National Project Implementation Plan - NVBDCP

widely involved for case detection and treatment. The national guidelines
for treatment of kala-azar are not strictly followed even in the public sector.
Even though cases of Post Kala-azar Dermal Leishmaniasis (PKDL) are
reservoir of the parasite the programme gets very little information on
cases of PKDL since this is difficult to diagnose and treat. There is yet no
standard treatment of PKDL. Although guidelines have been produced by
the national programme capacity development needs considerable
improvements and the guidelines often do not reach the end users. In the
absence of district plans for kala-azar elimination, the program
implementation occurs on an ad hoc basis.
2.3. b. Surveillance and reporting
The reporting of kala-azar is based on passive case detection supplemented
by additional case finding during the kala-azar fortnight. During the Kalaazar
fortnight kala-azar cases are identified by house to house search and
using serology tests. The labour intensive kala-azar fortnight in November
2006 detected very few cases. It had overlapped with EPI campaign and
there was no IEC prior to or during the fortnight. Further, there is no vector
surveillance, and studies on vector behavior, bionomics and susceptibility
are lacking. Only a small proportion of the health care providers have been
trained on kala-azar surveillance.
Some districts have started to include the reports from selected private
institutions. This carries the risk of double reporting in the absence of a
system for identification of patients through line listing and individual
patient treatment cards.
The registers and records of kala-azar cases were inadequate and provided
sketchy information which was often confusing. Consequently, the reporting
and feedback are unsatisfactory.
2.3. c. Vector Control
Data from the recent IDR indicate that the average coverage of IRS is 50%
for 1st round and only 20% for 2nd round. However uniform and complete
IRS coverage was only 7%. The JMM observed that the preparation for IRS
was inadequate in Bihar. The micro-plans for IRS are not being prepared
and there was no advance planning to train spray squads. There is no
contingency plan if the IRS round overlaps with other mass campaigns such
as Polio.
The storage facility for insecticides at the Block PHC level was reasonable.
However, the spraying equipments were inadequate and poorly maintained.
There is no vector surveillance, study on vector behaviour, bionomics or
susceptibility. There is a shortage of entomologists or insect collectors at
the state level in Bihar.
2.3. d. Recommended actions on Kala-azar Elimination
Diagnosis and treatment of kala-azar should be offered free of cost at
the point of delivery in the government and private sectors. Additional
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