training module for medical officers primary health centre - NVBDCP

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4.4: STRATEGIES FOR TRANSMISSION CONTROLThe concept and scope of integrated vector managementIntegrated Vector Management (IVM) has been defined by WHO as a rational decision making processfor the optimal use of resources for vector control. IVM entails the use of a range of biological, chemicaland physical interventions of proven efficacy, separately or in combination, in order to implement costeffectivecontrol and reduce reliance on any single intervention. In most high-burden areas, long-termmeasures targeting adult mosquitoes are more generally effective and applicable. Two such methodsare available: Indoor Residual Spraying (IRS) and Insecticide Treated mosquito Nets (ITNs). As thesemethods are costly and based on insecticides, they are targeted to high-risk areas, which are identifiedaccording to rigorous criteria. The choice between IRS and ITNs should be based on operationalfactors, community acceptance and local experience. The unit of intervention is the village.The scope of IVM is broad, and includes: Inter-sectoral collaboration – Development projects, agriculture, environment etc. Collaboration with other disease vector control programmes, e.g. malaria and dengue in urbanareas. Community participation - peridomestic sanitation in urban areas.Optimizing use of IVM: MicrostratificationMicrostratification refers to the use of surveillance and other epidemiological and program data todetermine for every village, whether it is in a high risk area; the selected villages will also bemicrostratified for application of either IRS or bednets as the primary vector control method. Whatever,the method, the coverage should be as close to 100% as possible. All members of the populationsshould sleep in houses, where every room has been sprayed, or they should sleep under an insecticidetreatednet. The selection of villages where bednets are used should be guided by epidemiological andentomological parameters. Where IRS operations are difficult to conduct, preference will be given tobednet use. The actual choice between IRS or ITN / LLIN will also depend on the availability of ITN /LLIN. Over time, bednet use will be scaled up, and the reliance on IRS may be minimized.The national malaria control program is currently using IRS as the primary method of vector control inrural settings, and anti-larval measures in the urban areas. Bed nets have already been introduced inthe program, and the program envisages a scale up in their use as an option that addressesenvironmental, operational and community acceptance considerations of IRS.Identification of high risk areasThe Technical Advisory Committee on Malaria in its meeting held in 2002 has rationalized the criteria forundertaking indoor residual spraying. These criteria are as follows: To spray on priority basis all areas taking sub-centre as a unit, with more than 5 API withsuitable insecticides where ABER is 10% or more. To spray on priority basis with suitable insecticide all areas reporting more than 5% SPR (basedon passive collection of blood slides), if the ABER is below 10% Due priority be accorded for spray if Pf proportion is more than 50%.71
To accord priority for IRS in areas with less than API 5 / SPR 5% in case of drug resistant foci,project areas with population migration and aggregation or other vulnerable factors.To make provision for insecticidal spraying in epidemic situations.Operational planning for IRS and ITNsWithin the target populations for IRS and ITNs, it is necessary to identify the populations to be coveredin the year under planning: the annual-plan target populations. Priority should be given to villages withhighest burden of malaria (generally, highest API). The epidemiological data should be thoroughlyanalyzed in this process. A meeting of MO-PHCs and MPHW supervisors (M) should be convened atdistrict or block level for operational planning target populations and prioritization of villages.Choice of insecticide for IRSFor IRS, the insecticides in use are DDT 50% WP, malathion 25% WP and synthetic pyrethroids (WP).The important factors that are considered in selection of insecticide for IRS include vector susceptibility,safety and residual effectiveness. Pyrethroids are preferably avoided because ITN/LLINs use them.Role of PHC staff in IRS activitiesThe MO-PHC should plan for IRS activities well in advance and carry out the following: Contributing to district level planning by providing relevant village wise microstratified information toDMO Indent for insecticide in time Dumping stations to be identified well in advance to dump insecticide a month ahead of spray Spray equipment to be checked and repaired Spare nozzle tips, jugs, buckets, plastic sheets, etc. to be purchased Manpower for spray to be calculated @ 30 houses in plains or 25 houses in hilly areas per pumpper day. Each squad consists of 5 FWs and 1 SFW operating two stirrup pumps.Insecticide requirementThe insecticide requirement is calculated based on the details given in table below:Table: Criteria used for calculation of requirement of insecticides for IRSS.No.InsecticideRequirement(in MT) for 1millionpopulation for2 roundsQuantity ofinsecticideadded to 10 LwaterDosageper sq.m ofactiveingredientArea (insq.m)coveredby 10 LsuspensionDurationofResidualeffect (inweeks)1. DDT 50% WP 150.00 1 kg 1 gm 500 10 - 122. Malathion 25% WP *900.00 2 kg 2 gm 250 06 - 083. Deltamethrin 2.5% 60.00 400 g 20 mg 500 10 - 12WP4. Cyfluthrin 10%WP 18.75 125 g 25 mg 500 10 - 125. Lambdacyhalothrin18.75 125 g 25 mg 500 10 - 1210% WP6 Alphacypermethrin5%WP37.50 250 g 25 mg 500 10 - 12The effectiveness of IRS depends on72
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TRAINING MODULEFORMEDICAL OFFICERSP
Page 3 and 4:
Distribution of malariaSESSION - 1:
Page 5 and 6:
National Malaria Eradication Progra
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1.2 : JOB RESPONSIBILITIES OF MO- P
Page 9 and 10:
SESSION - 2: MALARIOLOGY2.1: EPIDEM
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2.2: MORPHOLOGY, LIFE CYCLE AND TRA
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Table 2.1: Differentiation of chara
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2.3: VECTOR MOSQUITOES AND THEIR BI
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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 and 46: Visit the PHCs, subcenters and vill
Page 47 and 48: The Rapid Diagnosis Test (RDT) is d
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: 3. Therefore, unless the deceased h
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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