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TRAINING NODULE FOR
MEDICAL OFFICERS OF
PRIMARY HEALTH CENTRES
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PART - 2
TUTOR'S GUIDE
DIRECTORATE OF NATIONAL MALARIA ERADICATION PROGRAMME
DIRECTORATE GENERAL OF HEALTH SERVICES
MINISTRY OF HEALTH AND FAMILY WELFARE
GOVERNMENT OF INDIA
22 - SHAMNATH MARG, DELHI-110 054
K3
oVz\iBRARy
Community Health Cell
Library and Documentation Unit
BANGALORE
CONTENTS
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Introduction
1. PREREQUISITES FOR TRAINING
1.1. Organising Training Programme on Malaria forMO-PHC
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1.2. Calendar of Activities
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1.3. Selection of Faculty
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1.4. Requirement of Training Facilities in Training Institute
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1.5. Principles of Training
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1.6. Material to be distributed to the Participants at the Time of Registration
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1.7. Arrangements to be made for Inaugural Function
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1.8. Material for Exhibition on Inaugural Day
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1.9. Pre-test: Instructions to Tutor
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1.10. Field Visit-Briefing and other Details
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1.11. Epidemiological and Skill Learning Exercises : Instructions to Tutor
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1.12. Post-Test: Instructions to Tutor
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1.13. Evaluation of Training by the Participants
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1.14. Concludino;
Session
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2.
UNITWISE OBJECTIVES AND INSTRUCTIONS TO THE TUTOR
Unit-1 Introduction to Malaria Problem in India
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Unit-2 Life Cycle, Transmission and Morphology of Human Malaria Parasite
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Unit-3 Malaria Vectors - Mosquitoes and their Bionomics
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Unit-4 Job Responsibilities of Medical Officer-Primary Health Centre
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Unit-5 Malaria : Clinical Picture & Differential Diagnosis
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Unit-6 Supervision of Laboratory Services
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Unit-7 Antimalarial Compounds, their use in NMEP and Drug Resistance
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Unit-8 Development of Referral System for Malaria under the
Primary I lealth Care Delivery System
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Unit-9 Malaria : Case Management & Specific Treatment
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Unit-10 Investigations into Death Doe to Malaria
Unit-11 Strengthening of Surveillance Mechanism : Monitoring, Assessment and
Evaluation
Umt-12 Planning of Intervention Measures for Transmission Control
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Unit-13 Information, Education and Communication on Malaria Control
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Unit-14 Epidemiology of Malaria
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Unit-15 Monitoring of Epidemiological and Entomological Parameters
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Unit-16 Selection of High Risk Malarious areas (Subcentre-wise) on the
basis of Criteria Developed by the Expert Committee on Malaria, 1995
Unit-17 Management Information System in Malaria Control
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Unit-18 Malaria Epidemics/Focal Outbreaks-Control and Follow-up
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Unit-19 Integrated Vector Control Measures with Feasible Bio-environmental
ontrol Methods in High Risk Areas and Use of Impregnated Bednets
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Umt-20 draining of Peripheral Staff by Medical Officer of PHC
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APPENDICES
Appendix-1 Pre-Test Paj )er
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Appendix-2 Study on Knowledge, Attitudes and Practices pertaining
to Malaria and its Control
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Appendix-3 Model Paper for Epidemiological Exercises
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Appendix-4 Post-Test Paper
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Appendix-5 Proforma for Evaluation by Participants
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Appendix-6 Suggested Timetable for Medical Officers of Primary
Health Centres for 5 days' Training
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INTRODUCTION
Prior to implementation of malaria control measures (1953) and later malaria eradication
programme (1958) in India, Malaria was the major public health problem and affected all spheres
of human life. In 1933 Sinton, one of the eminent Malariologists said “the Problem of
existence in very many parts of India is the problem of malaria”.
In the past,.a lot of research work was carried out on various aspects of malaria in India and the
malariologists of this country were among the pioneers in this field.
The eradication strategy laid down that the entire country would enter maintenance
phase by 1966-67 and the responsibility of maintaining malaria free status would be taken over
by the General Health Services.
Under the concept of Rural Health Care, the health infrastructure was developed around
Primary Health Centres. The staff requirement and other logistic support have undergone many
changes in the light of recommendations of Chadha Committee, 1963 and Kartar Singh Commit
tee, 1973.
The resurgence of malaria in the country in late sixties was due to various technical,
administrative, organisational and logistic problems. It was apparent that malaria eradication was not
a feasible proposition and the objective was changed to malaria control. The Primary Health Centre
was made the nodal point for malaria case detection and treatment activities. For administrative and
technical supervision at the district level, the District Malaria Officer was made in-charge of malaria
control.
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It is well known that the distribution, intensity and prevalence of different parasite
species in the community determine the malaria control strategy in the area. The case
detection is the direct responsibility of PHC Medical Officer and he is the focal point of such
activities. As the efficiency of case detection determines the control strategy, the PldC Medical
Officer has a very great responsibility on his shoulders in the revised strategy of decentralised
planning of malaria control. He plans and supervises the activities ofMPW (M) and MPW (F),
Health Supervisor (Male & Female) and FTD, DDC, etc. On his reports monitoring and
assessment on malaria situation in his area, the intervention measures are planned and executed. He
is also responsible for treatment and management of serious cases of malaria with Pfakipartim
infection. 1 lis responsibility as a Clinician lies on early diagnosis and prompt treatment ofsuch cases
at the PHC. In case proper facilities are not available, he should send the cases to referral hospitals
to prevent mortality due to malaria.
It is, therefore, necessary that PHC Medical Officer should be trained properly on various
aspects of malaria control.
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PREREQUISITES FOR TRAINING
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1.1. ORGANISING TRAINING PROGRAMME ON MALARIA
The State Health Authorities will have to take the following steps for organising the training
programme. The guidelines given hereunder are only suggestive and the organisers of the training
course could add other details wherever needed. The suggestions for further improvement of the
tutor’s and learner’s guides are most welcome which will be incorporated in the reprint.
i) .
Resources:
The resources for the training should be earmarked and the funds must be made available for
the training well in advance by the State Programme Officer. The State Health Authorities shall
prepare the number of training courses to be conducted, ftx venues and tentative dates, earmark the
budget well in advance for smooth running of the training programme in the ensuing financial year.
ii) .
Venue of Training & Course Director:
The venue of each training course and the Course Director must be identified by the State
Programme Officer. While selecting venue of the training, the State Malariologist should keep in
mind that the training institution must have all the infrastructure facilities listed at Sr. No. 4. The
Regional Family Welfare Training Centre or any other reputed training centre with all the required
facilities very near to the participants' working place as well as field practice centre should serve the
purpose. The dates of training should be intimated to the training institution to reserve the slot for
the five days training.
The Course Director shall be a senior Health Official such as Regional Director/Zonal Officer/
Principal of R F W T C/Deputy Director (M)Z Chief Medical Sc Health Officer. The Course
Director should possess expertise in malariology and must have undergone training in Malariology
orMalaria Entomology conducted by the Directorate of NMEP/NICD/MRC/IVCZ(Hosur-TN)
or any other reputed organisation.
iii) . Training Period:
The training is for five days preferably from Monday to Friday without any intervening public
holidays. The training during peak malaria transmission period shall be avoided so that the Medical
Officer’s presence is ensured in the PHC to supervise the control measures and man the referral centre
for the management of severe and complicated malaria.
iv) . Number of Participants:
Each training course shall have 25 participants. The participants should be informed at least
one month before the commencement of training. The participants have to confirm in writing to the
Course Director about the time, date and mode of travel to the venue as well as requirement of
accommodation to the concerned Officer of the training.
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v) .
Course Co-ordinators:
The Course Director should identify senior officers for sharing the responsibility of different
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aspects of training such as accommodation, audio-visual & other class room facilities, field visit, etc.
I here shall be one or two course Co-ordinators who will be assisting the Course Director in the
oveiall coordination of different disciplines and activities.
vi). Transport:
One big bus shall be hired for 40 persons so that all the participants, faculty and resource persons
can travel together for the field exercises which will save time and facilitate interaction between
participants and faculty as against transporting them in small batches.
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1.2. Calendar of Activities
The Course Director in consultation with the Course Co-ordinators and other officers involved
in the training shall prepare calendar of activities, at least three months ahead of the training. A check
list for each aspect shall be prepared.
First Four Weeks (i.e. 12th to 9th week before the commencement of training):
The State Health Directorate shall be informed of the confirmed dates of training and issue
circular to all the DMHOs of the Region to sponsor specified number of Medical Officers of the
highly problematic PHCs on priority and to intimate the names of participants to the Directorate
of Health Services with a copy endorsed to the Course Director. The Director of Health Services
should allocate the funds with instructions on how to spend the money under each head. In case the
training course is conducted through WHO assistance, the general circular for spending money
under different heads must be communicated to the Course Director. The participants shall submit
in writing about their participation in the said training to ensure full attendance.
