Treatment and Mass Drug Administration

Treatment of the sick is not only a humanitarian action, but reduces the length of illness and, therefore, the period of commu-nicability, thereby aiding control. However, where treatment is incomplete, it can actually prolong the period of communicability, encourage the development of carriers or worst of all, resistant organisms. Case finding and treatment is the main method of control for leprosy (Section 12.6) and tuberculosis (Section 13.1), but careful follow-up is essential to ensure that treatment is taken for the whole period. Rapid diagnosis and treatment is particularly important in acute respiratory infections (Section 13.2) and meningitis (Sections 13.6 and 13.7). The development of effective single dose therapy for the treatment of the sexually transmitted infections (STIs, Chapter 14) has been one of the great challenges of chemotherapy, but the 'power of the needle' has also been the means of transmission of several communicable diseases. In many societies, having an injection (irrespective of what is given) is seen as the panacea of all ills, but unfortunately improperly sterilized needles (including intravenous infusions) have been responsible for much of the transmission of HIV infection and hepatitis B.

Mass drug administration (MDA) is used as a method of control of filariasis (Sections

15.7 and 15.8). However, an MDA needs to cover the entire population in the infected area and the full dose of treatment seen to be swallowed. This becomes an administrative exercise requiring a large number of assistants to ensure that the drug has been properly taken. One of the most successful campaigns, in the Pacific Island of Samoa, used women's groups who are a very well-organized segment of society, with the result that the coverage was over 90%. Generally, such organizations are not available resulting in a lower coverage rate.

Mass treatment is also used in the control of trachoma (Section 7.5). Treatments and MDA regimes will be found under the relevant diseases in Chapters 7-18.

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