SCOPE OF WORK TO BE PERFORMED WHEN A PATIENT IS DIAGNOSED WITH MALARIA INFECTION
1. Before the treatment of malaria positive patients, identification of the species of Plasmodium, either by examination of blood smears for malaria parasites or by RDT test for malaria antigens should be done.
2. Before initiation of treatment Blood should be collected from all the malaria positive (confirmed either by blood smear or RDT test) patients for bar-coding and for genotyping of the parasite species causing infection.
3. However, in situations where malaria treatment has been started or already completed without conducting the above measures, the confirmation or exclusion of the diagnosis of malaria infection should be performed through the detection of malaria antibodies in peripheral blood.
4. In all clinically suspected malaria patients who were not investigated prior to initiation of anti malaria treatment, a specimen of venous blood should be collected to determine the presence or absence of malaria antibodies.
This test should be done before, during the course, or within 4 weeks after the
completion of anti malaria treatment.
5. Collection (into tubes), storage and transportation of all the blood specimens for examination should be done within the given time period according to the guidelines provided by the AMC .
6. Since the diagnosis and effectiveness of treatment is assessed by further examinations, all positive (blood smears and RDT kits) and 10% of the negative blood smears & 10% of the negative RDT test kits should be stored appropriately and sent to the AMC headquarters.
7. Treat the malaria positive patient according to the guidelines issued by the Department of Health (General Circular No. 01-14/2008 issued by the Director General of Health Services). Please note that as per the above circular it is mandatory to treat all Plasmodium falciparum infected patients as inward patients.
8. The medical institution where the patient is diagnosed should notify the area RMO immediately after diagnosis, preferably via telephone (RMO Location and Contacts).
9. The area RMO should take the responsibility of the case investigation.
10. Other relevant RMO/ MOHs - (where the patient stayed or visited in past two weeks and where the patient is staying during and up to 4 weeks after treatment) should also be notified by the area RMO as early as possible, at least within 48 hours.
11. All malaria patients should be investigated by the staff attached to the respective RMO and MOH offices where the patient stayed or visited in past two weeks.
12. In the follow up field visits ensure the completion of taking Primaquine treatment within the prescribed period by patients who had Plasmodium vivax malaria.
13. This should be done by assessing the number of tablets remaining with the patient and number of days left for the completion of the full course of Primaquine treatment prescribed to the patient.
14. RMO should ensure that a minimum of three doses of Primaquine are administered under direct observation during case investigation/ follow up visits.
15. Repeated examination of blood smears should be done on Day- 7, 14, 21 & 28 for Plasmodium vivax and on Day- 2,3,7,14,21 & 28 for Plasmodium falciparum infected patients to asses the efficacy of treatment, to confirm the absence of parasitaemia after completion of treatment and to ensure 100% compliance to the treatment.
16. In case investigation screening for malaria parasites through the examination of blood smears or malaria antigen by RDT in all household contacts and neighbourhood residents living in approximately one kilometre radius and, spraying of insecticides (Focal indoor residual spraying- IRS) on all the surfaces inside the house and all the dwellings in approximately one kilometre radius from where the patient had been staying in the past fortnight prior to diagnosis should be completed within two weeks of diagnosis.
17. Entomological investigations and necessary vector control activities in the area should be completed within two weeks of the diagnosis of the case.
18. Education of the people regarding the natural history of malaria transmission and the things they should do to protect themselves from malaria infection should be carried out.
19. Formats regarding case investigations should be filled by and sent to the Anti Malaria Campaign Headquarters by the relevant Regional Malaria Officer/Officers within two weeks of completion of treatment.