PATNA, Feb. 10 -- Bihar is preparing for a massive public health exercise aimed at eliminating lymphatic filariasis, with authorities targeting nearly 8.97 crore people across 34 of the state's 38 districts during an 18-day Mass Drug Administration (MDA) campaign beginning Tuesday and continuing until February 28. Officials say managing adverse drug reactions (ADRs) will be critical to sustaining public confidence and ensuring high drug uptake. The campaign seeks to administer anti-filarial medicines - Albendazole, Diethylcarbamazine (DEC), and Ivermectin - to eligible residents in a supervised manner. Health officials emphasised that keeping ADR cases to a minimum will be key to the drive's success. "Containing adverse drug reactions helps build confidence among people to take anti-filarial drugs during the MDA round," said Dr Ravi Shankar Singh, senior regional director, Ministry of Health and Family Welfare (MoH&FW), at a pre-event launch. He noted that while reported reactions such as nausea, fever and headache - particularly when medicines are taken on an empty stomach - are generally not life-threatening, they can discourage participation. He added that such reactions may indicate the presence of microfilarial organisms in the body. Ahead of the door-to-door campaign, the state will hold a mega camp on February 11, with a target of administering at least 2 crore doses to Jeevika didis - members of women's self-help groups - and their families. Trained teams will then conduct household visits until February 28, ensuring eligible individuals consume the medicines in the presence of health workers. Medicines will not be distributed for unsupervised consumption under any circumstances, officials said. During the final three days of the campaign, special booths will be set up in schools to widen coverage. To address potential drug reactions, Bihar has deployed large numbers of rapid response teams, with medical and paramedical personnel trained to manage and monitor ADRs, according to Bikas Sinha of Piramal Swasthya, a development partner of the state government. Bihar accounts for roughly 1%-1.4% of reported ADRs, according to officials associated with the programme. Drug refusal remains another major challenge. Government data show that around 3 lakh refusals were initially recorded during last year's MDA round. However, 2.90 lakh cases were later converted into acceptance following interventions by health workers working with local influencers. Dr Rajesh Pandey of the World Health Organization (WHO) stressed the importance of follow-up visits to reduce refusal rates and improve coverage. He also highlighted that anti-filarial drugs are among the safest and that taking the medication once a year for five consecutive years can significantly reduce disease transmission. 19 districts, including Banka, Gopalganj, Bhagalpur, Jehanabad, Kaimur, Katihar, Khagaria, Munger, Sitamarhi, Siwan, Supaul, East Champaran, West Champaran, Madhubani, Nalanda, Nawada, Bhojpur, Buxar, and Patna will receive Albendazole and DEC. In the remaining 15 districts - Arwal, Aurangabad, Begusarai, Gaya, Jamui, Muzaffarpur, Saharsa, Saran, Sheikhpura, Sheohar, Vaishali, Darbhanga, Lakhisarai, Purnea, and Samastipur - beneficiaries will receive a triple-drug regimen of Albendazole, DEC, and Ivermectin. India has 348 endemic districts across 20 states and Union Territories, with about 6.25 lakh filariasis cases nationwide. Bihar alone accounts for approximately 1.58 lakh cases, officials said. Except for Araria, Kishanganj, Arwal and Madhepura, where the microfilarial rate has dropped below 1%, the MDA round will cover 396 blocks across 34 districts, said Anuj Singh Rawat, state consultant for the filaria elimination programme. The target population excludes children under two years, pregnant women, and the severely ill. Earlier, chairing a state-level coordination meeting, health secretary Lokesh Kumar Singh said Bihar was making rapid progress toward eliminating filariasis and underscored the need for interdepartmental collaboration to eliminate filaria by 2027. Anuj Ghosh of Global Health Strategies urged community members to motivate citizens to take anti-filarial medicines under supervision, calling public participation essential to the campaign's success....