Fifth to Eight Week: (i.e. Sth to Sth week before the commencement of training):
i). The letter for accommodation shall be addressed to the concerned Departments by the
Course Director.
ii) . Transporter for 40 seated bus shall be identified.
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iii) . Contractor for catering shall be contacted for tea & snacks and working lunch.
iv) .
1 he faculty for different lectures and field exercises shall be identified and get their
confinnation letters. I he faculty shall be provided literature concerning the topic. The
faculty shall also be informed that the facilities for overhead and slide projectors, Flip charts,
writing board, etc. are available with the training institution.
v) . The Officer in-chaige of the field visit shall visit the PHC to make arrangements for the field
exercises.
Ninth to Tenth Week: (i.e. 4th to 3rd week before the commencement of training):
i). 1 he Chief Guest and other speakers shall be identified and informed of the inaugural
programme.
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ii) . Preserved material for conducting the inaugural
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exhibition shall be procured and kept with
the officer-in-charge for this activity.
iii) . Invitation cards, if desired, for the inaugural session shall be got printed.
iv) . Certificates, if desired to be distributed, shall be got printed.
Eleventh Week (i.e. 14 days to 8 days before commencement of training):
i) . The banner for the training course shall be made ready.
ii) . Stationery items shall be procured.
iii) . Photostat copies of the lecture notes shall be completed.
iv) . Sets for distribution to the participants shall be made ready
v) . Invitation cards, if got printed, shall be posted.
Final Week: (i.e. 7th day to the day of commencement of training):
i) . The Course Director shall re-confirm all the preparations for the different activities and
ensure smooth inauguration of the training on the following Monday.
ii) . It should be ensured that the audio-visual equipment is in good working order. He should
ensure that the concerned officers and staff meet on Saturday and Sunday preceding the
actual training for completion of all preparations.
iii) . On Sunday the live specimens for Exhibition shall be collected and the exhibition material
shall be kept ready for display on Monday morning.
1.3. Selection of Faculty
As already indicated the identified faculty for the particular topic shall be informed well in
in
advance to allow sufficient time for preparation of lecture notes, transparencies and slides.
The faculty for the topic shall be proficient in the art of pedagogy who should allow sufficient
time for interaction with the participants. It is preferable to select a Chairman for morning and
afternoon sessions for moderating the topic and time keeping.
The faculty could be selected from the State Health Directorate, ROH&FW, RFWTC,
Medical Colleges, Dte. of NMEP, Zonal Office, DMHOs, etc.'
1.4.
Requirement of Training Facilities in the Training Institute
The following material is the minimum need for the training component.
1.4.1. Audio-visual equipments like (a) slide projector (b) over head projector (c) micro
phone system (d) television (e) VCP (f) cassettes on bio-environmental methods, impregnated
bednets and others which are relevant (g) white writing board/coloured pen set for the board (h)
duster (i) spare blank transparencies and pen set for transparencies, photography for inaugural/
concluding sessions.
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1.4.2. A good lecture hall with writing pad chair or ordinary chairs with seminar tables with
good ventilation but with least sound disturbance^
1.4.3.
Facilities for typing and photostafdrrangements
1.4.4. Demonstration material for pictorial exhibition of different malariogenic situations in
the State, live demonstration of vectors and aquatic stages, microscopic demonstration of parasites,
diffeient methods of personal prophylaxis, bio-environmental and chemical control methods, spray
equipments, charts, inaps depicting malaria related aspects, etc.
1.4.5.
Lecture notes, review papers and other teaching material, writing material, file covers, etc.
1.4.6.
Facilities for serving snacks, tea and lunch.
1.4.7.
Adequate transportation Sc accommodation facilities.
1.5. Principles ofTraining
7 he following major principles are to be followed while conducting the training:i) .
The training period should be judiciously balanced between class room lecture-discussion,
practical demonstration in Laboratory/field and work performance in the field pertaining to
the programme needs in the existing field conditions.
ii) . The learning objectives and the skills to be developed as given in Learners Guide should be
kept at the back of mind while conducting the training.
iii) . 7 he lectuie component should always incorporate sufficient time for discussion and the
moderator should ensure full participation of the learners so as to increase the learning urge
and full attention to the topic.
iv) . The pre-test proforma (Appendix-1) will give sufficient insight to the tutors about the
lacunae in the knowledge of the learners and enable them for constant guidance Scindividual
attention to the participants. Encouraging compliments for improvement in the learners
work would strengthen the learning skills of the participants.
v) . While discussing Drug Resistance (Unit 7) current drug resistance status in the State and
Map showing resistant areas will be emphasised/ displayed.
vi) . While teaching Malaria Vectors (Unit 3) emphasis will be on the bionomics of the local
vectors.
1.6. Material to be, distributed to the Participants at the Time of Registration
The following material shall be distributed to the participants at the time of registration.
i) . File Cover/Folder for keeping day to day learning material.
ii) . Writing Material; Note pad (bigger size), ball point pen, lead pencil, eraser and pencil
sharpener.
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iii) . Training Modules - Learner’s Guide.
iv) . Training Modules (Tutors Guide) for DDC/FTD Holders, Voluntary Link Workers and
MPWs.
v). Laminated folder on Malaria Parasite.
vi). Space for registration of participants which shall be completed before the inaugural session
in an ante-room.
1.7. Arrangements for Inaugural Session
The following arrangements shall be made for the inaugural session.
i) . Seating arrangements on the dais with name plates.
ii) . Banner on the training behind the dais.
iii) . Seating arrangements for participants and special invitees.
iv) . Working condition o^audio-visual equipment to be rechecked before the actual function.
v) . Standby generator shall be kept ready for meeting the exigency of power failure.
vi) . Copies of key note address, if desired.
vii) . Bouquets for the Chief Guest and VIPs, if desired.
viii) . Photography arrangements, if desired.
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Inaugural Tea 8c Snacks.
1.8. Material for Exhibition during Inaugural Session
The following display material shall be exhibited outside the lecture hall but in the vicinity
of place for inaugural tea.
i) . Microscopic demonstration with labelling of different stages of various species of malaria
parasite like ring, trophozoite, schizont of P. v. and ring, gametocytes of Pfi, etc.
This will be done daily for the first three days with 5 compound microscopes.
ii) . Aquatic stages of live specimens Anopheles, Culex and Aedes in petri dishes and adult male
8c female specimens of these genera in test tubes.
iii) . Display of pinned malaria vectors in the region focussed under simple microscope.
iv) . Spray equipment and other control measures - bio-environmental and chemical.
v) . Efficacy of larvicides (Enamel tray showing the dead larvae after larvicidal treatment).
vi) . Personal prophylactic measures - Models on the use of impregnated bednets, mosquito
proofing of house, etc.
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V11). Charts on life cycle of malaria parasite, life history
Anopheles and Culex.
viii). Posters on environmental sanitation and other IEC material.
Lx), lables and Graphs depicting epidemiological data and malaria incidence in different years
and monthly trend in the Region and State and highlighting problem districts and PHCs.
Charts, maps and photographs depicting epidemiology and control aspects of malaria.
Pictorial exhibition of different malariogenic situations in the State. Table on DDCs and
FTDs established and functioning.
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1.9. Pre-test
Pre-test model paper is given at Appendix-1. The tutor may not repeat the same questions for
every training batch. The pre-test papers should be evaluated immediately by the Faculty within half
an hour when the participants will be engaged in lecture discussion. The participants should be
informed about the errors committed by them in the pre-test paper
l.lO.Field Visit - Briefing and Other Details
The participants shall be informed about the exact time to assemble for field trip and the
exercises to be conducted there. 1 he participants are to be divided into five groups, selecting a group
leader for each group. 1 he tasks to be conducted are to be given in detail with the proformae for each
task and the area (village or part of a village) earmarked to each group should be specified. Resource
peison for each group should be identified who should accompany and guide the group in the field
exercises.
The Training Offi cer in charge of field visit will drop each group at the specific point and give
them time and place of collecting them back for the return trip. The resource person will take the
group round the villagee as per predetermined route so that the time is spent judiciously to extract
maximum work.
Each participant of the group shall be exposed in turns about blood smear collection, filing up
the profoima, interview with the community leaders, householders, private practitioners, Voluntary
Link Workers, etc. Similar method will be followed for IEC which shall be conducted side by side
with active and passive case detection components. Each participant may conduct KAP study on the
proforma (AppendLx-2) at least from three randomly selected households. The participants should
interact with the students and teachers of the school on IEC.
The afternoon session could be conducted at PHC headquarters. All the participants could be
divided into two batches; one batch for demonstration ofindoor residual spray while the second batch
for Laboratory demonstration Scevaluation of anti-malaria activities. During visit to the Laboratory,
the participants will also see the maintenance ofrecords, proformae, charts and maps.They will also
be shown stain preparation, staining and examination of blood smears. After completing the first
assignment, the batches will attend to the second assignment.
