The National Institute of Malaria Research and the National Vector Borne Disease Control Programme (NVBDCP), Odisha, with technical and financial support from MMV, are implementing the Comprehensive Case Management Programme (CCMP) in four districts of Odisha, across four different transmission settings. The goal is to ensure universal access to timely diagnosis, treatment and radical cure1 at the community level, and assess its impact on malaria transmission.
In each district, there is an intervention and control “block”, each comprising 100,000–150,000 people. In all the blocks, Accredited Social Health Activists (ASHAs) work at the community level to diagnose malaria, including Plasmodium vivax, with the recent introduction of bivalent rapid diagnostic tests (RDTs), and treat patients in line with national guidelines. In the intervention blocks, the uninterrupted supply of RDTs and antimalarials is assured along with supportive supervision of ASHAs.
Dr Madan Mohan Pradhan, Deputy Director Health Services, NVBDCP, Ministry of Health & Family Welfare, Odisha tells us more about this programme.
1. What excites you about CCMP?
CCMP allows us to reattribute patient data from outpatient clinics in towns to the village where a patient lives. This means that we can identify high burden areas and really focus our resources accordingly. For example, the microscopist in Hindol block realized that more cases were coming from a certain area, which led us to conduct a mass survey, and detect and treat a large reservoir of asymptomatic carriers. We believe this averted a malaria outbreak. It’s also exciting to see that everyone involved in the CCMP programme is really dedicated and committed to its success. The ASHAs are improving their ability to diagnose and treat malaria correctly, which means more patients are getting the right medicine.
2. What challenges have you faced during the roll-out of the programme and how have you overcome them?
Poor access, stock-outs and inconsistent quality of service were the main challenges. To overcome them, we revised the quantification system, created buffer-stocks, retrained the ASHAs, provided supportive supervision and are now also identifying alternative providers in remote areas. It’s been a substantial undertaking. Another challenge is to identify patients with G6PD deficiency.2 The national guidelines stipulate that all G6PD “normal” patients with P. vivax malaria should be treated with primaquine. But we don’t have a way to diagnose G6PD deficiency. ASHAs have been trained to inform patients of the signs of haemolysis and, that should they experience them, they must discontinue treatment and return to the health facility.
3. How will the data collected be used to further reduce malaria transmission?
By 2015, we will have a clearer picture of transmission; we will have identified areas with pockets of high transmission and will also have a clearer view of asymptomatic and imported cases. As we say in these parts, “malaria is local and focal”, but often in a big programme we end up taking an umbrella approach. With the CCMP data, we will be able to adapt our control measures accordingly and optimally.
1 Radical cure of P. vivax malaria involves eliminating hypnozoites (dormant liver-stage parasites) to prevent relapses.
2 Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited abnormality that causes the loss of a red blood cell enzyme. People who are G6PD deficient can suffer from serious adverse effects from the antimalarial drug primaquine.