namp national anti malaria program

NAMP

National Anti Malaria Program

Organisation & Implementation of National Anti Malaria Program in the District

Techniques of blood examinations; Staining & Identification techniques

Spraying techniques & Strategies

Monitoring of the program

Topics Discussed

Organisation & Organisation & ImplementationImplementation

N A M P is a Cat II centrally sponsored Venture 50 : 50 cost sharing

Central --- Drugs, Insecticides / Larvicides, Technical assistance

State --- Operational costs including staff salary

NMCP 53 ---- NMEP 58 ---- UMS 71 ---- MPO 77 ---- MAP 95 ---- EMCP 97 ---- NAMP 99

RBM 98

Integration of the malaria maintenance phase under NMEP with the General Health Services --- Chadha Committee 63

Along with MPO 77,the MPW Scheme (Kartar Sing Committee) & VHG Scheme 77 took shape

In addition to the District Health Officer, the existing unit officers have been designated District Malaria Officers – entrusted with the operational & evaluation aspects of the program

The DMO is assisted by Asst. Malaria Officers

Lab services decentralised; Lab technicians posted at each PHC; come under the DMO

Carry out active & Passive Surveillance ; 1 H.I (Surveillance Inspector) for 4 MPW

The PHC Medical Officers have a key role in the execution of the program

Malaria Trend across the centuries, in India

Six elements of Roll Back M a l a r i a

1. Evidence-based-decisions using surveillance, appropriate responses and buildingcommunity awareness

2. Rapid diagnosis and treatment

3. Multiple prevention. Better multipronged protection using insecticide treated mosquito nets, environmental management to control mosquitoes and making pregnancy safer

4. Focussed research to develop new medicines, vaccines and insecticides and to help epidemiological and operational activities

5. Coordinated action for strengthening existing health services, policies and providing technical support.

6. Harmonised actions to build a dynamic global movement.

N A M P Control Strategies

A P I > 2

Spraying

Entomological assessment

Surveillance ( active & passive )

Treatment

A P I < 2

Focal Spraying

Surveillance ( active & passive )

Treatment

Follow up

Epidemiological Investigation

Treatment

Presumptive

Radical

Tab. Chloroquine 600 mg ( 10 mg/kg ) + Tab. Primaquine 15 mg ( 0.25 mg/kg )

Tab. Primaquine 15 mg on day 2, 3, 4 and 5

Vivax

Falciparum

Tab. Chloroquine 600 mg ( 10 mg/kg ) + Tab. Primaquine 15 mg ( 0.25 mg/kg ) on day 1

Tab. Chloroquine 600 mg ( 10 mg/kg ) + Tab. Primaquine 45 mg ( 0.25 mg/kg )

Active surv

once in 15 days

4.8 188967.02642911105394232003(Jan to Nov)

5.2164378.8247255017313852002 (Jan to Nov)

5.3182878.8272055490345232002

8.8277875.0236525121315512001

8.4361874.0318617574430532000

10.8606067.73816512141563661999

11.6741763.34047516023639151998

10.0726257.64173523429724261997

9.2740757.04593027249805861996

10.6981445.34182240739923751995

16.11687646.148352397361049641994

19.22840051.876749429081480571993

17.82702147.772314522981516331992

14.12034646.367013574031447621991

16.92027942.751272484781200291990

Other UMS %Other UMS CasesChennai %Chennai

CasesRural CasesState CasesYear

MALARIA INCIDENCE IN RURAL AND URBAN AREAS OF TAMILNADU

Geographical Information system (GIS) is being developed in Tamilnadu for carrying out epidemiological mapping of the villages and for identifying vulnerable areas and seasonal pattern of disease outbreak.

7) Whenever necessary, focal spray is being carried out.

6) Mass and contact Blood survey are being carried out to prevent the occurrence of secondary cases.

5) Whenever imported cases recorded , the same is cross notified by the concerned Medical Officer to the respective Health Authorities of State for further remedial action at their end.

4) Creating awareness among the community for their participation.

3) Passive surveillance and anti-larval work in urban.

2) Two rounds of residual insecticidal spray during transmission period using synthetic pyrethroid in malaria endemic areas.

1) Malaria case detection is being carried out by house to house visit by collection of blood smears from fever cases and giving treatment for those who are found positive for malaria.

The control strategies adopted by the TamilNadu Public Health dept :

www.tnhealth.org/dphpm/dbmal

Active surveillance has become a problem all over the country in the recent past. In Tamil Nadu, IEC activities have made a great impact on surveillance, that more number of cases are being identified under passive surveillance than Active surveillance.

