Preface. I also extend my heartfelt thanks to all who have shared their views in developing this operational manual.

Transcription

1 Preface This Operational manual for sentinel surveillance site for Malaria has been prepared specifically for reference by the health personnel employed at sentinel sites. This manual highlights the operational and managerial issues, the roles and responsibilities of the sentinel site laboratory personnel, working at the Sentinel site laboratory and hospitals. This manual will also help in collection, compilation, analysis and interpretation of data and reporting regarding severe malaria cases and deaths and their geographical distribution. It will also help in predicting early outbreak and identifying risk factors responsible for severe malaria along with improvements in quality of Malaria laboratory. This will guide the Sentinel site Malaria Technician cum Coordinator (SSMTC) in proper documentation of malaria cases and deaths in Sentinel site Malaria Laboratory Register, Sentinel site Malaria Registers of OPD/IPD, Sentinel site fortnightly reports and case record forms for Positive cases and deaths due to Malaria. Malaria surveillance at these sentinel surveillance sites will further help in planning for programmatic interventions at the peripheral level. I acknowledge the contribution made by District Malaria Officers, Vector Borne Disease Consultants, Sentinel site Malaria Technicians cum- Coordinators and Laboratory Technicians in developing the Operational Manual through consultative work shop. Dr. Prameela Baral, MO, NVBDCP conceptualized and prepared the operational manual which was edited by a team of Technical Team comprising of Dr. M. M. Pradhan, Dy. Director, NVBDCP, Odisha, Head of Depts. of Microbiology/Pathology of three Medical College and Hospitals, Pathologist and Microbiologist of Capital Hospital BBSR, Dr. Amit Chatterjee, Consultant TMST and Dr. Joney Oomen, Clinical Consultant of TMST, Odisha. This final draft was also used to training the first batch of trainees comprising of SSMO and SSMTC of the first phase thirteen World Bank districts to obtain their valuable feedback which has been incorporated in the content. I also extend my heartfelt thanks to all who have shared their views in developing this operational manual. 1

2 ACRONYMS WHO World Health Organization NVBDCP National Vector Borne Disease Control Programme SSMTC Sentinel site Malaria Technician cum Coordinator NRHM National Rural Health Mission NIMR - National Institute of Malaria Research Center, ICMR Indian Council for Medical Research T &MST Technical and Management Support Team. P. Falciparum Plasmodium Falciparum P. Vivax - Plasmodium Vivax P. Malariae Plasmodium Malariae P. Ovale Plasmodium Ovale P. Knowlesi Plasmodium Knowlesi ACT Artimisinin Combination Therapy ASHAs Accredited Social Health Activists IDSP Integrated Disease Surveillance Project FTD Fever Treatment Depot MPW Multi Purpose Worker DHH District Head Quarters Hospital SDH Sub Divisional Hospital CHC Community Health Centre SSMO Sentinel Site Medical Officer CDMO Chief District Medical Officer DMO District Malaria Officer ADMO (Med) Assistant District Medical Officer (Medical) ADMO (PH) Assistant District Medical Officer (Public Health) DSMO District Surveillance Medical Officer. VBDC Vector Borne Disease Consultant DEO Data Entry Operator OPD Out Patient Department IPD In Patient Department SSLR Sentinel Site Laboratory Register SSMR Sentinel Site Malaria registers SC Sub -Centre API Annual Parasitic Incidence SPR Slide Positivity Rate 2

3 Sl no Table of contents Page number 1 Introduction 4 2 Malaria Surveillance Disease Surveillance Components of Malaria Surveillance Types of Malaria Surveillance Why Sentinel Surveillance for Malaria is necessary? Norms for establishing Malaria Sentinel Surveillance sites 6 3 Malaria Sentinel Surveillance Sites Manpower requirements at a Malaria Sentinel Surveillance Site Laboratory facilities available at the Malaria Sentinel Surveillance site Functioning of the Malaria Sentinel Surveillance Site Flow Diagram Documentation to be carried out at the Malaria Sentinel Surveillance site Standard Operating Procedure for onward transmission of reports 11 4 Epidemiological Indicators 12 5 Roles and Responsibilities of Malaria Sentinel Site personnel Sentinel Site Medical Officer (SSMO) Sentinel Site Malaria Technician cum Coordinator (SSMTC) Conclusion 14 Annexure 15 i Materials required at Sentinel Site Laboratory 15 ii Case record form and coding 15 iii Format for Sentinel Site Malaria Lab Register (SSLR) 16 iv Fortnightly report of Sentinel Site Laboratory 17 v Sentinel Site Malaria register for OPD/IPD (Med, Paed, OG and Casuality) 17 vi Case record form for Blood Smear Positive (Cases and Deaths) 18 vii Quality Assurance Formats 20 viii Format for Transmission of case record forms 20 3

