training module for medical officers primary health centre - NVBDCP

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4.2: OPERATIONAL IMPLICATIONS OF CASE MANAGEMENT STRATEGIESSuspected case of malariaThe definition of suspected malaria is “a patient with fever in endemic area during transmission season,or who has recently visited an endemic area without any other obvious cause and in the absence of aconfirmed diagnosis”. For ruling out other causes of fever, the following should be looked for.1. Cough and other signs of respiratory infection2. Running nose and other signs of cold3. Diarrhoea4. Pelvic inflammation5. Skin rash suggestive of eruptive illness6. Burning micturition7. Skin infections e.g. boils, abscess, infected wounds8. Painful swelling of joints9. Ear dischargeHowever, none of these symptoms exclude malaria with certainty. Only a trained clinician can come toa clinical diagnosis of malaria in the presence or absence of “other cause”. In the program, MPHWshave also been trained to rule out malaria based on these “other causes”, but it is not clearly known asto how well these definitions are practically used at the grass root level. Under the new strategy, ASHA/community volunteer will be the primary care provider, with minimal skills. They will be initially trained toperform a blood test on every case of fever. This may result in an overuse of blood tests initially. Overa period of time, they will be taught to be more discriminating in differentiating “suspected malaria casesfrom “all fever cases” and the number of blood tests carried out by them is likely to reduceproportionately.How and when to use RDT and blood smearIf a microscopy result can be made available to the provider managing the patient within 24 hours (inpractice on the day, when the patient presents or the day after), only microscopy is done. Antimalarialtreatment is given only on the basis of a positive slide-result.In inaccessible areas, where microscopy result cannot be made available within 24 hours, Pf RDTs areat present supplied. An RDT is done in front of the patient and a slide is also taken. If the RDT isnegative, the slide is sent for microscopy. If it is positive, the patient is treated for falciparum malaria,and the slide is discarded. Mixed infection cannot be ruled out in such cases, but the risk is low. TheACT treatment for P.falciparum is also effective for the blood stages of P.vivax. If the patient shouldhave a P.vivax relapse later, he or she is expected to return and then be diagnosed and treated withprimaquine.Wherever a microscopy result can be made available within 24 hours, microscopy should be used asthe only routine method. RDTs should be used in PHCs and other health facilities only in emergenciesin the absence of the laboratory technician.Rapid Diagnosis Test (RDT)45
The Rapid Diagnosis Test (RDT) is done with the Rapid Diagnosis Test Kit (RDK). This kit is regularlysupplied by the government through the nearest Primary Health Center. The kit contains the followingmaterials:1. Spirit swabs - one swab for one patient2. Lancets - one lancet for one patient3. Small glass tube (capillary tube) - one for each patient4. Test strips - one strip for one patient5. One multiple-well plastic plate - common for all tests6. Test tube – one test tube for one patient7. Buffer solution or reagent solution - a special liquid for doing the test, in a dropper bottle,common for all testsP la s m o d iu mfa lc ip a ru mP la s m o d iu mfa lc ip a ru mPut theblooddrop hereAllow the blood come up in the tubePositiveRAPID DIAGNOSTIC TESTNegativeProcedureTake informed consent for conducting the testArrange all equipment for RDT and taking blood slideCheck that the test kit is within its expiry date. If not, do not use it.Open a foil pouch and check that the powder inside it is still blue. If not, discard the test and useanother test.Remove the test strip and the small glass tube or loop from the foil pouch and place them on aclean dry surface.Take out the bottle containing the liquid and the dropper.Place a new test tube in the multiple-well plate.After drawing blood from a finger, touch the tip of the small glass tube to the blood drop on thefinger and let a small amount of blood come up in the tube or the loop.Touch the tube or the loop to the test strip just below the arrow mark to place the blood there. Ifthere is a paper where Plasmodium falciparum is written, remove it and place the blood on thestrip in the place that was covered by the paper.46
Page 1 and 2: TRAINING MODULEFORMEDICAL OFFICERSP
Page 3 and 4: Distribution of malariaSESSION - 1:
Page 5 and 6: National Malaria Eradication Progra
Page 7 and 8: 1.2 : JOB RESPONSIBILITIES OF MO- P
Page 9 and 10: SESSION - 2: MALARIOLOGY2.1: EPIDEM
Page 11 and 12: 2.2: MORPHOLOGY, LIFE CYCLE AND TRA
Page 13 and 14: Table 2.1: Differentiation of chara
Page 15 and 16: 2.3: VECTOR MOSQUITOES AND THEIR BI
Page 17 and 18: Bionomics of vector species in Indi
Page 19 and 20: 2.4: EPIDEMIOLOGICAL AND ENTOMOLOGI
Page 21 and 22: Entomological parameters should be
Page 23 and 24: Cerebrospinal fluid (CSF) is clear
Page 25 and 26: 3.2: LABORATORY DIAGNOSIS OF MALARI
Page 27 and 28: Examination of blood films for mala
Page 29 and 30: Plate 1: Plasmodium falciparum thin
Page 31 and 32: 3.3: MALARIA CASE MANAGEMENTAntimal
Page 33 and 34: This ACT is highly effective agains
Page 35 and 36: within 72 hours of treatment. Such
Page 37 and 38: In pregnancy, malaria, especially P
Page 39 and 40: Advice to the patients / caretakers
Page 41 and 42: The choice between IRS and ITN/LLIN
Page 43 and 44: Deploy staff for active case detect
Page 45: Visit the PHCs, subcenters and vill
Page 49 and 50: It should also be ensured that the
Page 51 and 52: Common problems for reluctance to g
Page 53 and 54: 3. Programme management Monitoring
Page 55 and 56: Worker (SFW) to the PHC-MO where a
Page 57 and 58: The data collected through the syst
Page 59 and 60: Outcome - IRS Coverage - Population
Page 61 and 62: Level Staff FrequencySupervisor (wh
Page 63 and 64: With improved access to quality cas
Page 65 and 66: If an epidemic is predominantly due
Page 67 and 68: 500@ 20-25 houses per pump per day
Page 69 and 70: 3.1.6 Name of Laboratory Technician
Page 71 and 72: 3. Therefore, unless the deceased h
Page 73 and 74: To accord priority for IRS in areas
Page 75 and 76: Consumption of insecticide as deter
Page 77 and 78: Step 9: Wash equipments (basin, mea
Page 79 and 80: ProgramComponentBed netimpregnation
Page 81 and 82: Benefit of indoor insecticidal spra
Page 83 and 84: The MO-PHC is expected to provide a
Page 85 and 86: Ensure that they have adequate supp
Page 87 and 88: 4.8: LOGISTICS MANAGEMENTPlanningPl
Page 89 and 90: Planning of LLIN coverage is compli
Page 91 and 92: communication among the community f
Page 93 and 94: Examine level of stocksLook for unr
Page 95 and 96: During planned bednet distribution
Page 97:
How many of the individuals actuall
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