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.

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

3

Sl no Table of contents Page number

1 Introduction 4

2 Malaria Surveillance 5

2.1 Disease Surveillance 5

2.2 Components of Malaria Surveillance 5

2.3 Types of Malaria Surveillance 5-6

2.4 Why Sentinel Surveillance for Malaria is necessary? 6

2.5 Norms for establishing Malaria Sentinel Surveillance sites 6

3 Malaria Sentinel Surveillance Sites 7

3.1 Manpower requirements at a Malaria Sentinel Surveillance Site 7

3.2 Laboratory facilities available at the Malaria Sentinel Surveillance site 7

3.3 Functioning of the Malaria Sentinel Surveillance Site 8

3.3.1 Flow Diagram 9

3.4 Documentation to be carried out at the Malaria Sentinel Surveillance site 10

3.5 Standard Operating Procedure for onward transmission of reports 11

4 Epidemiological Indicators 12

5 Roles and Responsibilities of Malaria Sentinel Site personnel 13

5.1 Sentinel Site Medical Officer (SSMO) 13

5.2 Sentinel Site Malaria Technician cum Coordinator (SSMTC) 13-14

6 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

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 - 2010 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.

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.

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

3. Malaria Sentinel Surveillance Sites (MSSS)

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

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.

8

3.3 Functioning of the Malaria Sentinel Surveillance Site

Category Nature of work Person responsible Transportation of Blood

Slides

Transmission of results and

reports

Blood test by

Microscopy and

RDT

BS collection from OPD/IPD during

the routine hrs in the morning

SSMTC/Staff Nurse/any person

identified by the technical

committee

BS: SSMTC and support staff of

SSL/ ward/any person identified by

the technical committee

SSMTC/ SSMO/Staff Nurse/ any other

person identified by the technical

committee to treating physician

RDT and BS collection during

emergency hrs and in absence of

SSLT

Staff Nurse/ Pharmacist/ pathology

LT working in shifts / any person

identified by the Technical

Committee during emergency hrs

SSMTC / support staff or ward

attendant identified by the

Technical committee on the

following day

Staff Nurse /Pharmacist/ any person

identified by the technical committee to

the treating physician

Recording in malaria registers at

OPD/ Causality/IPD(Med, Paed,

O&G ward)

Staff Nurse/Pharmacist/ any person

identified by Tech. Committee

SSLT to record the abstracts from

OPD and IPD registers in SSLR(

Master Register)

SSMTC to update the abstracts from

OPD and IPD registers of the suspected

cases of malaria who have undergone

RDT/BS

Filling of Case record forms of

positive cases , deaths and maintain

SSLR

SSMTC with help of Abstracts

from OPD/IPD registers or Staff

Nurse/Pharmacist/ any other

person identified by Tech.

Committee

SSMTC

SSMTC

BS examination at SSL and

maintenance of records and report

generation

SSMTC SSMTC SSMTC

Report transmission to concerned

officers and State HQrs

SSMTC

SSMTC Convener of the Technical committee

Sentinel Site SSMTC /

DEO/VBDC/DMO

Documentation Maintenance of Sentinel site Malaria

Laboratory Register

SSMTC

Maintenance of Sentinel site Malaria

register at wards(O&G, Med, Paed),

Casualty and OPD

Staff Nurse/Pharmacist/ any person

identified by the Tech. committee

Recording of abstracts by SSMTC Recording of abstracts by SSLT in the

SSLR

Filling of Case record forms of all

confirmed Malaria cases & deaths

by RDT(Govt. Supply)/BSE

SSMTC/ any other person

identified by the Tech. Committee

in case SSMTC is absent or on

leave

SSMTC SSMTC

SSMTC SSMTC/DEO/VBDC

In absence of DEO – Outsourcing

of data entry may be done as per

guidelines

By E-mail and hard copy by post

( First fortnight report by 20th and

second fortnight report by 5th of

each consecutive month)

Convener of the Technical committee

assisted by SSMTC /

DEO/VBDC/DMO

District compilation by DMO assisted

by VBDC

Support staff Assisting the SSMTC in collection of

BS and abstracts from different

nodal points(OPD/IPD/Casualty)

Ward attendant/ support staff of

SSL/or any other person identified

by the Tech. committee

9

3.3.1 Flow diagram for transmission of Blood slides to Sentinel Site Surveillance Sites for Malaria

3.3.2 Flow diagram for Documentation and Report generation at the Sentinel Site Laboratory for Malaria

Sentinel Site Laboratory for Malaria

Out Patient Department Wards (OG, Med, Paed) Casualty or Emergency

Sentinel site Malaria Registers (OPD or Pathology Lab

at CHC/SDH/DHH) A. First Fortnight Report

Report Report

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

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.

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 Convener of the Technical committee and DMO

Analysis Convener of Technical committee and DMO

Interpretation SSMO and DMO

Feedback Technical Committee members and concern Officers

who need to take action.