4 1. Introduction Malaria is one of the mosquito borne parasitic diseases of public health importance in Odisha. WHO reports 1.5 million cases annually in India of which 0.4 million cases are reported from Odisha. With about 4 % of India s population, Odisha accounts for 20% of cases and 17% of deaths. In 2010 the proportion of P. Falciparum (Pf) and P. Vivax (Pv) reported is 88% & 12% respectively. Similarly the API is 9 per thousand populations & SPR is 7.5%. National Vector Borne Diseases Control Programme (NVBDCP) is an umbrella programme for prevention and control of following six vector borne diseases- Malaria, Filariasis, Dengue, Chikungunya, Japanese Encephalitis and Kala-azar. It is an integral part of India s National Rural Health Mission (NRHM) in the state. Malaria is caused by five malaria parasites (P. Vivax, P. Falciparum, P. Malariae, P. Ovale and P. Knowlesi).Of these P.falciparum malaria is the dangerous variety that causes complications leading to death. In Odisha, proportions of Pf malaria have been showing an increasing trend from 10% in the year 1970 to 80% in the year 2000 which reflects growing drug resistance to falciparum. Therapeutic efficacy studies conducted by National Institute of Malaria Research Centre (NIMR) and other Indian Council for Medical Research (ICMR) indicate that the resistance of malaria cases to Chloroquin is widespread in India and Odisha. Most of the resistant variants have emerged in populations living in regions endemic to malaria as a result of the selection pressure exerted by the parasite. To counter the drug resistance in parasites, the use of Artimisinin Combination Therapy (ACT) has been emphasised in the National Drug Policy to be used by health volunteers (ASHAs) as it is effective and treatment failures with ACT is rare in India. Based on the state database and malaria indicators, the 30 districts are grouped into 12 high endemic, 5 moderately endemic and 13 low endemic districts. The 10 southern districts having 24 % of State population with 50% tribal population contribute majority of the cases and deaths. Due to Malaria operational difficulties, the risk of malaria continues to be high in remote rural, tribal, inaccessible, forested and forest fringed areas. Close monitoring of malaria in endemic areas is needed to assess the trend, severity and geographical distribution of the disease and forecasting early outbreaks. Infections with Plasmodium falciparum may become severe and even fatal if early diagnosis and case management is not timely done. Both plasmodium infection and malaria disease are influenced by environmental factors. Young children and pregnant women are the most vulnerable groups who need immediate attention and follow up care. 4

5 2. Malaria Surveillance 2.1 Disease Surveillance Disease Surveillance is defined as Ongoing systematic collection, compilation, analysis and interpretation of outcome specific data for use in planning, implementation and evaluation of public health practices. In simple words this means collection of information for useful action by those who implement and carry out public health action; and to those who develop local, regional, national and international policies for disease prevention and control. Disease surveillance can be for multiple diseases as in IDSP and for specific diseases like malaria. In this Operational Manual we will deal only with Malaria Sentinel Surveillance. 2.2 Components of Malaria surveillance: Routine malaria surveillance in India helps only in deriving the epidemiological trend of the disease and deaths and their geographical distribution. The various components of Malaria Surveillance in India are as follows: a) Data collection: The process by which data on malaria cases and deaths are collected and recorded in the reporting formats. b) Data compilation and analysis: The above collected data is arranged, analyzed and depicted in various tables, graphs and charts. From this useful information is derived about the time, place and person characteristics of cases and deaths. Similar analysis is done at Village/Ward, Sub- centre, Block, District, State and National level. c) Dissemination and Communication: Proper and timely dissemination of information is done to key stakeholders which enables them to take decision and timely actions for implementation of preventive and control measures at appropriate time. 2.3 Types of Malaria Surveillance: Various types of Malaria Surveillance are as follows: a) Passive Surveillance: When the patient presents herself/himself to the health service providers like ASHA/FTD, MPW (M&F) and other health facility. b) Active Surveillance: When the health provider (ASHA/FTD, MPW (M&F) visits the households and detects Malaria cases during his/her routine visit to households or during outbreak situation. 5

