National Project Implementation Plan - NVBDCP
National Project Implementation Plan - NVBDCP
National Project Implementation Plan - NVBDCP
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the in depth review in 2006, the coverage and quality of IRS are low in<br />
most areas. The coverage of ITNs varies widely among the States, from<br />
high in Assam to almost zero in Rajasthan (in depth review 2006). The low<br />
ITN coverage rates in many forested and urban areas reflect a lack of<br />
promotion and poor access. There are also new technological developments<br />
for vector control such as Long-lasting Insecticidal Nets (LLINs) which need<br />
to be introduced in India. The current spray pump will need to be gradually<br />
replaced by compression Pumps, which is faster, better and can be<br />
managed by one person only.<br />
2.3. Current Policies for Elimination of Kala-azar<br />
India is committed to the elimination of Kala-azar which includes the<br />
elimination of PKDL. According to the <strong>National</strong> Health Policy (2002), kalaazar<br />
is to be eliminated by 2010. The elimination programme has been<br />
accorded a priority and it is a centrally sponsored scheme. There is no<br />
formal written policy on kala-azar though national strategy document has<br />
been prepared. On Kala-azar the programme is guided by the<br />
recommendations made by the Technical Advisory Committee (TAC) which<br />
reviews the programme periodically as requested by <strong>NVBDCP</strong>.<br />
The major thrusts of the elimination program are (1) Early diagnosis and<br />
complete treatment (2) Disease surveillance and (3) IRS with DDT in the<br />
affected districts. The diagnosis is made by aldehyde test which is used as a<br />
screening test and confirmation by parasitic diagnosis through aspiration of<br />
the bone marrow or splenic puncture examination. Bone marrow aspiration<br />
and splenic puncture are invasive procedures that can be done only in well<br />
equipped hospitals since they are associated with the high risk of<br />
complications. The programme is using SSG as the first line drug. It is<br />
recommended as a course of 28 days duration and the medicine has to be<br />
given parenterally. Amphotericin B is recommended as the rescue drug.<br />
Passive case detection is supported by kala-azar fortnights organized once<br />
in an year for active search. Indoor residual spraying with DDT is<br />
recommended as two rounds in the affected districts.<br />
2.3. a. Case Management<br />
According to IDR (2006), over 60% of kala-azar patients approach the<br />
private sector for diagnosis and treatment. For diagnosis, rk39 dipstick is<br />
the state-of-the-art technology which is available in the private sector. In<br />
Bihar which is most endemic, patients at public facilities are tested by “rk<br />
39” through an outsourcing mechanism or by referral to a private provider.<br />
Some government doctors doubt the efficacy of the first line drug Sodium<br />
Antimony Gluconate (SAG), in use to treat kala-azar, because of observed<br />
treatment failure. In Bihar’s northern districts, SAG resistance is reported in<br />
about 60% cases.<br />
There are often delays in diagnosis and treatment due to lack of access,<br />
inability to afford, lack of information on treatment availability, and wage<br />
loss during hospitalization or treatment at home. NGOs have not been<br />
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