The participants will supervise the preparation of suspension, measure the discharge rate of
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nozzle tip, learn the spray techniques and calculate dose of active ingredient per sq. metre.
At the conclusion all the participants, faculty and resource persons will have group discussion
and summing up the field exercises.
1.11. Epidemiological and Skill Learning Exercises
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The exercises are given at Appendix - 3. These are to be distributed to the participants in the
class room and they have to individually solve the exercises within 60 minutes. The exercises,
preferably be given to the participants on the third day of the training for home work.
The tutor shall take the exercise one after the other systematically on the final day. Doubts of
participants will be cleared by the tutor. The solved epidemiological exercises will be kept with the
participants for future reference.
1.12. Post-test
Post-test model paper is given at Appendix - 4. The tutor may not repeat the same questions
for every batch of trainees. The comparison of Pre-test and Post-test papers will help the tutors to
evaluate the training and enable them to improve the training for subsequent batches. The Pre-test
and Post-test answer papers are to be retained by the Course Director.
1.13. Evaluation of Training by the Participants
The proforma for evaluation of training is given at Appendix - 5. The critical comments could
be anonymous and the faculty shall take these comments into consideration for improving the
training programme wherever needed, for subsequent batches.
1.14. Concluding Session
The Chief Guest for the occasion shall be contacted on the preceding day and ensure his
presence sharp in time, so that the participants are not detained for the occasion, since some of the
participants may have already made arrangements for return journey to their working places.
Note: Disbursement of per-diem and TA expenses shall be made during lunch break and during
epidemiological exercises on the last day.
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UNITWISE OBJECTIVES AND
INSTRUCTIONS TO THE TUTOR
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UNIT-1
INTRODUCTION TO MALARIA PROBLEM IN INDIA
Objectives :
i) various factors influencing the disease pattern in the community.
ii) nature of malaria infection.
iii) distribution of malaria and its important epidemiological characteristics.
iv) problem of malaria in India.
v) constraints in malaria control.
Instructions to Tutor
Discuss environmental factors, role of climate, distribution of malaria in the world, important
characteristics of malaria transmission, focal &. seasonal problem of malaria in India during forties,
prevalence of holo, hyper, meso and hypo endemic areas in India, socio-economic aspects, give
history of control measures, population break-up and results acheived. Describe strategy of
eradication and achievement during this period. Reasons for switching over to Modified Plan of
Operation. Strategies under Modified Plan of Operation and Malaria Action Programme (1995).
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Teaching Aids
Transparencies on :
1.
Malaria estimates in the pre-control era.
2.
Pilot control measures.
3.
Launching of NMCP in 1953 with objectives and achievements.
4.
Launching of NMEP in 1958 with objectives and achievements.
5.
Launching of MPO in 1977 with objectives and achievements.
6.
Malaria incidence at different points of time - 1958-59,
1965, 1976-77, 1980, 1984, 1989, 1994.
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MAP - Revised Strategy Objectives
8.
Endemicity malaria maps of India (a) Pre-independent India .
b). 1994 or the latest year.
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UNIT-2
LIFE CYCLE, TRANSMISSION AND MORPHOLOGY OF HU
MAN MALARIA PARASITE
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Objectives :
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i) recall the various stages in the life cycle of malaria parasite in (a) human host,
(b) mosquito vector.
ii) know why there are no relapses in infections with Pfalciparum and P.malariae.
iii) define the incubation period of malaria infection with different species of
malaria parasite.
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iv) identify different stages of malaria parasite species under the microscope.
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Instructions to Tutor
Describe the species of human parasites and the life cycle of malaria parasite in man and
mosquito. Discuss in detail the tissue phase in liver parenchyma cells, presence of hypnozoites in
7?t/iwxand Tow/eand the number ofmerozoites from cryptoschizont. Describe erythrocytic phase,
duration of schizogony in different species, the number of merozoites, formation of hemozoin
pigment, stippling in the host cell-, schizogony in Pfalciparitm, band forms in P.malariae and
gametogony with morphological description in different species &sex. Give details of sexual cycle,
the reasons for calling the female Anopheles mosquito as definitive host, formation of gametes,
zygote, ooldnete, oocyst, the release of sporozoites and the duration of sporogony in different species.
Describe microscopic differentiation of different species of malaria parasite. Give recapitulation of
life cycle through diagramatic presentation.
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Teaching Aids:-
Life cycle charts of different species. Microscopic demonstration of malaria parasites (different
species and stages) to be shown during exhibition.
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Transparencies on:
1.
Pictorial life cycle of malaria parasite.
2.
Exoerythrocytic tissue phase.
3.
Erythrocytic schizogony.
4.
Microscopic differentiation of malaria parasite species.
5.
Gametogony.
6.
Sporogony cycle.
7.
Diagramatic presentation of life cycle in man.
8.
Diagramatic presentation of life cycle in mosquito.
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MALARIA VECTORS - MOSQUITOES AND
THEIR BIONOMICS
Objectives :
i) define the vector.
ii) name different mosquito species of medical importance.
iii) know differences, important habits, distribution and sphere of influence of malaria vectors .
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iv) understand common breeding sites of mosquito vector.
v) how malaria is transmitted?
vi) learn life cycle of mosquitoes.
Instructions to Tutor
Enumerate vectors of malaria, filariasis, dengue, JE and other viral infections. Describe
place of mosquito in Class Insecta. Describe the body parts of the mosquito. Emphasise that
on\y Anopheles transmit malaria. Out of many species, only 9 vectors transmit malaria in India.
Name of the Vectors
Describe different characteristics of Anopheles, Aedes and Culex. Discuss all four stages of
mosquito. General bionomics of Indian vectors including their distribution, sphere of influence,
endemicity, transmission, sporozoite rate, larval habitats, resting places, biting time, feeding habits,
flight range and insecticide resistance should be discussed.
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Discuss in detail the vectors in the region and only broad outlines are to be mentioned regarding
the vectors which are not local.
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Teaching Aids
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Vectorial map - rural and urban
3.
Slides of mosquitoes - morphology indicating body parts
5.
Vector life cycle chart
2. Video cassettes
4. Vector morphology chart
Transparencies on :
1.
Bionomics of An.culicifacies
3.
5.
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9.
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An.philippinensis
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An.sundaicus
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An.annularis
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An. varuna
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Anjluviatilis
An.stephemi
An. minimus
An. dims
UNIT-4
JOB RESPONSIBILITIES OF MEDICAL OFFICER
PRIMARY HEALTH CENTRE
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UNDER NMEP
Objectives :
i) discuss job responsibilities pertaining to NMEP.
ii) interactXvith the Medical Officers about the bottlenecks in discharging job responsibilities
in the implementation of NMEP activities.
in) suggest remedial measures in overcoming the difficulties in the discharge of responsibilities
efficiently.
Instructions to Tutor
Panel Discussion
The Unit is to be discussed with the Medical Officers by three or four panel members from the
Distnct/Zonal/Regional/State/National experts available in the faculty. Each responsibility is to be
discussed thoroughly and remedial measures to be suggested, if any bottlenecks are expressed in the
discharge of responsibilties pertaining to NMEP activities.
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Transparencies on :
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Job responsibilities in Early Case Detection.
2.
Job responsibilities in Prompt Treatment.
3.
Job responsibilities on Insecticidal Spray.
4.
Job responsibilities on Referral Services.
5.
Job responsibilities on
pertaining to malaria.
miscellaneous activities like training of peripheral workers, etc.
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UNIT - 5
MALARIA: CLINICAL PICTURE 8c
DIFFERENTIAL DIAGNOSIS
Objectives:
i) diagnose a case of malaria clinically based on the sign and symptoms.
ii) suspect severe malaria and its complications.
iii) understand the necessity for early diagnosis and treatment of malaria especially in infants,
children and pregnant women.
iv)
differentiate cerebral malaria from other causes of coma.
v) order various investigations and interpret the results in malaria and its complications.
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Instructors to Tutor
Describe clinical presentation of classical malaria and other sign Sc symptoms. Salient features
of different species, suspected malaria fever cases and complications of Pfalciparum malaria are to
be discussed. Give details of differential diagnosis of cerebral malaria and the associated complica
tions. Describe clinical picture of Black Water Fever. The variations in sign Sc symptoms among
adults and children are to be enumerated. The common errors in diagnosis shall be highlighted.
Teaching Aids
Microscopic demonstration of different species and stages to be repeated on the second day of
training.
Tranparencies on:
1.
Clinical presentation of classical malaria.
2.
Other sign & symptoms.
3.
Salient features of malaria - Different species.
4.
Suspected malaria fever cases.
5.
Salient features of Pfalciparum malaria.
6.
Sign Sc symptoms of Pfalciparum malaria.
7.
Complications of Pfalciparum malaria.
8.
Differential diagnosis of cerebral malaria
9.