6 c) Sentinel Surveillance: It is a type of passive surveillance done at selected health facility where there is inflow of a large number of malaria cases. Sentinel site laboratories of Malaria are usually located in District Head quarters Hospital/ Sub-divisional Hospital/CHCs/ Medical College Hospital/ Corporate and Private Hospital. 2.4 Why Sentinel Surveillance for Malaria? In active and passive surveillance of malaria, the data generated is insufficient to provide relevant information on uncomplicated and severe malaria, their outcome and trends. Therefore, a specific health facility is selected in a defined geographic area where there is greater inflow of similar cases. The data collected from such health facility provides relevant information about the trend and severity of Malaria cases, their geographical distribution, forecasting early outbreaks and therapeutic efficacy of antimalarial drugs. 2.5 Norms for establishing Malaria Sentinel Surveillance sites: A minimum of two sentinel sites will be established in a high burden district initially. However there may be more than two sites if the district size is proportionately bigger. This may be located at Medical Colleges/ District / Sub- district hospitals /CHCs/Corporate and Private hospitals. In summary, the objectives of Sentinel Surveillance site for malaria are the following To assess the magnitude and pattern of cases and deaths due to malaria in the region To analyze the factors responsible for complicated malaria To improve the referral of cases from the Sentinel site hospitals to higher health care facility To improve the capacity of medical and paramedical staff for efficient management of severe malaria cases To suspect any preempting development of resistance to ACT by Plasmodium falciparum parasite To track the progress of severe malaria cases To forecast early outbreaks The overall purpose of Sentinel Surveillance is early diagnosis and reporting, efficient case management at hospital level, tracking the hospitalized severe malaria cases and clinical suspicion for any drug resistance 3. Malaria Sentinel Surveillance Sites (MSSS) 6

7 3. Malaria Sentinel Surveillance Sites 3.1 Manpower requirement for establishing the Malaria Sentinel Surveillance Site at Health Facility. Minimum manpower required for establishing a Malaria Sentinel Surveillance site is as follows a) Sentinel site Malaria Technician cum coordinator (SSMTC) b) Nodal Medical Officer for the Malaria Sentinel Surveillance Site (SSMO): Medicine specialist or Pediatric specialist or any Senior Medical officer looking after Medical wards or Pediatric ward c) Support staff (In Odisha Sentinel Site Malaria Technicians cum coordinators has been designated as Sentinel site Malaria Technician cum Coordinator as she/he has to coordinate with other Laboratory technicians in the health facility) One Sentinel site surveillance technical committee is to be formed under the chairmanship of Chief District Medical Officer with DMO, ADMO (Med), ADMO (PH), DSMO, Sr. Spl. Medicine and Sr. Spl. Pediatrics, VBDC and SSMTC as members to review the operational aspects and sentinel site reports each month to assess the trend of severe malaria cases and their geographical distribution. 3.2 Essential laboratory facilities available at the Malaria Sentinel Surveillance site: Blood Smear examination of malarial parasites including their density RDTs to test for malaria during emergency hours, absence of electricity, microscope being out of order and for laboratory technician on leave. Note: (i).the Sentinel site Laboratory must follow the standard NVBDCP guidelines and ensure the quality microscopic examination (ii)a list of equipment required for Sentinel Surveillance Site Laboratory has been given in the Annexure. 7

8 3.3 Functioning of the Malaria Sentinel Surveillance Site Category Nature of work Person responsible Transportation of Blood Slides Blood test by BS collection from OPD/IPD during SSMTC/Staff Nurse/any person Microscopy and the routine hrs in the morning identified by the technical committee RDT the technical committee Documentation RDT and BS collection during emergency hrs and in absence of SSLT Recording in malaria registers at OPD/ Causality/IPD(Med, Paed, O&G ward) Filling of Case record forms of positive cases, deaths and maintain SSLR BS examination at SSL and maintenance of records and report generation Report transmission to concerned officers and State HQrs Maintenance of Sentinel site Malaria Laboratory Register Maintenance of Sentinel site Malaria register at wards(o&g, Med, Paed), Casualty and OPD Staff Nurse/ Pharmacist/ pathology LT working in shifts / any person identified by the Technical Committee during emergency hrs Staff Nurse/Pharmacist/ any person identified by Tech. Committee SSMTC with help of Abstracts from OPD/IPD registers or Staff Nurse/Pharmacist/ any other person identified by Tech. Committee BS: SSMTC and support staff of SSL/ ward/any person identified by SSMTC / support staff or ward attendant identified by the Technical committee on the following day SSLT to record the abstracts from OPD and IPD registers in SSLR( Master Register) SSMTC Transmission of results and reports SSMTC/ SSMO/Staff Nurse/ any other person identified by the technical committee to treating physician Staff Nurse /Pharmacist/ any person identified by the technical committee to the treating physician SSMTC to update the abstracts from OPD and IPD registers of the suspected cases of malaria who have undergone RDT/BS SSMTC SSMTC SSMTC SSMTC SSMTC SSMTC Convener of the Technical committee Sentinel Site SSMTC / DEO/VBDC/DMO SSMTC Staff Nurse/Pharmacist/ any person identified by the Tech. committee Recording of abstracts by SSMTC Recording of abstracts by SSLT in the SSLR Support staff Filling of Case record forms of all confirmed Malaria cases & deaths by RDT(Govt. Supply)/BSE SSMTC Assisting the SSMTC in collection of BS and abstracts from different nodal points(opd/ipd/casualty) SSMTC/ any other person identified by the Tech. Committee in case SSMTC is absent or on leave SSMTC/DEO/VBDC In absence of DEO Outsourcing of data entry may be done as per guidelines Ward attendant/ support staff of SSL/or any other person identified by the Tech. committee 8 SSMTC By and hard copy by post ( First fortnight report by 20 th and second fortnight report by 5 th of each consecutive month) SSMTC Convener of the Technical committee assisted by SSMTC / DEO/VBDC/DMO District compilation by DMO assisted by VBDC

