Chloroquine & Primaquine

DISTRICT PLAN FOR FOCUSED INTERVENTIONS IN HIGH ENDEMIC AREAS FOR MALARIA OBJECTIVES:

• 1.    To reduce the incidence of Plasmodium falciparum infection by 5.0% in the district by the end of year 2012
• 2.    To reduce / eliminate deaths due to malaria by 0.0% in the district by the end of year 2012

DISTRICT PROFILE

Population (Total) : 3403204 ( 2001 census) Rural:; 2799357 Urban: 603847 Tribal:; 21.03 %

Administrative details :  _• Geographical area : 6227 sq KM   _• No. of Sub-Divisions : 3   _• No. of Blocks : 13   _• No. of Municipalities : 4   _• No. of NAC : Added area with Siliguri Municipal Corpn-1, Railway colonies- 2, Army Cantonment area- 2, BSF cantonment area- 5  _• No. of Gram Panchayats : 146    _• No. of Villages/Hamlets : 742   _• No. of Households : 7, 40, 000 (±) _• Major Festivals Observed : Swaraswati Puja, Bengali New years day, Siva-ratri, Doljatra, Iid, Durga Puja, Lakshmi Puja, Kali Puja, “Bhai Tika”,Maharam, X-mass day _• Public Sector Units : 158 Tea Gardens, No. of credible NGOs : FPAI(Kalchini), _• No. of Self Help Groups : (±) 2000   _• No. of Kalayani Clubs : Mother’s clubs-112

Physical environment details _• Forest : 1790 sq. Km, 28% _• Dams : Dam on Teesta & Govt canal – 58.38 thousand hectors _• Annual Rainfall : 3200 mm (avg) _• Humidity : 82% _• Temp : 31’ – 10’C (avg)

Health care delivery infrastructure   District Hospital-1, SDH-2, SGH-1, RH-5,  BPHC- 8,  PHC-38, Malaria Clinics (Microscopy center)-40, Sub-centers-537

SURVEILLANCE AND DIAGNOSIS

Diagnosis

Fortnightly Surveillance through regular/contractual staff Activities:

1. Regular Fever surveillance in the villages of Sub-Centers’ jurisdiction.
2. Collection of blood smears for MP test, RDT of severe cases, distribution of ACT (if RDT + ve ) through DOTS as per district guideline. And the blood smear of the patient should be send to the Microscopy centre through messenger for confirmation.
3. If any Pf detected through RDT, massage should be communicated to the higher tire and following action would be taken immediately

• Collection of migratory history
• Contact survey
• Mass survey in the surrounding jurisdiction
• IEC
• Regular monitoring of the patient at least for 5 days
• If Pt. Is migratory another survey at 3rd Wks

Establishment of FTDs and Malaria Clinics in Tea Gardens , in Forest villages & in remote villages.

In the 158 tea gardens of the district FTDs established and in few villages FTDs are working under direct supervision of Sub centers(ASHA vols)

Involvement of ASHA, AWW for reporting of fever cases

The following personnel will be deployed for reporting fever cases: ASHA: ( ±) 1707, AWW: ( ±) 6289, OTHERS: Tea garden hospitals, Pvt Hospitals, FTDs

Establishment of Microscopy facility at Sector PHC/CHC by deploying trained Lab Technician (regular/contractual)

Microscopy facilities at PHC/ CHC level established since September 2002 by deploying 38 contractual Lab Technicians in this district It is proposed to provide one malaria Technical lab supervisor (MTLS) in each community block .This may be in lieu of MTS as proposed already.

• Proposal for increase the number of LTs to extend microscopy center up to Gram Panchayet level as the RDT quality always not dependable. Presently the result of the Active blood smears colleted at field level those were not examining within 24 hours due to distance/ Transportation / load. These MCs at GP level may be established if it approved by the State / Higher authority.

Provision of RDT Kits at Sub-Centers

All the 537 sub centers of the district provided with RDK and ACT as this district is a CQ resistance district and it is not possible always to examine the blood smears within 24 hours.

Arrange transportation and storage of RDKs and Micro slides

District store supplied these to the Block Head quarters (CHCs) and block authorities issued these to the PHCs / Sub Center level / Health service providers.

URBAN AREAS:

Establishment of Malaria Clinics in Health Posts, Dispensaries, Hospitals Only one malaria clinic in Jalpaiguri town runs by Dy CMOH-II, Jalpaiguri. To be established 4 malaria clinics in the four municipalities within 2012.

Identification of Private Clinics for reporting of fever cases & establishment of Malaria Clinics 158 tea gardens’ clinics already established for service and reporting. Private clinics regularly reporting malaria cases. Army Hospitals, Air Forces Hospital, Para military forces Hospitals, Rail way hospitals are not reporting Fever / malaria cases, these to be established within 2012. Other Private clinics are not reporting Fever / malaria cases, these to be established within 2012.

Sentinel Sites:   1. Dist. Hospital, Jalpaiguri    2. Alipurduar S.D Hospital,Alipurduar    3. Malbazar S.D Hospital,Malbazar     4.Birpara State General Hospital

Annual requirements prepared in January every year and communicate to the state regularly. Making available drugs to FTDs, Malaria Clinics for treatment on the basis of RDK / Microscopy

As 2nd ANM and ASHA volunteers recruited in most of the Sub Center areas, they are equipped with antimalarials e.g. RDK, ACT, Tab CQ, PQ, Glass Slides etc.Supervisors, MPHWs monitoring the stock in a regular interval.