Action CHC MO I/C, DMO, CDMO, VBDC and other

programme officers

Note:

i) Reports will be disseminated to the next higher level by 5th

and 20th

of each month.

ii) Feedback from the higher level will reach the district by 20th

of each month.

iii) Quality assurance will be done for laboratories as per guidelines of NVBDCP

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

Self evident 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

Record room

register/SSLR

3. Total number of in patients

admitted as suspected malaria

during the fortnight

Total number Clinically suspected

malaria out of the total number of in

patients admitted to Sentinel site

hospitals

Age, Gender wise, PW,

Village/Ward, SC and Block wise

Record

room/SSLR

4. Total no. of inpatients

diagnosed as severe malaria (

as per standard case definition

of severe malaria)

Total number in patients diagnosed as

severe malaria out of the total number of

in patients admitted to Sentinel site

hospitals

Age, Gender, PW ,village/ward/ SC

and Block wise

Record

room/SSLR

5. % OPD cases attributed to

malaria

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

Age(<1 yr,1-4 yr,5-14 yr,>15yr),

Gender wise, PW,

Suspected/Confirmed, Species

specific(PV /Pf/

Mixed),village/Ward/SC/Block

Record

room/SSLR

6. % Inpatients attributed to

Suspected malaria

Total no. of inpatients admitted as

suspected Malaria during a specified

period /Total number of Indoor

admissions during the same period X

100

Age(<1,1-4,5-14,>15yr), Gender

wise, PW, PV/Pf/Mixed,

Ward/village/ SC and Block wise

Record

room/SSLR

7. % Inpatients attributed to

Severe Malaria out of total

inpatients admitted as

suspected malaria

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

Age(<1 yr,1-4yr,5-14 yr,>15yr),

Gender wise, PW, species

specific(PV/Pf/Mixed),Ward/Village/

SC and Block wise

7. % Inpatients attributed to

confirmed severe malaria

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

Age, Gender wise, PW,

Ward/Village/Sub center and Block

wise

8. % Inpatients attributed to

confirmed severe malaria out

of total inpatients admitted to

hospital

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, Gender wise, PW,

Ward/Village/SC and Block

Record

room/SSLR

9 Total number of Deaths Total number of deaths during a

specified period

Age, Gender wise, PW,

Ward/Village/SC and Block wise

9. No. of confirmed malaria

death( by RDT(Govt.)/BSE)

Total number of confirmed severe

malaria deaths/ total number of deaths in

the inpatient department during a

specified period

Age, Gender wise, PW,

Ward/Village/SC and Block

Record

room/SSLR

10

.

Proportional Mortality due to

malaria

No of deaths due to confirmed severe

malaria(Govt RDT/BS) / Total number

of deaths in hospital X 100

Age(<1,1-4,5-14,>15), Gender wise,

PW, PV/Pf, Ward/Village/SC and

Block

Record

room/SSLR

11

.

CFR due to Malaria No of confirmed Malaria deaths ( Govt

RDT/BSE)/ Total no of confirmed

malaria cases[(Govt RDT/BSE) (

Outpatients +Inpatients)] X 100

Age(<1,1-4,5-14,>15), sex, PW,

Ward/Village/SC and Block

Record

room/SSLR

Note: The age/ sex/address/Block details to be included in confirmed cases and Death cases)

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.

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 bio-

safety 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 as-

lack 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.

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

16

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: ……………………………………..

Sl.

No

.

Date

Nam

e of

pati

ent

(fath

er’

spou

se’s

nam

e)

Ad

dre

ss –

Su

b c

entr

e

Vil

lage

& S

C

Age

( Y

rs)

Sex

(M

/ F

)

Pre

gn

an

t W

om

en

(Y

/N)

99

9Y

/N

ST

/ S

C

Date

of

on

set

of

fever

Date

of

firs

t co

nta

ct w

ith

Ser

vic

e

Pro

vid

er(A

SH

A/M

PW

/CH

C/A

YU

SH

/MH

U//

PH

C/

SD

HS

/DH

H/O

ther

s)

Pla

ce o

f In

ves

tigati

on

pri

or

com

ing t

o

com

ing t

o t

he

SS

H(

AS

HA

/MP

W/M

O/C

HC

/SD

H/D

HH

/

Oth

ers)

0

Res

ult

of

Blo

od

sli

de

or

RD

T(P

F/P

V/M

ixed

in

fect

ion

)

Date

of

rep

ort

ing t

o S

enti

nel

Sit

e

Investigations for Malaria

Dia

gn

osi

s

Date

of

imit

ati

on

of

trea

tmen

t at

SS

H

Wh

eth

er A

dm

itte

d a

t S

SH

( Y

es /

NO

) If admitted

Date

of

Inves

tigati

on

at

SS

H

Res

ult

of

Blo

od

sli

de

(Pv /

Pf/

Mix

ed)

Res

ult

of

Pf

RD

T (

Pos

/ N

eg)