9 3.3.1 Flow diagram for transmission of Blood slides to Sentinel Site Surveillance Sites for Malaria Sentinel Site Laboratory for Malaria Out Patient Department Wards (OG, Med, Paed) Casualty or Emergency Flow diagram for Documentation and Report generation at the Sentinel Site Laboratory for Malaria A. First Fortnight Report Sentinel site Malaria Registers (OPD or Pathology Lab at CHC/SDH/DHH) Sentinel site Laboratory Register Sentinel site Malaria Registers (Ward (OG, Med, Paed) &Casualty) B. Second Fortnight Report Case Record forms for Confirmed cases and deaths due to malaria by BSE / RDT 9

10 3.4 Documentation to be carried out at the Malaria Sentinel Surveillance site a) Sentinel Site Malaria Register (SSMR for IPD/Casualty/ Patho Lab of Sentinel site Health facility All admitted (IPD) cases of suspected malaria who are advised blood test for malaria to be documented in this register. This register will be filled up by the Staff Nurse/ Pharmacist or any other person identified by the Technical Committee on duty in Casualty, Medicine, Pediatric and Obstetrics & Gynecology ward. The abstract from the SSMR (IPD) is to be documented by the SSMTC on the following day of his/her visit to the ward in the Sentinel site Laboratory Register. b) Sentinel Site Malaria Register (SSMR for OPD/ Patho Lab) Entries on suspected cases of malaria attending OPD/Pathology laboratory of Sentinel site hospital who are advised for blood test will also be made in the SSMR for OPD by the Staff Nurse / Pharmacist/ any other person identified by the Technical Committee. The abstract from the SSMR (IPD) is to be taken down by the SSMTC on the following day of his/her visit to the ward in the Sentinel site Laboratory Register. c) Sentinel site Laboratory Register (SSLR) All the cases of suspected malaria attending the OPD/ Casualty/Pathology laboratory of Sentinel site health facility or admitted to indoor and who are advised by the service provider for Blood test for malaria is to be documented in this register. This master register is to be filled up by the SSMTC or any other person identified by the Technical Committee. In addition the abstract from the SSMR of Causality/OPD/ IPD/ Patho laboratory of sentinel site health facility needs to be updated in the Sentinel Site Laboratory Register to avoid duplication and missing of cases each day. d) Individual Case history records of confirmed malaria cases and deaths: The individual case record forms of confirmed malaria cases and deaths by RDT (Govt. Supply) and BSE to be filled up by SSMTC/Staff Nurse/Pharmacist/any other person identified by the Technical Committee of the sentinel site health facility at the earliest to avoid loss to follow up. Note: Relevant formats and instructions regarding filling of the SSLR, SSMR at OPD, IPD and Casualty/Pathology laboratory of Sentinel site health facility and individual case history record forms of confirmed malaria cases and deaths have been placed at annexure. 10

11 3.5 Standard Operating Procedure for onward transmission of reports Report Transmission: a) Sentinel site reporting format- A [fortnightly] [OPD cases] b) Sentinel site reporting format- B [fortnightly] [IPD cases ] The fortnightly reports are generated from the data collected from Sentinel Surveillance Site Laboratory Register (SSLR) and Record room of the hospital. The Sentinel surveillance site Laboratory Register generates the details of suspected and confirmed malaria cases and deaths diagnosed by RDT (Govt. supply) / BSE) while additional information like the total number of Out patients and Indoor patients and total number of inpatient deaths are obtained from the Record rooms. The reports are tabulated by Sentinel Site Malaria Technician cum coordinator (SSMTC) under the supervision of Sentinel Site Medical Officer (SSMO) and Vector Borne Disease Consultant (VBDC). The tabulated data are submitted to the District Malaria Officer (DMO) and VBDC for analysis, interpretation and further needful action. The sentinel site laboratory report is placed before the Technical committee members of the Sentinel Surveillance Site Hospitals each month for their appraisal and needful action. Case history records forms of confirmed cases and deaths due to malaria are analyzed by the SSMO and the output is sent to DMO for action. An annual summary is prepared from the annual output of sentinel site as a part of annual malaria report. Summary Action Initiated by whom Data collection SSMTC/ Staff Nurse /Pharmacist/ any other identified person by ADMO(Med) Data compilation at Sentinel Site Laboratory SSMTC Report generation Analysis Interpretation Feedback Action Convener of the Technical committee and DMO Convener of Technical committee and DMO SSMO and DMO Technical Committee members and concern Officers who need to take action. CHC MO I/C, DMO, CDMO, VBDC and other programme officers Note: i) Reports will be disseminated to the next higher level by 5 th and 20 th of each month. ii) Feedback from the higher level will reach the district by 20 th of each month. iii) Quality assurance will be done for laboratories as per guidelines of NVBDCP 11