In the urban areas- in the all municipal wards at least one FTD may be opened with the IPP VIII volunteers of municipalities. These volunteers will be trained and equipped with antimalarials. Blood smears of these areas may be examined in the urban malaria clinics (with Dy CMOH-II / ACMOHs / Supdts)

Ensuring availability of anti-malaria drugs for treatment of uncomplicated malaria in PHCs/CHCs/Health care infrastructure in Tea Gardens. Anti malarial drugs for treatment of uncomplicated malaria available at ASHA vols /SCs/PHCs/ BPHCs/RH/ Health care infrastructure in Tea Gardens etc entire rural population of the district covered with the Sub-Centers.

Ensuring availability of anti-malaria drugs, infusion facilities and other supportive drugs for treatment of severe malaria in PHCs/CHCs/Private Clinics/Health care infrastructure in Tea Gardens. Anti malarial drugs infusion facilities and other supportive drugs for treatment of severe malaria available at PHCs/ BPHCs/RH/ SGH /SDH /DH .

Making available necessary logistics at District hospitals for management of multi-organ failure cases- At District hospital for management of multi-organ failure cases (ITU)

Arrange transportation and storage of drugs, etc. Transportation and storage of drugs, etc.available at district, Block PHCs and at PHCs

Training of medical, paramedical personnel and NGOs, particularly in Management of severe Pf malaria. Training of medical, paramedical personnel and NGOs, particularly in Management of severe Pf malaria.

INTEGRATED VECTOR CONTROL – INDOOR RESIDUAL SPRAYING

Preparation of PHC-wise requirement of insecticides and spray equipment All the block head quarter equipped with insecticides (DDT) and spray equipments (e.g.- Stirrup pumps, buckets,nozele tips, nozzle tips with extension cover, lather washer, net for st.pump etc)

Arrange transportation and storage of insecticides and spray equipment Blocks are allotted fund for transportation during operational period.

Recruitment of spray workers for squads Experienced trained old spray workers engaged for DDT spray works. But since 2010 after absorption of DDT spray workers as permanent Gr-D employees it becomes difficult to recruit spray workers in this district as unabsorbed old spray workers remains very few and scattered all over the district which cause very difficult to make gangs.

Training of spray workers, Supervisors on dosage of insecticide, use of spray equipment, preparation of suspension, etc. Before every spray operation supervisors, spray workers trained in doses, preparation of suspension, use of spray equipments, discharge rates etc

Route Map for Spray operations & advance notification to community for IRS and steps to be taken for coverage and quality (1 week prior to due date and on the scheduled date) After planning local panchayets, village leaders initially informed. 2 week prior the schedule date communicated to the supervisor, MPHWs, ASHA vols, to announce to the villagers. Three days before the operation ASHA vols visited house to house for communication and for 100 % acceptance.

Identification of the PHC/District, State, NVBDCP Monitors/Supervisors All the PHCs of the district monitored by different level of officers regularly.

Concurrent and consecutive supervision of spraying and planning of Field visit. All the supervisor tires (District level to SC level) involve in planning. When spray in operation then all the supervisor tires visiting the operation.

Supervision & monitoring of IRS by PHC, District, State as per plan District Level: Dy CMOH-II, Other district level monitoring officers, AMO & DE cell Block Level: BMOH,MI & all other block tire supervisors GP level: GP supervisor, MPHWs SMO:

Compilation of spray completion reports of all PHCs for transmission to state, NVBDCP After completion, reports of all PHCs complied at district and transmitted to State.

Proper stocking of balance DDT and spray equipment for next round of IRS Balance stock of DDT & Spray equipments for next round stored at Block level & district store. But there are no separate specific store rooms for storage of DDT

INTEGRATED VECTOR CONTROL – INSECTICIDE TREATED BED NETS (ITNs) /LONG LASTING INSECTICIDAL NETS (LLINS)

Preparation of Sub centre-wise micro-plan for requirement, distribution of ITNs /LLINs

LLIN/ ITB distribution done in our district irrespective of BPL/APL to cover 100% population of the area.

Assessment of Sub centre-wise community owned bed nets

Before planning implementation SC workers surveyed the area to find out the actual number of community owned bed nets in the area by house to house survey.

In this district Self Help groups were done the insecticide treatment of community owned bed nets.

Sub centre-wise calendar prepared before ITBN for organization of camps for insecticide treatment of bed nets .

Advance notification to community for insecticide treatment camps (1 week prior to due date and on the scheduled date)

Advance notification to the community for ITBN camps noticed to the community at least three times 10days & 3 days before. On the day of operation house to house monitoring done.

INTEGRATED VECTOR CONTROL – USE OF LARVIVOROUS FISH

Mapping of water bodies (mosquito breeding places) for introduction of Control - Use of larvivorous fish

Larvivorous fish culture primarily introduced in our district since 2008 in selected blocks, not in hilly blocks/ where “Flash flood” / “dryness of most of the water bodies take place”

Establishment of hatcheries at PHCs/Networking with Fisheries Dept for stocking larvivorous fish

Seven Hatcheries constructed for LVFC in the different PHCs of this district. Sadar ( CMOH office complex)-1, Rajganj ( RH complex)-1, Maynaguri ( RH complex)-1,  Dhupguri ( RH complex)-1, Banarhat (PHC complex)-1,  Mangalbari (BPHC complex)-1,  Mal (SDH complex)-1

Arrange equipment for transportation of larvivorous fish to identified breeding sites Fishes liberated in the selected water bodies of the high endemic areas of the blocks. Before liberation IEC done in the villages through miking, postering, leaflets-distribution etc)

Training of Health Workers, Personnel of Dept of Fisheries for stocking, transportation, introduction of larvivorous fish