Complications of cerebral malaria.
10.
Black Water Fever.
11.
Sign Sc symptoms in adults and children.
12.
Errors in diagnosis .
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UNIT - 6
SUPERVISION OF LABORATORY SERVICES
Objectives:
i) realise the importance of accurate and prompt microscopic confirmation of malaria
diagnosis.
ii) judge the efficiency of laboratory technician.
iii) recognise the quality of staining of blood smear.
iv) assess the accuracy of microscopic diagnosis.
v) inspect the laboratory records and find out the accuracy of its maintenance.
vi) assess the epidemiological situation in the area.
vii) assess how passive agencies, FTDs, DDCs, and others are functioning.
viii) assess the efficiency of active case detection.
Instructions to Tutor
The importance of early microscopic examination of blood smears and prompt treatment of
all malaiia cases (EDPT ) should be emphasised. Discuss essential aspects of microscopy and need
for random checking of blood smears. I he timelag between the blood smear collection, staining,
examination of blood smears, despatch of results to the periphery and the administration of radical
treatment should be inspected by the Medical Officers from the records and the tutor shall highlight
the importance of EDPT for accelerating the Malaria Action Programme (MAP). Give salient
points in cross-checking the field activities from the relevant records and how the records & charts
are to be maintained up to date.
Transparencies on:
1.
Importance of microscopy vis-a-vis chemotherapy.
2.
Essential aspects of microscopy.
3.
Checking random samples of blood smears.
4.
Inspection of records - timelag.
5.
Cross-checking of field activities from records.
6.
Maintenance of records & charts at PHC.
I
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13
ANTIMALARIAL COMPOUNDS, THEIR USE IN NMEP AND
DRUG RESISTANCE
Objectives :
i)
ii)
iii)
iv)
chronological development of antimalarial compounds.
their action on pre-erythrocytic, asexual and sexual stages of parasite.
their mode of action.
their toxicity to human beings. .
v) the use of antimalarials in NMEP.
vi) drug resistance and its distribution in India.
Instructions to for Tutor
Describe the use of antimalarials as per classification as well as curative and preventive aspects.
Discuss the action of antimalarials and the factors influencing the efficacy. Give details of chemical
groups. Describe agewise dosage schedules for presumptive and radical treatment in high and low
risk areas and Chloroquine resistant P.falciparum areas. Discuss in detail the salient features of
important antimalarials including long acting sulpha group, Artemisinin, Mefloquine, Halofantrine,
etc. give details about chloroquine resistant foci in India and the Pf monitoring for liquidation of
resistant foci.
Transparencies on:
1.
2.
Objectives
3.
Use of antimalarials for treatment of malaria: curative Sc preventive.
4.
5.
Action of antimalarials.
6.
7.
Chemical groups.
Presumptive treatment in low risk areas.
8.
Presumptive treatment in high risk areas.
9.
Presumptive treatment in Pf resistant areas.
10.
11.
Radical treatment for Pvivtix 2nd Pmalariae.
12.
13.
14.
Use of antimalarials for treatment of malaria:prophylactic.
Factors influencing efficacy.
Radical treatment in /yresistant area.
Agewise dosage of sulpha combination.
Use of new antimalarials.
15.
Use of Mefloquine.
Chloroquine resistant foci in India.
16.
Chloroquine resistant Map of India.
14
or
UNIT - 8
DEVELOPMENT OE REFERRAL SYSTEM FOR
MALARIA UNDER THE PRIMARY HEALTH CARE
DELIVERY SYSTEM
I
Objectives :
i) need to develop a referral system for malaria.
ii) functions of different echelons of PI IC personnel in treatment of malaria
iii) the importance of developing
Hospitals.
liaison with CHC,
cases.
Sub-Divisional and District
iv) drugs and equipment required for treatment of serious malaria cases.
I
I
Instructions to Tutor
i
Give details about the important aspects in the diagnosis of malaria and essential requirements
needed in the referral centre. Discuss the role of peripheral workers in the identification of sign &c !
symptoms of malaria, serious complications and criteria for referral to PHC. List the essential i
facilities to be provided for referral in PHC. Describe the criteria for referral to district hospital and
the relevant records Sccase sheet to be sent along with the referral patient. Give referral links between
PHC and CHC/District Hospital/Taluk Hospital.
I
Transparencies on :
•
!
1.
Important aspects in diagnosis of malaria.
2.
Essential requirements in referral centre.
3.
Role of peripheral workers in the referral system.
4.
Criteria for referral to PHC.
5.
Essential facilities for referral in PHC.
6.
Criteria for referral to District and Records to be sent.
7.
Records to be sent along with the referred patient.
8.
Referral links between PI IC and CI IC/District Hospital /Taluk Hospital.
I
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15
i
t
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UNIT - 9
MALARIA - CASE MANAGEMENT & SPECIFIC
TREATMENT
Objectives :
i) specific treatment of malaria.
ii) treatment and management of complicated malaria.
iii) treatment of malaria in a) infants 8c children
b) pregnancy
*
iv) requirement for case management under specific situations encountered in complicated
cases of malaria.
Instructions to Tutor
Describe management of uncomplicated malaria caused by P.vivax, P. ma lariae 2nd Pfalciparum
and then complicated Pfalciparum malaria. Describe management of sign and symptoms such as
hyperpyrexia, dehydration, acute renal failure, oliguria, hyperkalaemia, hypokalaemia, pulmonary
oedema, gastrointestinal bleeding, jaundice deliver damage, shock, anaemia, hypoglycaemia, etc.
Discuss nursing care and laboratory follow-up. Give details of management of pregnant women,
treatment of infants 8c children. Case management Scdon’ts in the treatment shall be discussed in
detail. Chemoprophylaxis, its disadvantages and recommended dose shall also be covered in the
discussion.
Transparencies on :
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Management of uncomplicated malaria.
Management of complicated Pfalciparum malaria.
Management of hyperpyrexia and dehydration.
Management of acute renal failure and oliguria.
Management of hyperkalaemia, hypokalaemia and pulmonary oedema.
Management of gastrointestinal bleeding, jaundice and liver damage.
Management of shock, anaemia, PCV less than 20%. Fib less than 7 gm and hypoglycaemia
Nursing care.
Laboratory follow-up.
Management of pregnant women.
Treatment of infants 8c children.
Resume of common complications for management.
Don’ts in management.
Chemoprophylaxis.
UNIT - 10
INVESTIGATIONS INTO DEATH DUE TO MALARIA
Objectives :
i) investigations into death due to malaria.
ii) epidemiological significance of malaria deaths.
iii) how to avoid wrong classification of deaths which are likely to inflate the figure
Instructions to Tutor
Discuss in detail the epidemiological investigation on death due to malaria and the limitation
of time between death and investigation. The tutor should emphasise that P/alciparum only is the
direct cause of malaria deaths. Concomitant malaria infection in many seriously ill patients should
be looked into before concluding the cause of death. The investigatior should record the relevant
information such as the place of symptoms first noticed, medical history, statements from relatives,
medical 6c paramedical personnel, details of drugs administered, route of drug administration, !
chronological order of events. Postmortem report if available, time lag in the diagnosis and i
treatment, etc. 1 he sub-items of the proforma should be discussed thoroughly.
Transparecies on:
1.
Epidemiological investigation: Place of first sign & symptoms, place of death, time lag of !
investigation.
2.
Mortality due to P.f'alc'iparum : Pathological changes leading to death, concomitant infection, •
etc.
|
Investigation on death due to malaria: Case history antimalals 8cother drugs administered and
the route of administration.
3.
4.
Investigation : Details of sub-items in the proforma, particulars of physicians attended the case,
time lag in the diagnosis 8c treatment, remedial measures in the localities, etc.
-I
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17
UNIT - 11
STRENGTHENING OF SURVEILLANCE MECHANISM
MONITORING, ASSESSMENT AND EVALUATION
Objectives :
i) differentiate between monitoring, assessment and evaluation of a programme.
ii) identify various components of programme activities to be monitored.
iii) remember when and at what period of the year, each activity is given priority for
monitoring.
iv) draw logical conclusions during the p rocess of monitoring and formulate the remedial
actions to improve programme implementation.
Instructions to Tutor
Define the terms Monitoring, Assessment and Evaluation with explanatory note to distinguish
the terms. Give the salient aspects and follow-up action consequent to Monitoring by MO-PI IC.
Discuss different parameters used in the Monitoring. Describe the frequency of Assessment along
with parameters. Explain important points pertaining to Evaluation.
Transparencies on:
1.
Definition of Monitoring, Assessment and Evaluation.
2.
Important points pertaining to Monitoring by MO-PHC.
3.
Salient aspects of Monitoring and follow-up action consequent to Monitoring.
4.
Parameters in Monitoring.
5.
Salient points pertaining to Evaluation.