12 4. Epidemiological Indicators: The following indicators are to be derived from the data obtained from sentinel site report Sl Indicator Description Break down [with %] Data Source 1. Total no of OPD cases during the fortnight Self evident Age(<1 yr,1-4 yr,5-14 yr,>15 yr) Gender wise, village /Ward /Sub center and Block wise OPD register/ Record room 2. Total number of patients admitted to indoor during the fortnight 3. Total number of in patients admitted as suspected malaria during the fortnight 4. Total no. of inpatients diagnosed as severe malaria ( as per standard case definition of severe malaria) Self evident Total number Clinically suspected malaria out of the total number of in patients admitted to Sentinel site hospitals Total number in patients diagnosed as severe malaria out of the total number of in patients admitted to Sentinel site hospitals Clinically suspected malaria/ confirmed malaria/confirmed severe malaria, Age wise(<1 yr,1-4 yr,5-14 yr,>15yr), Gender wise, Species wise( PV/Pf/ Mixed), PW/Ward/ village /Sub center/block wise Age, Gender wise, PW, Village/Ward, SC and Block wise Age, Gender, PW,village/ward/ SC and Block wise Record room register/sslr Record room/sslr Record room/sslr 5. % OPD cases attributed to malaria 6. % Inpatients attributed to Suspected malaria 7. % Inpatients attributed to Severe Malaria out of total inpatients admitted as suspected malaria 7. % Inpatients attributed to confirmed severe malaria 8. % Inpatients attributed to confirmed severe malaria out of total inpatients admitted to hospital Total no. of outpatients confirmed by RDT(Govt. Supply) or BSE for malaria during a specified period/ Total number of OPD cases during the same period X 100 Total no. of inpatients admitted as suspected Malaria during a specified period /Total number of Indoor admissions during the same period X 100 Total no. of inpatients admitted and diagnosed as severe Malaria during a specified period /Total number of In patients admitted as suspected malaria during the same period X 100 Total no. of inpatients diagnosed as severe malaria and confirmed by RDT(Govt. Supply/BSE) for malaria during a specified period /Total number of Indoor admissions during the same period X 100 Total no. of confirmed severe malaria cases during a specified period/total no. of suspected malaria cases admitted during the same period X 100 Age(<1 yr,1-4 yr,5-14 yr,>15yr), Gender wise, PW, Suspected/Confirmed, Species specific(pv /Pf/ Mixed),village/Ward/SC/Block Age(<1,1-4,5-14,>15yr), Gender wise, PW, PV/Pf/Mixed, Ward/village/ SC and Block wise Age(<1 yr,1-4yr,5-14 yr,>15yr), Gender wise, PW, species specific(pv/pf/mixed),ward/village/ SC and Block wise Age, Gender wise, PW, Ward/Village/Sub center and Block wise Age, Gender wise, PW, Ward/Village/SC and Block Record room/sslr Record room/sslr Record room/sslr 9 Total number of Deaths Total number of deaths during a specified period 9. No. of confirmed malaria Total number of confirmed severe death( by RDT(Govt.)/BSE) malaria deaths/ total number of deaths in the inpatient department during a specified period Age, Gender wise, PW, Ward/Village/SC and Block wise Age, Gender wise, PW, Ward/Village/SC and Block Record room/sslr Proportional Mortality due to malaria CFR due to Malaria No of deaths due to confirmed severe malaria(govt RDT/BS) / Total number of deaths in hospital X 100 No of confirmed Malaria deaths ( Govt RDT/BSE)/ Total no of confirmed malaria cases[(govt RDT/BSE) ( Outpatients +Inpatients)] X Age(<1,1-4,5-14,>15), Gender wise, PW, PV/Pf, Ward/Village/SC and Block Age(<1,1-4,5-14,>15), sex, PW, Ward/Village/SC and Block Note: The age/ sex/address/block details to be included in confirmed cases and Death cases) Record room/sslr Record room/sslr

