Vishnu M S

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Malaria Surveillance
Baseball and malaria keep coming back Gene Mauch.

What is surveillance?
Continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill-health

Steps in surveillance:

Types of surveillance
Depending on the method of data collection Active surveillance there is an active search for cases eg: house to house surveys. Passive surveillance data collection by public health agencies from the patients who come to them. eg: national notifiable disease surveillance system Sentinel surveillance can be active or passive.

Malaria surveillance
National Malaria Control Programme(1953) National Malaria Eradication Programme(1958)

According to the Modified plan of operation (1977), the endemic areas were divided into two.

With API <2

With API >2

Surveillance is carried out in both areas.

Objectives:
Maintenance of an ongoing watch over the status of malaria in a group/community. Detect changes in trends/distribution in malaria in order to initiate investigative/control measures. It is a basis for measuring the effectiveness of anti malaria programme.

Ultimate objective - Prevention & control of malaria in the community

Two types of malaria surveillance

Active
Passive

Aim of malaria surveillance:

1. Case detection timely collection and examination of blood smears Providing facilities for proper treatment

2.

Active Surveillance & Surveillance worker

The key player in active surveillance is the local surveillance worker or a MPW
Surveillance inspector

Surveillance worker

Surveillance worker

Surveillance worker

Surveillance worker

2000 houses

2000 houses

2000 houses

2000 houses

Rationale of fortnightly visits by surveillance worker

Technical justification for a fortnightly blood smear collection is based on transmission dynamics of malaria. Incubation interval denotes the duration of the full cycle of malaria parasite. It is the sum of the time taken for the development of the parasite in the mosquito and that in the human being. The incubation interval in case of P.vivax is approximately 22 days while for P.falciparum it is 35 days. Thus, surveillance cycle of less than one incubation interval will catch most of the secondary cases before the commencement of next cycle.

Active Surveillance
Surveillance worker/MPW : fortnightly visit to house

Enquiry: WAS/IS there a fever case?

YES Presumptive Rx Thick+Thin smear collection Dispatch slides to unit lab Slide positive Returns to patient A course of radical Rx

(Single dose of Chloroquin)

House card entry

Passive Surveillance
Cases of fever which escape active surveillance are screened by passive surveillance
Patients with fever or H/o recent fever Local health agencies (PHC,Subcentres,Hospitals,Dispensaries,Physicians) Blood smears Presumptive Rx

Slides collected by surveillance worker Sent to unit lab Positive Radical Rx

Parameters Of Malaria Surveillance

Annual Blood Examination Rate (ABER)
Annual Parasite Incidence (API)

Annual Falciparum Incidence (AFI)

Slide Positivity Rate (SPR)

Slide Falciparum Rate (SFR)

API and ABER

API = Confirmed cases during one year x 1000

Population under surveillance

Measure of malaria incidence in a community Depends on ABER.

ABER = No. of blood smears examined in a year x100 Population covered under surveillance Reflects the efficiency & adequacy of case detection mechanism. A minimum ABER of 10% of the population/year was fixed under MPO.

10th Five Year Plan

ABER over 10% API 1.3 OR less 25% reduction in morbidity & mortality due to malaria by 2007 & 50% by 2010