I
UNIT - 12
I
PLANNING OF INTERVENTION MEASURES FOR TRANS
MISSION CONTROL
Objectives :
i) about the preliminary information which is essential
measures.
for planning of intervention
ii) how to analyse the preliminary information and utilise the same while planning
intervention measures.
st
iii) various transmission control/intervention measures.
iv) how to plan residual insecticidal spraying.
v) how to supervise the spray operations.
Instructions to Tutor
r
Discuss the relevant information needed for planning control measures. Explain the investi-j
gations to be carried out both parasitological and entomological during transmission period.
Describe various transmission control measures and personal protection methods. Give exercises for!
selection of population for residual insecticidal spray with due priority to high risk areas as,
recommended by the Expert Committee on Malaria (1995). Discuss salient aspects pertaining to!
vector resistance vis-a-vis change of insecticide. Describe procurement of insecticide &o its distribu- '•
tion and explain how to calculate manpower required for the spray. Discuss the details of advance I
spray programme, its execution and supervision.
Teaching Aids
Keep the microscopic demonstration of different stages of malaria parasites on third day also.
Transparencies on :
1.
Information needed for planning control measures.
2.
Investigations to be carried out regarding transmission period.
3.
Transmission control measures.
4.
Selection of population for residual insecticidal spray.
5.
Insecticidal requirement.
6.
Vector resistance to insecticide & change of insecticide.
7.
Procurement & distribution of insecticide and manpower required for spray.
8.
Advance spray programme, spray execution and supervision.
19
!
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*1
UNIT - 13
INFORMATION, EDUCATION AND COMMUNICATION ON
MALARIA CONTROL
Objectives :
i) undeistand the importance of IEC for community co-operation and participation in the
successful implementation of Malaria Action Programme.
ii) create awareness and change the attitudes and practices among the members of the
community about the cause, prevention, early treatment and management of malaria
leading to the reduction in the mortality and morbidity.
in) create awareness and healthy practices about the drastic reduction in the frequency of
contact between man and mosquito by using personal prophylactic measures especially use
of impregnated bednets.
iv) create awareness and change the attitudes, practices and demand among masses regarding
various methods which will bring about reduction in the parasite load in the community
through early case detection and prompt treatment.
v) create awareness and healthy practices on the methods which can bring about reduction
in the mosquitogenic conditions through bio-environmental and chemical control
methods.
vi) create awareness about the importance and demand of achieving over 80 per cent coverage
of targeted rooms during every round of indoor residual insecticidal spray operations.
Instructions to Tutor
Describe the purpose, general objective and specific objectives of IEC.(The Operational
Manual on Malaria Action Programme may also be referred by the tutor on relevant aspects of IEC).
Discuss the strategy and media mix for effective implementation of IEC. The tutor may identify the
responsibility at Central, State and peripheral levels. The guidelines for observation ofMalariaWeek
at various levels with main activities especially at peripheral levels shall be discussed. Responsibility
ofMO-PHC in the implementation of IEC shall be emphasised in the lecture-discussion. Salient
points to be covered in IEC shall be listed by the tutor.
Transparencies on :
1.
2.
3.
4.
5.
6.
7.
Purpose and objectives of IEC.
Strategy and media mix.
Responsibilities of IEC at various levels.
Observation of‘Malaria Week’: Guidelines.
Malaria - Week - Main Activities.
Responsibility of MO-PHC.
Salient points to be covered in IEC .
20
a.
UNIT-14
EPIDEMIOLOGY OF MALARIA
Objectives :
i) distribution of malaria in terms of time, place and person.
ii) factors governing the endemicity of malaria.
iii) effect of environment on transmission of malaria.
|
iv) how different factors have.a bearing on malaria transmission and influence the planning
I
and evaluation of malaria control.
Instructions to Tutor
Classify the areas on the basis of spleen rate in children. Discuss in detail various epidemiolog
ical factors related to parasite species, gametocytes, incubation interval, seasonal variation in respect
of P.vivax^nA P.falciparum. environment, vectors, human host, genetic variation in the endemic
population and human immune mechanism.
Transparencies on :
1.
Endemicity classification as per WHO.
2.
Factors related to parasite species.
3.
Factors related to gametocytes.
4.
Incubation interval Sc seasonal variation.
5.
Environmental factors.
6.
Vectorial factors.
7.
Host factors.
8.
Genetic factors.
9.
Human immune mechanism.
i
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21
UNIT - 15
MONITORING OF EPIDEMIOLOGICAL AND
ENTOMOLOGICAL PARAMETERS
FOR ADVANCE ACTION AND FOLLOW-UP OF EPIDEMIC
Objectives :
i) advance action to prevent or liquidate the epidemic.
ii) follow-up to study the impact of remedial measures undertaken.
Instructions to Tutor
Explain the nature and cause of epidemics. Identify the role of MO/PHC and DMO in
monitoring epidemiological parameters for undertaking advance action. Explain with sufficient
examples and exercises on how to calculate each parameter and its epidemiological significance.The
epidemiological parameters to be covered in the lecture - discussion are i). ABER &.MBER ii). API
iii) . Afl iv). SPR v). SIR and vi). Pf%. Only the relevant aspects of entomological parameters such
as i) Hand collection method, ii) Pyrethrum spray collection iii) Human bait Schuman baited traps
iv) infection Sc infectivity rates are to be discussed.
Transparencies on :
1.
Nature and cause of epidemics.
2.
Role of MO-PI IC/DMO in monitoring and containment of epidemic.
3.
Epidemiological parameters : Efficacy Sc adequacy of surveillance.
4.
ABER/MBER: Calculation formula Sc significance.
5.
API and Afl: Calculation formula Sc epidemiological significance.
6.
SPR: Calculation formula and epidemiological significance.
7.
SfR and Pf%: Calculation formula and epidemiological significance.
8.
Entomological parameters: Correlation with epidemiological parameters.
9.
Adult vector density: Hand collection method: Method of calculation and significance.
10.
Pyrethrum spray collection: Significance.
11.
Man - Mosquito contact: Significance.
12.
Sporozoite rate: Method of calculation and significance.
22
UN IT-16
SELECTION OF HIGH RISK MALARIOUS AREAS
(SUBCENTRE-WISE) ON THE BASIS OF CRITERIA
DEVELOPED BY THE EXPERT COMMITTEE ON
MALARIA, 1995
1
♦
Objectives :
1.
compile data for identification of worst affected high risk’malarious areas in the PI IC
ii. list out the subcentres based on the criteria recommended by the Expert Committee on
Malaria (1995) by adopting prescribed methodology.
iii. highlight the subcentres requiring indoor residual spray on the basis of MPO guidelines.
Instructions to Tutor
The tutor may also refer the Operational Manual of Malaria Action Programme (MAP), 1995
besides consulting the detailed note, pertaining to the Unit. Only ‘I ligh Risk Rural’ areas are to be
identified as per the criteria laid down by the Expert Committee on Malaria - 1995.The tutor should
give at least one exercise for each criteria so that the participants will be able to identify the criteria
under which the subcentre could be classified as high risk area. The examples given in the Annex
should be discussed to make the participants familiar with the criteria.
Transparencies on :
I
1.
Identification of high risk areas as per criteria recommended by the Expert Committee on
Malaria - 1995.
2.
Methodology for selection of high risk areas.
3.
Table to be completed at PHC for selection of high risk subcentres.
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23
UNIT - 17
MANAGEMENT INFORMATION SYSTEM IN
MALARIA CONTROL
Objectives :
i) the importance of each form used in NMEP especially those to be maintained by the
peripheral health worker, PI IC laboratory and maintenance of registers, charts,
graphs, tables, etc. at PI IC.
ii) the timely submission of complete, accurate and relevant data to the concerned in the
prescribed forms.
I
iii) collection and interpretation of information to take corrective measures immediately.
Instructions to Tutor
Describe the purpose and flow of information pertaining to Malaria Action Programme.
Enumerate the charts and registers to be maintained at PHC. (The tutor may consult the
Operational Manual for Malaria Action Programme 1995 for differentcharts and registers to be kept
at PI IC). I he collection of data at subcentre level and the utilisation of information for monitoring
the programme at different levels should be covered in the Lecture-Discussion. Discuss different M E
forms including the new forms giving more emphasis to the forms to be maintained at Pl IC. Give
brief account of use of MIS at the Dte. of NMEP.
Transparencies on :
1.
Purpose and flow of information under MIS
2.
Charts and registers to be maintained at PI IC
3.
Data collection at subcentre and utilisation at different levels
4.
MIS in NMEP
5.
Use of MIS at the Directorate of NMEP
24
UNIT - 18
MALARIA EPIDEM1CS/F0CAL OUTBREAKSCONTROL AND FOLLOW-UP
|
Objectives :
: I?;
i) define the epidemic
•- - T »
ii) delineate the area affected with epidemic in his PI 1C
'•A‘
<1
iii) know various measures undertaken to control an epidemic
iv) plan and provide logistic support for epidemic control
• ■' f
v) participate in implementation of the remedial measures
; /;';s
vi) help in epidemiological investigation to ascertain the cause of epidemic
■■■ <
■ l!