13 5. Roles and Responsibilities: 5.1 Sentinel Surveillance Site Technical Committee To conduct monthly review of Sentinel surveillance site Laboratory database, logistics, operational aspects, constraints and further plan for preventive measures to be undertaken by different stake holders. To define the role and responsibility of service providers at IPD,OPD, Causality and Pathology laboratory of Sentinel site Health Facility and monitor and supervise the activities of each of the sentinel site health personnel. 5.2 Sentinel Site Medical Officer (SSMO) 1. SSMO is responsible for overall arrangements and all activities for malaria surveillance at the Sentinel surveillance health facility. 2. Conduct on the job site training of the staff involved in surveillance activities. This includes Medical Officers of hospital CHC, SSLTs, Staff Nurse, Pharmacist, ward attendants and any other person identified by the technical committee. 3. He/ She should ensure that Standard Operative Procedures (SOPs) are complied with by the staff while collecting, processing, storing and examining blood slides and conducting RDT. 4. SSMO to check the SSMR, SSLR, case record forms for their completeness, discuss issues if any with concerned staff and guide them. She/he should monitor the progress in blood slide collection on daily basis. 5. Arrange for the collection, transportation and examination of blood slides on daily basis and in emergency hours and ensure that results of blood slide examination are provided immediately to the treating physician. 6. Contact the state NVBDCP officials for any clarification/problems regarding staff, availability of the listed consumables, user manuals, flow charts, case record forms, death formats and other methodological issues. 7. Regularly conduct monthly meetings for positive cases and deaths due to Malaria. 5.3 Sentinel Surveillance Malaria Technician cum Coordinator (SSMTC) 1. He/she will record the particulars of Blood slides in Sentinel Site Malaria laboratory registers (SSLR) and Sentinel site malaria registers (SSMR) and fills up the case record forms for confirmed positive cases and deaths. 13

14 2. He/she will collect the blood specimens and strictly follow the instruction for labeling; ensure appropriate labeling of specimens for routine testing and follow universal biosafety measures and guidelines of bio-waste management. 3. Take all precautionary measures to avoid damage to specimens during transportation, follow standard operative procedures for staining of slides, conduct examination and document the findings in assigned registers. 4. He/ she will inform about the blood slides found positive on examination to all concerned stake holders and complete daily dairy and get it duely signed by SSMO. 5. Make arrangements to replenish the monthly requirement of laboratory logistics through the Senior Laboratory technician of the hospital after approval of Technical committee. Also keep up to date information about stocks of anti malarial (tablets/ injections) and laboratory logistics. 6. Receive necessary abstracts of SSMR from OPD, Causality and Wards (OG, Med & Paed) after holidays and fill up the Sentinel site Laboratory Register (SSLR). 7. Prepare graphs and charts on malaria morbidity and mortality regularly and display them in the laboratory along with other display materials. 8. Send complete and timely reports of each fortnight to the DMO Office/State NVBDCP. 9. Send 5% of Negative slides and all positive slides for cross checking to the concerned Central laboratory and RD and ROH &FW as per Quality Assurance Guide lines. 10. Inform SSMO in case of increase in number of malaria cases from a particular geographical area or age group of patients. 11. Inform the SSMO timely on all events relevant to data and specimen collection such aslack of supplies, staff issues, power failures, labeling errors, missing blood specimens or missing surveillance forms etc. 6. Conclusion The data from sentinel surveillance sites will give information on geographical distribution, gender wise and age wise distribution, and proportional mortality and morbidity rate due to malaria cases and deaths. Higher case fatality rate indicates delayed referrals, inadequate services at the health facility, entry of new infection in previously non-immune community. Likewise sudden increase in severe malaria cases reported from a specific sub centers indicates an outbreak situation which needs immediate action. 14

15 Annexure I a) Materials Required at Sentinel Sites Laboratory Sl no. Materials/Consumables 1 Laboratory guidelines for the laboratory 2 Operational Manual 3 Wall chart/ flow chart 4 Case record forms 6 Sentinel site laboratory register 7 Death investigation format 8. Sentinel site Malaria Laboratory registers Sentinel site Malaria registers and for OPD,IPD and Causality Consumables/ equipments 9. Apron 10. Sterile disposable gloves 10 Alcohol swabs, Sterile dry cotton swabs 12 Disposable Lancets 13 Clean Blood slides 14. One piece of clean cloth 14 Circular band-aids 15 Glass marking pencil 16 Wooden box for transportation 17 Glass rods 18. JSB stain 19 Desiccant packs 20 Binocular microscope 21 Distilled water 22 Almirah 23 Puncture proof containers 24 1% Sodium Hypochlorite solution 25 Color coded biomedical waste disposable bags(yellow, blue, black) 26 Logistics for preparation of JSB stain 27 RDT kit ANNEXURE II Coding for Case recording Forms State District Site type Odisha - XX MBJ - XXX MCH - 01 DHH - 02 SDH - 03 CHC - 04 PS - 05 CS - 06 PS -07 Eg. Mayurbhanj 01. MCH- Medical College & Hospital 02.DHH- District Head Quarters Hospital 05.PS- Public sector 07.PS- Private Sector 03. SDH Sub divisional Hospital 04.CHC Community Health Centre 06.CS Corporate sector 15

