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Dr. K. Barman Assistant Director O/o Joint Director of Health Services (Malaria) Assam

Quality Assurance Challenges in Malaria Control Assam on 6 th September, 2009 at Bhubaneswar, Orissa. Dr. K. Barman Assistant Director O/o Joint Director of Health Services (Malaria) Assam Hengrabari, Guwahati - 36. CHALLENGES OF MALARIA in the State.

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Dr. K. Barman Assistant Director O/o Joint Director of Health Services (Malaria) Assam

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  1. Quality Assurance Challenges in Malaria ControlAssamon6th September, 2009atBhubaneswar, Orissa Dr. K. Barman Assistant Director O/o Joint Director of Health Services (Malaria) Assam Hengrabari, Guwahati - 36

  2. CHALLENGES OF MALARIA in the State • Malaria is a major public health problem in the state. • The population of the state approximately 3% of the Indian’s population, but the state contributes - - 5-10% of malaria cases, 10-15% of Pf cases and 15-30% death due to malaria of the country. • The distinct epidemiological paradigms of malaria attributable to eco-geographic, ethnic and social-cultural diversity are the major challenges in malaria control.

  3. EPIDEMIOLOGICAL SITUATION OF MALARIAOF ASSAM

  4. Malaria incidence of Assam

  5. Year wise Malaria Death

  6. Quality Control & AssuranceDiagnosis of Malaria A) Diagnosis : Microscopy • Laboratory - Space & working environment - improved due to NRHM. - Water supply – running water is not available in some of the laboratories. - Power supply also is not available in remote laboratory. • Microscope - Purchase according to the specification of NVBDCP from DGS&D approved firm. No AMC was done with the firm. Spare parts- 5X eye piece were provided . • Technician - Qualification of Lab tech.- Higher Secondary pass with diploma holder from Medical Colleges. - Reorientation training organized annually - 2006 - 192 nos. - 2007 - 43 nos. - 2008 - 83 and 461 (newly recruited by NRHM) - 2009 - 36 nos.

  7. Contd. 4. Micro slides - Blue Star Company, maintaining B/S specifications 5. Cleaning & Reuses of Slides - Negative slides only used. • Immersion Oil - Liquid paraffin used. • Stain JSB - Readymade stain used. • Slide preparation & Staining - Both Thick & thin films prepared. Filtered paper not used in all laboratory. Staining and examination of slides by lab tech.

  8. Quality Assurance -- Microscopy • MO PHC – supervise the laboratory regularly. • Cross Checking of Slides - at 6 laboratories . 3 Zonal lab, 1 State Office, 2 RD Offices, MOH & FW Performance of 2008: • Total Nos. Positive slides cross checked= 11526, discrepancy= 2.65% • Total Nos.Negative slides cross checked= 15425, discrepancy=1% Gaps : • Sufficient number of slides are not received by the designated lab. from the malaria clinic of the district. Action initiated: • Discrepancy – a) new recruitment of LT and training organized. b) uses 10X eye piece and substituted by 5X. • Transportation cost of cross checking slides are now borne out of hospital users money. • MTS are instructed to ensure the cross checking of slides. • DMO are also directed to take necessary action against the technician for not sending of slides to the designated lab for cross checking.

  9. RDT • RDT uses in the high endemic villages as per direction. • Specification - RDK for Pf Provided by NVBDCP. • Transportation and Storages maintain according to the guidelines. • Pack of 25 test kit – chance of wastage is more & distribution to users become limited. • Training of worker - No of ASHAs = 20303 (2008) 19425 (2009) - No of HW = 537 (2008) 920 (2009) - No. of MTS = 32 (2008) • Replenishment of RDT of ASHAs by HW/MTS. They also supervised the ASHA

  10. Treatment Quality Control 1.Anti malarial – most of the drugs received from NVBDCP. Drugs inspector Health Deptt. collected drugs from periphery for testing at Regional Drug Testing Laboratory, Guwahati. 2. Health personal including ASHAs are trained on New Drug Policy. 3. Flow chart containing logithrim of treatment prepared and displayed in health institution. 4. ASHAs specially trained on malaria in high endemic villages 5. MO PHC trained on management of malaria 308 (2006), 269 (2007), 277 (2008).153 (2009) 6. Special training on management of critical malaria cases at Medical College Hospital Guwahati for 4 nos. MO of Diphu Civil Hospital, Karbi-Anglong. 7. Pre & post test evaluation perform in the training programme..

  11. Treatment. Quality Assurance – • Early diagnosis by RDK & Treatment – 35119 / 58551 i. e 59 % Pf cases treated in 24 hrs during 2008 • Early diagnosis by RDK & Treatment – 11868 / 38978 i. e 33 % Pf cases treated in 24 hrs during 2009 • Replenishing of drugs , RDK to ASHAs-- maintained by HW/MTS • Supply chain of drugs – monitoring initiated through monthly stock position statement. • Expert from Medical Colleges supervised the District hospital for management of malaria cases. • Second line of drugs (SP-ACT) started in all Pf cases • Drug Resistance study initiated by RD H&FW, Shillong

  12. QA for Insecticides • Monitoring of vector resistance – by NIMR(2009)

  13. Quality Control Indoor Residual Spray Selection criteria for IRS Sub-centre is taken as unit Priority – I API>5 where ABER is 10% or more SPR>5%, ABER is below 10% Priority – II Pf proportion is >50% Area with drug resistance foci. Priority - III Pf > 30%, API > 5 Priority - IV Pf< 30%, API> 5

  14. Population targeted from IRS - 2009 Priority I = 4925116 Priority II = 2311069 Total targeted population = 7236185 No. of SC = 1195 No. of Villages = 6428 No. of Squad engaged = 370 (per round)

  15. Spray Coverage 2008, 2009 2008 1st Round = 74.40 % (Rooms) 79% population 2nd Round = 74.71 % (Rooms) 70% population 2009 1st Round = 70.61 % (Rooms) 71.21 population

  16. Quality Control--- Indoor Residual Spray As per stratification of the area, DDT squads are being deployed to the districts • Spray squads engaged by Districts and training of squads at the PHC . • Checking of pumps and other logistics of the spray operation by the DMOs/ CD Quality Assurance for IRS • Concurrent Supervision -- HW of the allotted SC engaged to DDT squad for regular supervision. Over& above MTS and supervisory HW also supervise the operation. • Consecutive Supervision – Districts, State & RD H&FW, NVBDCP, Delhi supervise the Spray Operation • Advance information to the Community regarding spray operation through Panchayats. Remarks from State Supervisory team A) Community acceptance of DDT is now poor. B) Quality of Spray not satisfactory.

  17. Contd. Long Lasting Insecticide Net 4 lakhs Nets received from NVBDCP High Malaria Endemic villages identified considering high risk criteria and inaccessible area for distribution of nets. 750 malaria high risk villages in 50 BPHC selected for 100% coverage. Nets already sent to the District. Distribution of Nets at identified villages started in the district. Impregnation of bed net Impregnation of nets organized in the villages through camp approach, involving ASHA/NGO and supervised by FW , Supervisor & MTS IEC campaign also organized in the camp

  18. . Thank you.

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