Instructions to Tutor
Introduce technique of monitoring ofcpidemiological parameters. Define epidemic. Enumer
ate key factors responsible for epidemic, parasite load, vector bionomics, population dynamics,
environmental and climatological factors, go on to describe monitoring of malaria incidence, study
of trends, cross-checking of laboratory results to verify trends, delineate all affected areas by rapid
survey including lever survey, mass survey, keeping records of population involved. Measures for
liquidation of foci, antivector measures like space spray, residual spray, entomological investigations
necessary, follow-up action, detailed planning of epidemic control, analysis of results and reporting
to different authorities, role of Medical Officer, PHC, DMO and Mobile Unit. Under insecticide
discuss calculation of manpower and insecticide required. Show the four proformae given in the
Operational Manual on epidemics and discuss the need of each proforma.
I
I
Teaching Aids
1.
Definition and types of epidemics
2.
Key factors for monitoring, prediction and early case detection of malaria outbreaks
3.
Monitoring of malaria incidence
5.
Delineation of affected area through rapid and mass survey
6.
Estimation of population involved
4. Cross-check of laboratory results
a. Anti-vector measures b. Other measures c. Entomological investigation d. Duration of
epidemic control measures c. Follow-up action
8.
■'1
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Detailed planning of epidemic control measures
a. Manpower requirement b. Material requirement
d. Anti-vector measures
9.
I
7. Measures for liquidation of foci
Spray squads
e. Mass survey proforma
c. Proformae for recording field data
■i
ii
10. Reporting system
■
25
i
UNIT-19
INTEGRATED VECTOR CONTROL MEASURES WITH
FEASIBLE BIO-ENVIRONMENTAL CONTROL METHODS
IN HIGH RISK AREAS AND USE OF
IMPREGNATED BEDNETS
Objectives :
1. acquaint with different bio-environmental control methods
2. implement bio-environmental control methods wherever feasible through intersectoral
co-ordination
3. learn the technique of impregnating the bednet and highlight the benefits of impreg
nated bednets as a personal protection measure among the community members
Instructions to Tutor
Give introduction to the subjectbefore playing the video cassettes. Allow 15 minutes discussion
after playing video cassettes. The suitable bio-environmental control measures in different malaria
paradigms shall be discussed.
Teaching Aids
1.
Video cassettes on bio-environmental control methods
2.
Video cassettee on use of impregnated bednet
3.
Demonstration showing impregnation technique of bednet
26
UNIT - 20
lir
TRAINING OF PERIPHERAL STAFF BY
MEDICAL OFFICER OF PHC
%
a
Objectives :
i} the importance of training the peripheral staff under bis administrative control.
u) the method of conducting training course based on the job requirements of each
category.
1
irfe
in) the preparation/utilisation of proper training aids for each course curriculum.
SF
Instructions to Tutor
. ............................
<
i
; 'ii
coveicd in impai tmg trammg for efficient discharge of the role of worker in the Malaria Action
rogramme. A l the prerequisites needed for (he training centre should be discussed thoroughly and
le method of di awing calendar of activities for training should be covered. (The training curriculum
or each cadi e of peripheral worker will be supplied to MO-PHC before the actual training would
commence for grassroots level workers).
6
■
Transparencies on :
1.
Norms for establishment of FTD, DDC, VLW, MPW
and Microscopist as per size of
population
2.
Category of peripheral workers to be trained
3.
Salient points for designing training curriculum
4.
Essential components of training
27
~r."-
—
§
1
APPENDICES
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APPENDIX - 1
PRE-TEST PAPER
Name of the Participant:
Designation:
Address:................. :
1
Model Paper for Multiple Choice Questions (MCQ)
Tick (\Z) one choice only which is the nearest correct answer
1.
Why Pfalciparum peak usually appears 6 to 8 weeks after the peak of Pvivax?
(a) Due to delayed release of hypnozoites
(b) Due to shorter sporogony but very prolonged schizogony
(c) Due to longer sporogony and late gametogony
(d) Due to innate immunity developed by the human host.
2.
Which species of human malaria parasites do not possess hypnozoite stage in the
hepatocytes?
(a) Pvivax and P. falciparum
(b) P.falciparum and Pmalariae
(c) Pmalariae and P.ovale
(d) Povale and Pvivax
3.
What is the synonym of Ookinete?
(a) Zygote
(b) Microgamete
(c) Travelling vermicule
(d) Oocyst
28
. j
p4-
4.
Which type of area is classified as hyper endemic?
(a) Spleen rate in 2-9 years age group does not exceed 10%
(b) Spleen rate in 2-9 years age group is between 11 and 50%
5.
(c) Spleen rate in 2-9 years age group is between 51 and 75% and <25% in adults.
■’
(d) Spleen rate in 2-9 years age group is over 75% and low in adults.
wi
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w
Wi
S
What is die daily d'ose of 8 aminoquinoline for a
11 month old child having P.vivax
infection ?
(a) Nil
I
(b) 2.5 mg
"Sil
(c) 7.5 mg
(d)
15 mg
,?S3
6.
What is the ideal method for control of malaria in tropical aggregation of labour?
•xJ
(a) By employing the local population only
(b) By importation of labour from malaria free zones
•/'t/ ’S’.ffl
(c) ’By mass vaccination
i '’ I
(d) By screening and surveillance for detection and treatment of labourers and others living
in the area
5
7.
1
-
■s
■:
|
Which of the following is not contributed by construction activity?
(a) Creation of more breeding places
(b) Creation of high humidity increasing the longevity of vector
(c) Creation ofaggregation ofimmune and non-immune human population bringing different
strains of malaria parasite
(d) Promotion of very high immunity among the inhabitants resisting the infection
8.
J <d
■
;
•' ■n 6
■‘••J
How many spray squads are required to cover 5 lakhs population in a single round to
be completed in ten weeks as per NMEP norm?
(a) 44 squads
(b) 22 squads
(c) 11 squads
(d) 5 squads
29
1
‘
9.
How much is the requirement ofMalathion 25% wp to cover 10 houses each having an
average sprayable surface area of 150 sq.metres?
(a) 6 kg
(b) 12 kg
(c) 24 kg
(cl) 40 kg
10.
How many tablets of Chloroquine (150 mg. each)
are consumed for presumptive
treatment in population of 5 lakhs showing 20 per cent AB ER withi no backlog of blood
smears?
(a) 3 lakhs
(b) 4 lakhs
(c) 6 lakhs
(d) 10 lakhs
30
II Match the following
Ml
Species
No.of tissue inerozoites
(a)
P.vivax
30,000
(b) Pfalciparum
15,000
(c)
15,000
Pmalariae
(d) P. ovale
t
r
I
a
10,000
!
i
%
M2
Insecticide
Dose/sq.metre
(a)
2.0 gm
DDF
(b) HCH
0.02 to 0.025 gm
(c)
1.0 gm
Malathion
(d) Synthetic pyrethroids
M3
M4
¥'t
!
0.2 gm.
Vector
Infection
1.
Xenopsylla cheop is
(a) Dracun cuius medinensis
2.
Musca domesliea
(b) Dengue virus
3.
Mesocyclops leuckarti
(c) Yerseiiia pest is
4.
^ledes aegypci
(d) Salmonella paratyphi
■
Stippling
1.
P.vivax
(a) Zeinianns stippling
Pfa/ciparum
(b) Jarno’s stippling
3.
Pmalariae
(c) Maurers dots
4.
P ovale
(d) Schuffner’s dots
31
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Species
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M5
Species
Duration of pre-er ythrocytic cycle
1.
P.vivax
(a) 9 days
2.
Pfalciparum
(b) 14-16 days
3.
P malarias
(c) 8 days
4.
P. ovale
(d) SVi -6 days
True or false
1. I lyper density of gametocytes also causes fever .n vertebrate host.
True/false
2. Life cycle of malaria parasite in man is also known as Cycle of Ross
True/false
3. Pre-erytl irocytic cycle is absent in P.faldparum
Truc/false
4.
One female gamete is formed from one female gametocyte
True/false
5.
Anopheles vector is capacablc of transmitting malaria within a week after taking infective blood
meal
True/false
Expand the following
1
DDC
2
HCH
3
MPO
4
G6PD
5
JSB Stain
6
DDT
7
MLO
8
FTD
9
IPR
10
NMCP
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32
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P/5 3T4
LIBRARY
AND
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DOCUMENTATION
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Please identify die following human Plasmodia
ii
S.No.
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33
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Match the figures on the right side with the disease given on the left side
(as given for J.E.)
Plague
Typhoid
T6
Japanese
Encephalitis
w
Scabies
1f
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Malaria
/AX
Guineaworm
Disease
Kala-Azar
34
L ■
\
9.
