National Project Implementation Plan - NVBDCP

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