National Project Implementation Plan - NVBDCP

elimination target in at least half of these districts at the sub district level.
This will contribute to the achievement of the national goal since the project
focus will be on the districts that contribute maximally to the cases of Kalaazar
in India.
6.1.1 Sub Component 2.a: Improving Kala-azar Case Management
6.1.1 2.a. a) Early diagnosis, complete treatment and referral
Early diagnosis and complete treatment strategy would help elimination of
the parasite, reduce case fatality rates and increase the credibility of the
health system, which in turn will help to increase the utilization of health
services by people affected by Kala-azar
The case definition of kala –azar will be uniformly applied. A case of kalaazar
is a person from an endemic area who has fever of more than 2 weeks
with splenomegaly and positive dipstick test. All Patients suspected to be
suffering from kala-azar should be tested by dipstick test. Confirmation of
Kala-azar cases can be done by examination of bone marrow aspiration in
hospital settings since these are envisage. However, this would be required
in a few patients only since dipstick test is quite reliable. Once diagnosed,
Miltefosine a safe oral drug will be administered under direct observation. In
order to retain its efficacy and delay the appearance of drug resistance,
treatment cards and patient wise box would be made available at the
treatment point. Drug can not be used during early pregnancy and married
women in reproductive age who do not use contraception regularly and in
infants. The programme will undertake pharmaco vigilance as a part of
efforts to maintain the usefulness of this drug in the programme for a long
time. Miltefosine will be introduced in 16 districts. In other districts, SSG
will continue to be used provided that the resistance level to SSG is less
than 10%. Monitoring of side effects and management of side effects will be
intensified to minimize the complications from this drug. Efforts will be
made to intensify completion of medicine and the use of rescue drugs if
there is unresponsiveness and toxicity from SSG. In the districts where
resistance levels are higher than 10%, amphotericin B will be used as
recommended by the national programme.
The activity schedule for the first year is presented in Table 1. A detailed
log-frame for subsequent years will be developed later, based on lessons
learnt in the six months of implementation.
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