymology 40 2.3 History 40 2.4 Geography 42 2.4.1 Topography 44 2.4.2 Drainage 44 2.4.3 Soils 44 2.4.4 Climate 44 2.4.5 Temples 45 2.5 Municipal administration and politics 47 2.6 Economy 47 2.7 Transport and communication 48 2.8 Education 49 2.9 Filariasis: Night Clinic and Administrative Functions 50 2.10 Major Industries 52 2.11 Population Characteristics 52 2.12 Landuse 53 Chapter Three CREATION OF GIS INFORMATION BASE FOR FILARIASIS PATIENTS 3.1 Introduction 54 3.2 Using GIS for Public Health 57 3.3 The Business of Health Care Geographic 58 3.4 A Wealth of Tools 59 3.5 Tomorrow's Health Care 61 3.6 GIS Information Base filariasis Patients in Kumbakonam: 1998- 2008 63 3.7 Conclusion 66 Chapter Four DIMENSIONS OF FILARIASIS IN KUMBAKONAM: A FACTOR ANALYTIC METHOD 4.1 Introduction 67 4.2 Filariasis in Kumbakonam 73 4.3 Technique of Analysis 73 4.3.1 The Process of Factor Analysis: Data Matrix 75 4.4 Extracting the factors 77 4.5 Interpretation of the factors 78 4.6 Household level variation in vector infection and mf prevalence 80 4.6.1 Households with mf carriers 80 4.6.2 Households with infected mosquitoes 81 4.6.3 Transmission dynamics 81 4.6.4 No.