Date

of

Ad

mis

sion

at

SS

H

Fin

al

Dia

gn

osi

s

Ou

tcom

e (c

ure

d &

dis

charg

ed

/ re

ferr

ed/l

eft

wit

hou

t

dis

charg

e/d

ied

)

Da

te o

f o

utc

om

e

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

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

17

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 -

B. Reporting format for Indoor Patients

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)

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

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

To

tal

In p

ati

en

ts a

dm

itte

d

To

tal

In p

ati

en

ts a

dm

itte

d a

s

susp

ecte

d m

ala

ria

To

tal

In

pa

tien

t d

iag

no

sed

as

severe

mala

ria

*

Severe malaria

Cases Confirmed

To

tal

Preg

na

nt

Wom

en

wit

h

Ma

lari

a

SC

s/S

Ts

Severe Malaria Cases Time lag

between onset

of fever and

reporting to

Sentinel site

Deaths

due to

all

causes

during

the

fortnig

ht

Deaths

due to

confir

med

malari

a

PV

PF

Mix

ed I

nf

< 1 Yr 1-4 yrs 5-8 yrs 9-14 yrs >15 yrs

M F M F M F M F M F

< 3

d a ys

3-

7 d a ys

> 7 d a ys

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

18

Annexure V: Sentinel Site Malaria Register for OPD / IPD ( Med, Paed & OG) and Causality

Sl.

No

.

Na

me

& A

dd

ress

(Vil

lage/S

C/B

lock

CH

C)

Ag

e a

nd

Sex

SC

/ S

T

PW

(Y

/N)

Da

te o

f o

nse

t o

f

illn

ess

Da

te o

f B

loo

d

test

do

ne

prio

r

com

ing

to S

SH

Pla

ce

of

Blo

od

test

do

ne

prio

r

com

ing

to

SS

H(A

SH

A/M

P

W/S

C/P

HC

/CH

C

/SD

H/D

HH

/oth

er

tha

n G

ov

t.

Ho

spit

al)

Da

te o

f a

tten

din

g

Sen

tin

el

site

Ho

spit

al(

OP

D /

IPD

/ C

au

sali

ty )

Da

te o

f B

loo

d t

est

do

ne a

t S

en

tin

el

site

Ho

spit

al)

Resu

lt B

loo

d

test

(Pf

of

Pv

)

Prov

isio

nal

dia

gn

osi

s

1 2 3 4 5 6 7 8 9 10 11 12

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- 5th

std/ 6 - 7th

std/

8 -10th

std/Graduate)

5. Occupation of Respondent(Tick mark the appropriate

response)

1. Agricultural workers 2. Non- agricultural

Labourer

3. Migrant daily wage earner 4. Business 5.

Large business/self employed 6. Govt

Service/Pvt service

6. Current place of residence(Tick mark the appropriate

response and then write the present address)

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 3. 2- 6 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 (1st, 2

nd, 3

rd)

2. Weeks of Gestation

19

10. Distance of his village from the health facility

(PHC/CHC/SDH/DHH/MC/Others) (Tick mark the correct

response)

1. < 5 Kms 2. > 5 kms

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)

__//__//____ 1. ASHA/ HW/ MPW/Others 2.

Govt Hospital (PHC/CHC/SDH/DHH) 3. Others (

Priv Lab/Nursing Home/Priv hospital

14. Result of Blood slide examination/RDT at this facility level(

Please tick the correct option)

1. Pf._______ 2.PV_________ 3. Mixed________

15. If referred; source of referral after the first blood test(Tick

mark the correct response)

ASHA/ HW/MO /PHC/CHC/SDH/DHH

16. Time taken by him to reach this Health facility or referral

center ( please Tick mark the correct option)

1._______ hrs 2.Days_________ to

(PHC/CHC/SDH/DHH/MC)

17.Date of admission to the sentinel surveillance site hospital __//__//____

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 ---------//-----//-------------

22. 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

facility from the SSH(Tick mark the correct option)

1. Yes 2. No

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

from SSH? (Tick mark the correct option)

1. Yes 2. No

28. Whether admitted?, If yes then date of admission & name

of higher health facility(Tick mark the correct option)

1. Yes 2. No

__________________________

29. Was his blood tested for Malaria at this higher health

facility?

1. Yes 2. No

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 :

Signature :

SSLT/SN/MPW/MPHS/ SS Coordinator

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.

1 11

2 12

3 13

4 14

5 15

6 16

7 17

8 18

9 19

10 20

ii) Malaria Negative samples ( 5% of total Negatives) Sl No Date of collection Blood Slide No. Sl No Date of collection Blood Slide No.

1 11

2 12

3 13

4 14

5 15

6 16

7 17

8 18

9 19

10 20

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: -------------------

3. Name of the District: -------------------

5. Total number of case record Forms: ---------------

6. Case record forms for BS numbers: From ----------------- to ----------------

Case record forms sent by: ------------------ ---------------------------

(Name) (Signature)

Case record forms received by: --------------------- -----------------------

(Name) (Signature)