Spraying techniques & Spraying techniques & StrategiesStrategies

Space spray treatments

Thermal fogSpace spray equipment

Hand-carried

Vehicle-mounted

Aircraft application

Residual Spray Treatments

No Residual Effects

Outdoor

Indoor

Rapidly reduce populations of flying insect pests and vectors ( A D U L T S )

Sound knowledge on the Vector breeding sites, lifespan, feeding habits, seasonal trends (Ecology) essential for successful, cost-effective anti-adult spraying campaigns

Exacting, periodical & continuous efforts vital for the success of operations

Dose and residual effect are important considerations in determining the number of spray rounds needed to protect a population during the whole, or only the peak, of thetransmission season.

Residual Effects

S P R A Y I N G

/ Cold fog

��

Coarse sprays with a VMD over 400 µm

Fine sprays with a VMD between 100 and 400 µm

Mists with a VMD between 50 and 100 µm

Fogs or ultra-low volume (ULV) sprays with a VMD below 50 µm

A very important characteristic of space sprays is the size of the droplets being Dispersed, since this determines the time that they remain in suspension in the air and their ability to penetrate into spaces that are not fully open.

A space spray – technically a fog (sometimes referred to as an aerosol) –is a liquid insecticide dispersed into the air in the form of hundreds of millionsof tiny droplets

S P A C E S P R A Y S

Sprays, measured by their volume median diameter (VMD), are divided in accordance with their droplet size into

WHO Classification of Pesticides by Hazard WHO Classification of Pesticides by Hazard (WHO/UNEP/ILO, 1994)(WHO/UNEP/ILO, 1994)

Class 1a Extremely hazardousClass 1a Extremely hazardous

Class 3 Slightly hazardousClass 3 Slightly hazardous

Class 1b Highly hazardousClass 1b Highly hazardous

Class 2 Moderately hazardousClass 2 Moderately hazardous

UH Unlikely to be hazardousUH Unlikely to be hazardous

The technical products listed in Table 1 as recommended for malaria control belong to class II, with the exception of malathion and pyrimiphos-methyl, which belong to class III. In fact, all the formulations used, at the dilutions actually applied, belong to class III.

Techniques of blood Techniques of blood examinationsexaminations

MICROSCOPIC DIAGNOSIS

Conventional light microscopy is the established method for the laboratory confirmation of malaria.

Microscopy offers many advantages

It is sensitive. It is informative. It is relatively inexpensive.

It is a general diagnostic technique that can be shared with other disease control programmes, such as those against tuberculosis or sexually transmitted diseases.

It can provide a permanent record (the smears) of the diagnostic findings and be subject to quality control.

Microscopy suffers from three main disadvantages

It is labour-intensive and time-consuming, normally requiring at least 60 minutes from specimen collection to result.

It is exacting and depends absolutely on good techniques, reagents, microscopes and, most importantly, well trained and well supervised technicians.

There are often long delays in providing the microscopy results to the clinician, so that decisions on treatment are often taken without the benefit of the results.

MonitoringMonitoring

Monitoring and evaluation

Monitoring measures the implementation of the range of strategic activities

Evaluation measures the extent to which the objectives are being reached

Monitoring, which is a continuous on-going activity allows step-by-step recording of the progress made by health programmes

Evaluation is concerned with impact indicators, which allow periodic assessment of the way in which strategies and implemented activities reach

the planned objectives.

Parameters of Malaria Surveillance

A P I =Confirmed cases during the Yr

Population under surveillance X 1000

A B E R =# of slides examined

Population under surveillanceX 100

Index of Operational Efficiency

WHO – 1 % of Pop / month ; MPO – 10 %10 % of Pop / Yr

15 %20 %Passive as % of new OPD cases

1 %2 %Active

Non-transmission seasonTransmission season (July – oct)

Monthly blood examn rates

Slide Positivity Rate

Annual Falciparum Incidence

Slide Falciparum RateSpleen Rate

Measure of Endemicity of Malaria

pf proportion

Vector Indices :

1. Human Blood Index 2. Sporozoite Rate

3. Mosq density ( # of mosq/man-hour-catch ) 4. Inoculation Rates

5. Man biting Rate ( biting density – bites/day/person )

12-0.005-0.00410.1-122,66,64725,94,9432002

10-0.003-0.0049.6-102,43,09925,44,7662001

7-0.0020.0040.0039.4172,48,42425,20,5572000

91-0.050.020.059.51541252,42,98425,14,9631999

21-0.010.0020.0810.75212,42,03624,92,2191998

Radical Rx

givenDeathAPISFRSPRABERpfTotal

+ve

Blood smears

examined

Total PopulationYear

Malaria Situation in Coimbatore district ( 1998 – 2002 )

Source : District Malaria Officer, Coimbatore

National Surveillance Programme of Communicable Diseases

In Tamil Nadu, a National Surveillance Programme for Communicable Diseases has been launched in Dharmapuri,

Villupuram, Coimbatore, Madurai and Salem.

