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