16 Sl. No. Date Name of patient (father spouse s name) Address Sub centre Village & SC Age ( Yrs) Sex (M / F) Pregnant Women (Y/N) ST / SC Date of onset of fever Date of first contact with Service Provider(ASHA/MPW/CHC/AYUSH /MHU//PHC/ SDHS/DHH/Others) Place of Investigation prior coming to coming to the SSH( ASHA/MPW/MO/CHC/SDH/DHH/ Others) Result of Blood slide or RDT(PF/PV/Mixed infection) Date of reporting to Sentinel Site Date of Investigation at SSH Result of Blood slide (Pv / Pf/Mixed) Result of Pf RDT (Pos / Neg) Diagnosis Date of imitation of treatment at SSH Whether Admitted at SSH ( Yes /NO) Date of Admission at SSH Final Diagnosis Outcome (cured & discharged / referred/left without discharge/died) Date of outcome Annexure- III NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME, ODISHA Sentinel Surveillance Site Malaria Laboratory Register (SSLR) Period From. To Sentinel Site : District/Sub-district/CHC/PHC/Medical College/Public Sector/Corporate Sector/Private Sector. Name of the District:.. Investigations for Malaria If admitted Coding for Diagnosis / Final Diagnosis Coding of Outcomes 1 Uncomplicated Malaria UM A patient with fever without any other obvious cause and confirmation of diagnosis (microscopy showing asexual malaria parasites in the blood and / or rapid diagnostic test (RDT) for malaria antigen in blood positive). 1 Cured and discharged CD 2 Severe Malaria SM A patient, who requires hospitalization for symptoms and / or signs of severe malaria with laboratory confirmation of diagnosis. 2 Referred RF 3 Died DD 4 Left without discharge LD 16

17 Total In patients admitted Total In patients admitted as suspected malaria Total Inpatient diagnosed as severe malaria * Total Pregnant Women with Malaria SCs/STs < > 7 PV PF Mixed Inf Annexure IV: Sentinel Site Reporting Formats A & B NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME, ODISHA Name of the Sentinel Site: Fortnight: 1st/ 2nd DISTRICT: Month: Year: A: For Outdoor Patient Record - Total New OPD Cases Suspected Malaria cases Malaria Cases Confirmed (Both BSE & RDT) Pregnant Women with Malaria SC /ST Malaria Cases Total <1 yr 1-4 yrs 5-8 yrs 9-14 yrs >15 yrs M F M F M F M F M F PV PF Mixed infection Total B. Reporting format for Indoor Patients Severe malaria Cases Confirmed Severe Malaria Cases Time lag between onset of fever and reporting to < 1 Yr 1-4 yrs 5-8 yrs 9-14 yrs >15 yrs Sentinel site Deaths due to all causes during the fortnig ht Deaths due to confir med malari a M F M F M F M F M F Criteria to diagnose a case of severe malaria: Cerebral malaria presenting with convulsions, lethargy, coma, paralysis and other neurological manifestations Severe anaemia Renal failure, which may be combined with severe haemolytic anaemia in the syndrome of black water fever Adult respiratory distress syndrome, which may progress to pulmonary oedema Liver failure with jaundice and haemorrhagic tendency Septicemia Bacterial pneumonia Hyperpyrexia Severe Dehydration Hypoglycemia (often caused more by quinine than by malaria) DIC(Disseminated Intravascular Coagulation) 17

18 Sl. No. Name & Address (Village/SC/Block CHC) Age and Sex SC / ST PW (Y/N) Date of onset of illness Date of Blood test done prior coming to SSH Place of Blood test done prior coming to SSH(ASHA/MP W/SC/PHC/CHC /SDH/DHH/other than Govt. Hospital) Date of attending Sentinel site Hospital( OPD / IPD/ Causality ) Date of Blood test done at Sentinel site Hospital) Result Blood test(pf of Pv) Provisional diagnosis Annexure V: Sentinel Site Malaria Register for OPD / IPD ( Med, Paed & OG) and Causality Annexure6. Case record form for Blood Smear Positive (cases and Deaths) Patient I. D. No. OPD/IPD Regd.no. Blood slide No. 1. Name and Address : Shri/Smt/Ms S/O/D/O- 1. Village/Ward 2. Sub centre 3.Block CHC 2. Age 3. Gender (Tick mark the appropriate response) 1. Male 2. Female 4. Educational status (Tick mark the appropriate response) 1. Not educated 2. Educated (1-5 th std/ 6-7 th std/ 8-10 th std/graduate) 5. Occupation of Respondent(Tick mark the appropriate response) 6. Current place of residence(tick mark the appropriate response and then write the present address) 1. Agricultural workers 2. Non- agricultural Labourer 3. Migrant daily wage earner 4. Business 5. Large business/self employed 6. Govt Service/Pvt service 1. Resident of the area 2. Visitor to the area Present address of the case - 7. Duration of stay at the current place of residence 1. < 1 months 2. < 2 months months 4. > 6 months 8. Marital Status(Tick mark the appropriate response) 1. Married 2. Unmarried 3. Divorcee 9. If pregnant(tick mark the appropriate response) 1. Order of pregnancy (1 st, 2 nd, 3 rd ) 2. Weeks of Gestation 18

