National Project Implementation Plan - NVBDCP

chloroquine in P. falciparum cases is widespread in India 2 . The share of P.
falciparum malaria has been increasing in India since 1980s, and is
currently about 45 percent of reported malaria cases. At present different
treatment policies are applied in different parts of the country based on the
chloroquine resistance level, so that ACT (artemisinin+sulfadoxinepyremethamine)
is used as first line treatment for P.falciparum malaria only
in clusters of PHC areas, where reported chloroquine resistance is above
25%. The experience from other countries such as Cambodia, Thailand and
Vietnam indicates that a rising share of P. falciparum malaria is a sign of
chloroquine treatment failure, and that this trend can be reversed by
treating all P. falciparum cases with Artemisinin-based Combination Therapy
(ACT).
Furthermore, millions of fever patients who do not have malaria are given
presumptive treatment with a single, sub-curative dose of 10 mg/kg
chloroquine (600 mg in adults) by the government health services. This can
increase drug pressure, cause unnecessary side-effects, is wasteful and
reduces confidence of the public in the services. Progressively, all fever
patients suspected of malaria should be tested to confirm the diagnosis of
treatment before treatment is given. The JMM recommended
discontinuation of presumptive treatment with chloroquine 10 mg/kg.
According to JMM, several important changes in the policy on diagnosis and
treatment of malaria are required; the most important of these include the
following 3 :
(i) Use ACT as the first line treatment for all confirmed falciparum malaria
cases. Introduce this policy in a phased manner to cover nation-wide –
according to a prioritized plan including diagnostics, training, quality
assurance, supply chain management and information to the public.
(ii) Reform the surveillance of malaria by expanding the coverage of
passive case detection. The target should be prompt blood slide or RDK test
for all suspected malaria cases. Strengthened and expanded PCD should
help the programme to achieve the target of about 10% annual blood
examination rate. Active Case Detection (ACD) should be restricted to
pockets of problem areas particularly areas with poor access to PCD or used
during focal outbreaks.
(iii) Testing all suspected malaria cases 4 before treatment: The main
challenge in terms of training, logistics and funding for implementing the
2 Since 2001, 64 studies of resistance to chloroquine have been conducted following WHO
protocol. Only five of these 64 studies found that the level of resistance to chloroquine was
less than 10%. Seventeen studies showed levels of resistance between 10% and 25%, and 42
studies showed levels of resistance greater than 25%. WHO recommendation is to use 10% as
the cut off level for drug resistance.
3 National Vector Borne Disease Control Programme: Joint Monitoring Mission Report, February
2007
4 Precise guidelines on criteria for suspicion of malaria should be prepared by NVBDCP at
central level according to following principles: Malaria should be suspected in patients who
present with fever or anemia living in malaria- risk areas (e.g. PHC) or having visited an
endemic area within the last month. A malaria-endemic area could for example be defined as
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