With all its efforts failing to control lymphatic filariasis or elephantiasis in some districts, the Ministry of Health and Population has decided to administer ivermectin along with diethylcarbamazine and albendazole.

Ivermectin, an antiparasitic drug, was also used in Covid-19 treatment in many countries including Nepal, though the World Health Organisation had recommended the use of the drug only for clinical trials.

“We have decided to use ivermectin, along with diethylcarbamazine and albendazole in five districts,” said Chuman Lal Das, director at the Epidemiology and Disease Control Division. “We will administer two drugs—diethylcarbamazine and albendazole—in five districts and three drugs including ivermectin in the other five districts.”

Lymphatic filariasis also known as elephantiasis is a mosquito-borne parasitic disease caused by filarial worms transmitted by different kinds of mosquitoes including Culex, Anopheles, and Aedes.

It is the second major infectious disease after leprosy that causes permanent and long-term disability in Nepal.

Doctors say the disease may be acquired during childhood and its visible manifestation may occur only later in life. The disease can lead to temporary or permanent disability, pain, and social stigma.

The Health Ministry has been planning to launch a mass drug administration campaign from March 12 in 10 districts, which have the highest infection rate of the disease. Officials said that additional drugs will be provided to people of Kapilvastu, Dang, Banke, Kailali and Morang districts.

Jhapa, Bara, Lamjung, Baglung, Parbat, are other districts, where only diethylcarbamazine and albendazole will be administered.

“Though we are using ivermectin for the first time, many countries including India have been using it for a long time and have achieved the desired results,” Dr Gokarna Dahal, an official at the Epidemiology and Disease Control Division. “We have decided to include additional drugs to control elephantiasis, as the disease did not come under control despite up to 13 years of administration of diethylcarbamazine and albendazole.”

The World Health Organisation will supply all the drugs—ivermectin, diethylcarbamazine and albendazole, officials said.

The government started a mass drug administration programme to eliminate lymphatic filariasis in 2003. Under the programme, healthy people above five years of age are given diethylcarbamazine and albendazole.

Five rounds of mass drug administration programme have already been conducted in most of the districts and the disease has been controlled in 53, according to officials.

But despite the continuation of the campaign for 12 years, the disease has not come under control in the said districts.

The government had committed to eliminating lymphatic filariasis as a public health problem by 2020. When the target could not be achieved due low coverage of the programme in some districts, the Health Ministry extended the deadline to 2028 and now it has been extended to 2030.

Apart from eliminating the disease from the said districts, authorities have to launch mass drug administration in other 12 mountain districts, as transmission assessment surveys show prevalence of the disease in those areas. Blood samples of 300 people from some mountainous districts were collected and examined in a laboratory, which shows that people of the area are infected with the disease.

Entomologists said that along with the continuation of the mass drug administration programme, authorities need to pay attention to the awareness drive to increase acceptance of the programme.

“Studies show that people are not taking the medicine provided to them,” Shishir Panta, an entomologist, told the Post. “In some places, we have found parasites positive in the people who have taken the drugs continuously.”

The mass drug administration programme was postponed due to the Covid-19 pandemic.

Health Ministry officials agree that health indicators such as maternal health, child health, nutrition, family planning, and regular immunisation were affected by the pandemic.

They say Nepal's progress in the health sector has reverted to the 2008 status, meaning that the achievements made in the past 14 years have been lost. Public health experts stress the need for extra efforts to reclaim the gains.

The World Health Organization identifies the disease as a major public health problem, with an increasing prevalence worldwide. Nepal is one of the 73 countries in the world where lymphatic filariasis is endemic.