19 10. Distance of his village from the health facility 1. < 5 Kms 2. > 5 kms (PHC/CHC/SDH/DHH/MC/Others) (Tick mark the correct response) 11. Date of onset of fever // // 12. Date of seeking medical treatment for fever from the service provider ( ASHA/HW/MPW/MO/ Others) // // 13. Date and place of doing blood slide examination/rdt at (ASHA/HW/MPW/MO/ Others) (Tick mark the correct response) 14. Result of Blood slide examination/rdt at this facility level( Please tick the correct option) 15. If referred; source of referral after the first blood test(tick mark the correct response) 16. Time taken by him to reach this Health facility or referral center ( please Tick mark the correct option) 17.Date of admission to the sentinel surveillance site hospital // // 1. ASHA/ HW/ MPW/Others 2. Govt Hospital (PHC/CHC/SDH/DHH) 3. Others ( Priv Lab/Nursing Home/Priv hospital 1. Pf. 2.PV 3. Mixed ASHA/ HW/MO /PHC/CHC/SDH/DHH 1. hrs 2.Days to (PHC/CHC/SDH/DHH/MC) // // 18. Date of doing blood slide examination/rdt at SSH // // 19. Place of doing Blood slide examination/rdt at SSH (tick mark the correct option) 2. Govt Hospital(CHC/SDH/DHH/ Medical College) 3. Others ( Priv Lab/Nursing Home/Priv hospital) 20. Result of Blood slide examination/ RDT examination at SSH (Tick mark the correct option) 1. Pf 2. Pv 3. Mixed 21. Date of initiation of treatment at SSH //-----// What is the provisional diagnosis at SSH during the time of admission? (tick mark the correct option) 1. Uncomplicated Malaria 2. Suspected Severe Malaria 23. What is the final diagnosis at SSH 24. Outcome (Tick mark the correct option) 1. Cured 2. Relieved and discharged 3. LAMA (Left against Medical advice) 4. Died 25. Whether referred for his/her illness to a higher health 1. Yes 2. No facility from the SSH(Tick mark the correct option) 26. Cause of referral from first SSH to Health facility ( To be answered by the patient/ Guardian only) 27. Did he present himself to the institution he was referred 1. Yes 2. No from SSH? (Tick mark the correct option) 28. Whether admitted?, If yes then date of admission & name 1. Yes 2. No of higher health facility(tick mark the correct option) 29. Was his blood tested for Malaria at this higher health 1. Yes 2. No facility? 30. What are the result of this blood test? 1. PV. 2. Pf 3. Mixed 31. Outcome (Tick mark the correct option) 1. Cured 2. Relieved and discharged 3. LAMA 4. Died 32. Final diagnosis(tick mark the correct option) 1. Uncomplicated malaria 2. Complicated malaria 33. If answer to Q 27 is No then cause of not attending the referred health facility Date : SSLT/SN/MPW/MPHS/ SS Coordinator Signature : 19

20 Annexure VII: Quality Assurance Formats a) Format for Transportation of samples from Sentinel Surveillance Site Laboratory (SSL) to State Reference Laboratory (SRL) (QA sample transport sheet-should be filled in duplicate, one copy to be retained by the SSL after acknowledgement and the other copy for the SRL) 1. Name of Sentinel surveillance sites Laboratory: 2. Date of sending the Blood slides / / 3. Total number of Blood slides : i) Malaria positive samples (all positives) Sl No Date of collection Blood Slide No. Sl No Date of collection Blood Slide No ii) Malaria Negative samples ( 5% of total Negatives) Sl No Date of collection Blood Slide No. Sl No Date of collection Blood Slide No iii) Cross checking of tested Blood slides at State reference Laboratory All positive slides and 5 % of percent of negative slides to be sent to the State Reference laboratories for cross checking and the cross-checking reports to be communicated to the respective laboratories with a copy to State Hqrs. The Laboratory technicians of SSL laboratories with reported discrepancy reports will undergo refresher training at State reference Laboratory for updating of their knowledge. Annexure VIII Form for Transmission of Case record forms of Malaria Positive cases from SSL to State NVBDCP) (Fill in duplicate, one copy to be retained by the SRL and the other copy retained with the sentinel site laboratory) 1. Date of sending the case record forms: // // 2. Name of the SSL: Name of the District: Total number of case record Forms: Case record forms for BS numbers: From to Case record forms sent by: (Name) (Signature) Case record forms received by: (Name) (Signature) 20