National Project Implementation Plan - NVBDCP

Chapter 2
Key Findings and Recommendations of Joint Monitoring Mission
(JMM) of NVBDCP
At the behest of GoI, a Joint Monitoring Mission (JMM) led by WHO which
included over 30 national and international experts undertook a
comprehensive review of NVBDCP during the months of January and
February 2007 and made important recommendations on policy and
strategy. Further, the NVBDCP in collaboration with Indian Council of
Medical Research has undertaken in-depth reviews (IDR) of malaria and
Kala-azar interventions in 2006. This section summarizes the key findings
and recommendations of the JMM and IDR.
2.1. Current Policies for Malaria Control
2.1. a. Case Management
The current policy for malaria diagnosis and treatment in the public sector
varies according to whether a given area is classified as a low malaria risk
area or a high-risk area. Primary health centers are classified as high
malaria risk areas if any of the following applies (otherwise it is classified as
low risk area):
Deaths due to malaria have been reported (on clinical diagnosis or
microscopic confirmation).
The Slide Positivity Rate (SPR) has doubled during the last three years,
provided the SPR in the second or third year reaches 4% or higher; or
the average SPR of the last three years is 5% or higher.
Of all reported malaria cases the proportion of P. falciparum proportion
is 30% or higher, provided the SPR is 3% or higher during any of the
last three years.
Any area having a focus of Chloroquine-resistant P. falciparum.
Agglomeration of migrant labor in endemic/receptive and vulnerable
areas.
High-risk areas are further divided, for the purposes of malaria diagnosis
and treatment, between those areas where a high (greater than 10%) level
of resistance to chloroquine in P. falciparum cases has been ascertained and
those areas where such high level of resistance has not been ascertained.
However, it has been very difficult to successfully undertake and complete a
large number of studies on drug resistance as such studies require a lot of
effort, especially for ensuring follow up of enrolled patients.
The following flow-charts summarize current malaria treatment policies;
(i) low-risk areas and (ii) high-risk areas where chloroquine resistance
levels greater than 10% has been ascertained; and high-risk areas where
levels of chloroquine resistance has not been ascertained.
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