The National Surveillance Programme of Communicable Diseases was started as a Pilot scheme in 1997.

It helps to forecast epidemics outbreak.

Communicable disease surveillance is important to develop strategies for control and prevention of disease.

The Zonal Entomological Team

Zonal Entomological Teams attached to all the 72 Zones in the country

Carry out Entomological Surveys & Surveillance

Common Tasks are, to find out

1) Which Anopheline Sps are present

2) Which of them are Vectors of Malaria

3) The biology & behaviour of adult vector mosquitoes’ nesting habits (in/outdoors), feeding habits, seasonal changes in the numbers biting humans, duration of adult life and the areas in which they are found

4) Breeding Habits of the Mosquitoes

5) Which Vectors are Susceptible (or) Resistant to Insecticides

Distribution of Pf % in India, 1986-97

Last Modified : 15 October, 2003WHO Regional Office for South-East Asia

Chloroquine Resistance Status Of India,1997


Dynamics of P.falciparum in India,1985-99


Status of P.falciparum Resistance to Anti Malarial Drugs In India,1986-95


Pf Resistance Status of Alternative Anti malarials in India,1997


Early diagnosis and Prompt Treatment% of health personnel involved in patient care trained in malaria case management and IMCI.% of health facilities able to confirm malaria diagnosis according to national policy (micro s c o py, rapid test etc.).% of patients hospitalised with a diagnosis of severe malaria and receiving correct antimalarial and supportive

treatment according to the national guidelines.% of patients with uncomplicated malaria getting correct treatment at health facility and community levels

according to national guidelines within 24 hrs of onset of symptoms.

I.IMPACTCrude death rate among target groups.Malaria death rate (probable and confirmed cases) among target groups.% of probable and confirmed malaria deaths among patients with severe malaria admitted to a health facility.Number of cases of severe malaria (probable and confirmed) among target groups.Number of cases of uncomplicated malaria (probable and confirmed) among target groups.Annual Parasite Incidence (API) among target groups (by region/according to the epidemiological situation).

Proposed RBM Core Indicators

II.MALARIA PREVENTION AND DISEASE MANAGEMENTPrevention% of countries having introduced pyrethroids for public health use and insecticide-treated materials in the list of

essential drugs and materials.% of service providers (health personnel, CHW…) trained in techniques of treatment of nets and/or indoor

spraying according to the national policy.% of households having at least one treated bednet.% of pregnant women who have taken chemoprophylaxis or intermittent drug treatment, according to the national

drug policy.% of antenatal clinic staff trained in preventive intermittent antimalarial treatment for pregnant women.

Prevention and control of epidemics% of countries with epidemic prone areas/situation having a national preparedness plan of action for early

detection and control of epidemics.% of malaria epidemics detected within two weeks of onset and properly controlled.

III.HEALTH SECTOR DEVELOPMENTHealth Policy% of districts with plans of action reflecting national health policy.% of districts using health information for planning.% of countries having a policy of universal coverage for all with a basic package including relevant malaria control activities.

V. SUPPORT/PARTNERSHIP% of countries with agreed national RBM budget met by donor funding.% of countries with functional sentinel sites for surveillance efficacy of 1st and 2nd line antimalarial drugs.Number of antimalarial drugs which have progressed to the level of phase III trials.

IV. INTERSECTORAL LINKAGES% of countries with multisectoral and inter-agencies partnership established.% of countries having established official linkages, including the elaboration of research agenda of public health interest, between research institutions and Ministry of Health.

Community Action% of countries having national guidelines for malaria prevention and treatment including training of all the informal health providers and recommendations for home treatment of febrile illness/suspected malaria, recognition of the most frequent signs of danger for children, prevention of malaria during pregnancy and use of insecticide treated materials.% of villages/communities with at least one Community Health Worker trained in management of fever and recognition of severe febrile illness.% of mothers/caretakers able to recognise signs and symptoms of danger of a febrile disease in a child < 5 years.

Service Delivery% of health facilities reporting no disruption of stock of antimalarial drugs, as specified in the national drug policy, for more than one week during the previous three months.

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National Malaria Eradication Programme Programme Achievements

PARASITOLOGICAL DIAGNOSIS- SMEAR

namp national anti malaria program

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