Do you try to convince the fever cases to give blood smear if they refuse to co-operate with the
Mi’W?
10.
Does the drug distributor give all the doses of drug personally to all the malaria confirmed
cases?
11.
Do you or any other villager rush the complicated cases of suspected malaria to the nearest
clinic or hospital or PI IC for immediate treatment?
12.
Do you or any member of your family or neighbour go to faith healer for malaria treatment?
13.
if so, what type of advice do you render to such person?
14.
Do you receive advance notice of insecticidal spray?
15.
Do you get all the rooms of your house sprayed with insecticide?
16.
Do you get your house sprayed during every spray round?
17.
Do you know why the insecticide is sprayed in the houses?
18.
Do you advise members of the family to sleep indoors after insecticidal spray to avoid mosquito
biting?
19.
Do you keep utensils, food articles, drinkin g water and (odder protected from insecticidal
contamination when spray is undertaken?
20.
Do you ensure that the houses are not locked when spray squads visit y>'o u r I o c a 1 i ty fo r s p r a yin g ?
Name of the Investigator.
Designation
Address
36
<
EXERCISE-3. In a village having a population of 2000, two new malaria cases were recorded in
December 1994. The progressive total cases recorded in the preceding month were 8 during the same
year. Six cases were treated and cured , while the remaining cases persisted with infection.
(a) What was the incidence in December?
(b) What was the API for 1994?
(c) What was the point prevalence in December?
EXERCISE-4.
In one of the Pl ICs the agewise break-up of malaria cases was as follows:
Age Group
No. of
malaria cases
% of
total
No.
examined
Positive
Rate (%)
< 1 year
10
0.5
1092
0.9
1-4 Years
425
22.0
6188
6.9
5-14 Years
450
23.3
7644
5.9
> 14 years
10 18
54.2
21476
4.9
dotal
1933
100.0
36400
5.3
I
|-
(a)
Which age group had the highest-percentage of cases?
(b)
Which age group was at the greatest risk of contracting malaria?
(c)
Why the above two answers are different?
EXERCISE-5.
In a forest fringe village in Keonjhar district of Orissa the incidence of malaria among villagers
who frequent the forest was 12/1000 persons while the same among the villagers who do not go into
the forest was 3/1000 persons.
(a)
Find the relative risk of malaria among villagers frequenting forest?
(b)
Interpret your findings in words.
(c)
Calculate the risk difference between the above two groups
(d)
Interpret your findings in words.
38
I
EXERCISE-6.
1
In a PI IC having 30,000 population, 4320 fever cases were blood filmed. 1 he microscopic
examinauon revealed 180 malaria cases and 108 of them were P.fa/ciparun, inaction. Dmang the
!
I
year 45 people died due to confirmed deaths due to malaria out of total 300 deaths in the vil age
(a) Find ABER, SPR, SfR, API, Afl and Pf %
4
1
1
(b) What was malaria case fatality rate?
(c) What was crude death rate?
i.
(d) What was malaria mortality rate?
?
EXERCISE-7.
In a spleen
survey conducted on 2-9 years age group of 200 children the results were as follows:
1
No.of various classes found
92
63
32
7
4
2
Classes of Spleen.
0 (not palpable)
1
2
3
4
5
Total =
!
|
200
(a)
What was the spleen rate and Average Enlarged Spleen index?
(b)
If in the above village the spleen rate among adults was 26%, bow do you classify the degree
■
t
i
of endemicity of malaria?
EXERCISE-8. In a village there
metres for a human dwelling.
are 200 human dwellings. The average sprayable area is 150 sq
.•n*:
’I
What will be the requirement of:-
I
1. DDT 50% wp
S
2. BIIC 50% wp
£
if
3. Malathion 25% wp
4. Synthetic pyrethroid 2.5 % wp
5. Synthetic pyrethroid 10% wp
(The dosage for synthetic pyrethroid 2.5% wp is 20 mg/per sq.metre and for 10% wp is 25 mg/
sq.metre).
39
I
APPENDIX-4
POST-TEST PAPER
Name of the Participant:
Designation:
Address:................. :
i
.1
Model Paper for Multiple Choice Questions (MCQ)
Tick (^/) one choice only which is the nearest correct answer
1.
Which of the following do not generally constitute severe manifestation and complica
tion of malignant malaria?
(a) I lyperpyrexia 8c Cerebral involvement
(b) Renal dysfunction, I lacmoglobinuria 8c jaundice
(c) Lymphangitis 8c Lymphadenitis
(d) Pulmonary oedema 8c I lypoglycaemia
2.
How much will be SPR when ABER is 10% and API is 2.6?
(a) 1.3%
(b) 2.0%
(c) 2.6%
(cl) 5.2%
3.
Why Pvivax peak usually appears 6 to 8 weeks earlier to Pfalcip.arum peak?
(a) Due to quick release of hypnozoites
(b) Due to shorter sporogony and early gametogony
(c) Due to predilection for younger RBC
(d) Due to absence of early immunity
40
4.
Which of the following species of human malaria parasite possess hypnozoite stage in
the hepatocytes?
J
I
(a) Pvivtix and P./ii/i i/uinun
(b) Pmn/iiriae and Povii/e
i
(e) 1’viviix and P.ova/e
(d) P.iniilariiic and P. vivnx
■ I
5.
-1
Which type of area is classified as rncso-cndemic?
I
J
CO Spleen rate in 2-9 years age group does not exceed 10%
(b) Spleen rate in 2-9 years age group is between 51 and 75% and <25% iin adults
(c) Spleen rate in 2-9 years age group is over 75% and low in adults
■
(d) Spleen rate in 2-9 years age group is between 1 1 and 50%
6.
1i
Why mosquito is a definitive host in respect of malaria parasite?
(a) It transmits infection from man to man
d
(b) The parasite propagates sexually in the mosquito
II
(c) 'flic development of parasite takes place in 10-14 days
(d) A large number of vector mosquitoes can become infective from a single vertebrate carrier
7.
II
■ I
Erythrocyte schizogony of the P.falciparum usually takes place
I
f
I
(a) in peripheral circulation
(b) in pleural cavity
(e) in peritoneal fluid
I
(d) in capillaries of internal organs
8.
I
Band forms of trophozoites are found in
A
’ £
(a) Pvivtix
(b) Pja/iiparmn
(c) Pma/ii riae
i
(d) P.ova/e
41
"r1.
I
9.
What is the requirement of malathion 25% wp for a population of1,00,000 for one round?
(a) 15 m.tons
(b) 30 m.tons
(c) 112 in.tons
(d) 300 m.tons
10.
How many approximate no.. of tablets of Chloroquine (each 150 mg base) are required
for presumptive treatment in ai population of one lakh showing 10% ABER with no
backlog of blood smears?
(a) 10,000 Tablets
(b) 20,000 Tablets
(c) 30,000 Tablets
(d) 1,00,000 Tabs
True or False
1.
Cattle sheds are not to be sprayed as per the revised Operational Guidelines (1995) of NMEP
True or False
2.
Life cycle of malaria parasite in man is called “Cy cle of Golgi”
True or False
3.
Hyper density of gametocytes causes irregular fever in Pfalciparum
4.
True or False
Malaria and Filaria are the only human parasitic infections transmitted by the mosquitoes in
the world
True or False
5.
Mixed infection means all asexual stages are present in the peripheral blood
6.
Natural light from north direction is ideal for microscopic examination
smear
True or False
True or False
7.
Exflagellation takes pl ace in respect of macrogametocyte
True or False
8.
Infants and Pregnant women are not to be administered Primaquine
True or False
*2
IT
Expand the following
1
MAP
2
VLW
3
NMCP
4
AB PR
5
IPR
6
R 111
7
BIIC
8
pmi-id
• t
I
I
■<
1
I1
PSC (vector density parameter)
9
10
UL>T
i
I
11 - Match the Following
M.I.
■i.
Species
(i)
72 hours
(ii)
50 hours
(hi)
48 hours
(iv)
48 hours
I
(a) P.vivax
(b) PfcP('^rum
i
I
(c) P.malariae
(d) P ovale
M.n
I
a
I
le no. of
Approximate
in erj^hrocytic^chizont
merozoites i
Species
I
(i) 8
(a) Pvivax
(b) P.fnlcipartun
(c) P.malariae
A
(h)
8
(hi)
16
•A
J
(iv) 24
(cl) P. ovale___________ —
M.in
Tnsecticidc/larvicide
__
(a) DLHVDelttunethiin
(b) MLO/Temephos
(c) BHC/Malathion
(d) Pyrethrum (space spray)
No. of spray rounds____________ __ —
whenever malaria +ve case is detected
C>)
(h)
(hi)
.5
.•
Three rounds a year
Two rounds a year
(iv) Weekly
43
I
M.IV.
M.V.
Landmark
Discoverer
(a) Extrinsic cycle
(i)
(bj P.nid/ariae
(ii) Jasvvant Singh Sc Bhattacharjce
(c) P.fakipariun
(iii)
Sir Ronald Ross
I
(d) Malaria Stain
(iv)
Laveron
♦
Stage
Stephens
Habitat
(a) Hypnozoites
(i)
Capillaries of bone marrow
(b) Sporozoites
(ii)
Hepatocytes
(c) Trophozoites
(iii)
Salivary glands
(d) Immature Pf gametocytes
(iv)
Erythrocytes
44
Please identify the following human Plasmodia
■'■' I
.■ 1
S.No.
t
I
►
i
1
• 4
I
£}
$
■ • Ii
1J
I
I
£
i.t
3
A
i
■I
Ij
■I
tj
■
II
I
9
10
i
45
s
Match the figures on the right side with the disease given on the left side,.
(as given for J. E.)
Plague
♦
Typhoid
Japanese
Encephalitis
Wl
Scabies
1
Malaria
Guincaworin
Disease
Kala-Azar
46
i
\
APPENDIX-5
PROFORMA FOR EVALUATION BY PARTICIPANTS
(Anonymous)
■
■i
■«
Q_l. Do you consider the training workshop useful?
Q_2. Which aspects of the training need more emphasis?
.
•4■ f
•
i.
’(
Q.3. Whether the duration of training is adequate? If not, kindly suggest required duration with
reasons.
CM. What level of officers do you recommend for similar training course in future?
I
II
i
Q_5. Is the material supplied in the training sufficient? If not, kindly suggest what other material is to be supplied ?
QjS. Would you be able to implement the new action plan in your area without hurdles. If not, kindly
give the reasons and remedial measures ?
Q_7- Would you suggest ca psule courses for peripheral workers involved in NMEP ?
. II
I•1
I
I
■I
I
I
Q_B. Any other suggestions & remarks.
7
47
1
APPENDIX-6
Time
T
Activity
Faculty
I Day
09.00-10.00
Registration
10.00-10.30
Inaugural Function
i.
Introduction of Participants & Faculty
ii.
Welcome Address - Local Health Authorit
iii.
Objectives of'Praining - Course Director
iv.
Key Note Address - Chief Guest
V.
Vote of 1 hanks - Local Organiser
y
10.30-11.00
Inaugural Tea
11.00-11.30
Exhibition: should include the following:i.
Charts on life cycle of MVIAnopheles. Maps, Graphs,
tables & Photographs depicting epidemiology & control
aspects of malaria. Posters on environmental sanitation,
llsC.1 ictorial exhibition of the malariogenic situations in
the State. Pables/Graphs of malaria incidence in different
years/months & trend in the the State and District. Map
of problem Districts & PI ICs. P'l'Ds, DDCs.
ii.
Live demonstration of mosquito stages. Pinned malaria
vectors in the region focussed under simple microscope.
48
: ■ h
iii.
Microscopic demonstration of malaria parasite
iv.
Spray equipment 6c other control measures - Bio-cnvironmental and chemical. Efficacy of larvicides.
v.
Personal prophylactic measures - Models on impregnated
bednets, mosquito proofing of house.
11.30-12.00
Pre-test
s
Lecture-Discussion
12.00-13.00
Unit 1.
13.00-14.00
I
-
1
Introduction to Malaria problem in India
Lunch
Lecture-Discussion
14.00-15.00
15.00-16.00
Malaria problem in the State; problem Districts
PI ICs -State Faculty
Unit 2.
Lecture-Discussion
}
Life cycle, transmission and morphology of human malarial
parasite
[i
1
Lecture-Discussion
i
16.00-17.30
Unit.3
Malaria vectors - mosquitoes and their bionomics
II Day
£
10.00-11.00
Panel Discussion
Unit.4
11.00-12.30
Job Responsibilities of MO-PI IC tinder NMEP
i:
Lecture-Discussion
’T
Unit 5.
Malaria: Clinical Picture 6c Differential Diagnosis
12.30-13.00
Unit 6.
Supervision of Laboratory Services
13.00-14.00
Lunch
14.00-15.30
Lecture-Discussion
Unit?.
Antimalarial Compounds, their use in NMEP and
Drug Resistance.
f
49
I
i
I
15.30-17.00
I
I
Lecture-Discussion
Unit 8.
Development of referral system for malaria under PI IC
delivery system;
Lecture-Discussion
Unit 9.
Malaria: Case Management &. Specific Treatment.
Lecture-Discussion
Unit 10.
’I
17.00-17.30
Investigations into death due to malaria.
Lecture-Discussion
Unit 11.
Strengthening of Surveillance, Monitoring, Assessment and
Evaluation
Ill-Day
10.00-11.00
Lecture-Discussion
Unit 12.
11.00-11.^15
Planning of intervention measures for transmission control
Lecture-Discussion
Unit 13.
11.45-13.00
Information, Education and Communication on malaria
control
Lecture-Discussion
Unit 14.
Epidemiology of malaria
Lecture- Discussion
Unit.15.
Monitoring of Epidemiological and Entomological param
eters for advance action and follow-up of Epidemic.
13.00-14.00
Lunch
14.00-15.00
Lecture-Discussion
Unit 16.
15.00-16.00
I .ecture-Discussion
Unit 17.
16.00-17.00
Management Information System in malaria control
Lecture-Discussion
Unit 18.
17.00-17.30
Selection of high risk malarious areas (subcentrc-wise) on the
basis of criteria developed by the Expert Committee on
Malaria, 1995.
Malaria cpidemics/focal outbreaks - Control and follow-up.
Briefing to participants on field visit.
50
IV Day
09.00-13.00
Field visit to a PI IC
The following aspects will be covered in the field visit
through practical demonstration&discussions
Active case detection
i.
Domiciliary visits Sc wall stencilling
ii.
Fever survey Sc collection of blood slides
iii.
Recording 8c method of despatching the blood smears
iv.
Presumptive 8c Radical treatment
2.
Passive case detection
i.
Malaria clinics 8c their function
ii.
Dispensaries 8c Private practitioners of allopathic &
indigenous system of medicine
iii.
Functioning of DDCs 8c FTDs
iv.
Exchange of information with “ Voluntary Link Worker".
4.
IEC for community participation
i.
Community role in the successful indoor residual spray Discussion with opinion leaders and householders. Reasons
for refusal of spray, if any.
ii.
Personal prophylactic measures, prevention ofperi-domestic
8c domestic mosquito breeding; anti-larval measures in se
lected situations.
i-
.i
i
II
in.
Visits to school Scpanchayat for creating awareness of antimalaria activities
iv.
KAP study on a predesigned proforma
13.00-14.00
14.00-18.00
I
1.
'•
i;
A
Lunch
5.
Demonstration of indoor residual spray
i.
Calculation of population for spray and seasonal spray staff.
ii.
Formulation of suspension of adulticides and larvicides.
m.
Spray equipment
measurement of nozzle discharge rate.
Demonstration of technique for indoor residual spray, indoor
pyrethrum space spray and larvicide spray. Calculation of
dose of active ingredients.
51
I
---- -----------
iv.
1 recautions to be observed duri
'
~ handling
'
nng spraying,
safe
and storage of insecticides.
6.
Laboratory Demonstration
i.
Practical demonstration of processing of fever survey blood
smears collected in the field visit and staining with JSB
1
*
T
*
ii.
Sample examination of blood smears.
iii.
Maintenance of Lab. equipments.
iv.
Maintenance of lab. records. •
V.
Supervision of lab. services including time lag between
blood smear collection & radical treatment.
vi.
Demonstration of malaria parasite & mosquito.
7.
Evaluation of anti-malaria activities
i.
Up to-date maintenance of relevant fo
rms, records, charts,
graphs, maps, etc., in the PI IC.
ii.
Visit to PI IC stores for the maintenance of logistics and
storage procedure.
iii.
Analysis of reports with malariometric indices.
iv.
Discussion points for presentation of field reports
♦
VDay
10.00-11.00
Lecture Discussion & Video Fil m shows
Integrated vector control imeasures with feasible bio-environmental control methods iin high risk areas (Video Film
show).
Unit 19.
Use of impregnated bednets. (Video Film show)
11.00-12.00
Review of important aspects of all the topics.
12.00-13.00
Lecture - Discussion
>
Unit 20.
Training of peripheral staff by MO-PI IC
13.00-14.00
Lunch
14.00-16.00
Practical Exercise
Epidemiological Sc Skill learning exercises
52
4
•>
t
t
16.00-16.30
Post-test
16.30-17.00
Evaluation of training by participants
17.00-17.30
Concluding Session
i.
Distribution of certificates by the Chief Guest
ii.
Remarks by the Chief Guest
iii.
Remarks by Participants.
iv.
Remarks by the Regional/State Training Co-ordinators
v.
Vote of thanks by Chief Local Organiser.
h
I
5
53
<
Position: 1800 (3 views)