Final Annexure-II of Kala- Azar not yet received 1. Raghunathganj -II Block 4. Bhagwangola -I Block 2. Msd-Jiaganj Block 5. Bharatpur -II Block 3. Raninagar -II Block 6. Kandi Block
Annexure 2: Block level activities and data for last three years ----- Documents to keep in file State: District: Block Last three years (Year under consideration and the previous 2 years) Last three years (Year under consideration and the previous 2 years) Year 2019 Year 2020 Year 2021 A General profile 1 The population of the block 2 Total number of Villages in the block 3 No of staffs sanctioned Vs in position MO (______/______) (______/______) (______/______) MTS (______/______) (______/______) (______/______) KTS (______/______) (______/______) (______/______) ANM/Staff Nurse (______/______) (______/______) (______/______) MPW (______/______) (______/______) (______/______) LT (______/______) (______/______) (______/______) Village wise State Projected RCH Population Copy of Emplopyees details
B Surveillance 4 Total number of KA cases ( New+Relapse+HIV-KA ) reported 5 Total number of PKDL cases reported 6 Annual of Incidence of kala-azar cases per 10000 population at block level 7 Number of villages reported any case 8 Number of New (non-IRS) Villages reported any case 9 Number of hot spot villages (3-5 kala-azar case/PKDL) 10 Index case-based search done – for no of cases KA (No of suspects identified/No of confirm case) (______/______) (______/______) (______/______) PKDL (No of suspects identified/No of confirm case) (______/______) (______/______) (______/______) 11 House to house – no of villages covered KA (No of suspects identified/No of confirm case) (______/______) (______/______) (______/______) PKDL (No of suspects identified/No of confirm case) (______/______) (______/______) (______/______) 12 Camp based – no of camps done KA (No of suspects identified/No of confirm case) (______/______) (______/______) (______/______) PKDL (No of suspects identified/No of confirm case) (______/______) (______/______) (______/______) Patient Treatment Card All Test reports and LamB receiving BHT Copy of Miltefosine DOT Yellow Card for PKDL ADR Form Kala Azar Patient Line list Register Focal Case Search microplan and report Active Case Search microplan and report Active Case Search based camp details
13 Total number of RDT used 14 RDT is available for kala-azar (Yes/No) 15 No of KA cases tested for HIV 16 Integration with private network (formal and informal) exist? (Yes/No) Total number of listed Pvt network practitioners Sensitization of private network done (Yes/No) Yes No No Number of suspects referred by Pvt practitioners and confirmed (______/______) (______/______) (______/______) KA (______/______) (______/______) (______/______) PKDL (______/______) (______/______) (______/______) Pharmacist’s Stock register with Expiry Date and disbursement details No. of tests on Lab Register and total Kit utilization should be equal to the Stock Register HIV Test report should be attached with the Patient Treatment Card Marking at RK39 register and Patient Line-List Register If tested from in-house ICTC Lab, then Patient should be marked as RK39 positive in the ICTC Lab register Attendance Sheet of 2019 Batch Latest Complete list should be prepared Should be mentioned on the “Referred by” Column of Lab register
C Capacity Building 17 Number of staff/volunteers trained MO MTS KTS ANM/Staff Nurse MPW LT ASHA 18 Number of block level task force meeting done 19 KA case search integrated with other health programmes (Yes/No) Training or Any Meeting with Kala-azar sensitization attendance sheet should be kept in record from every year Training attendance on ACS/IRS/VBD sensitization Meeting Resolution for every reported Year having all the designated members Discussion of Kala-azar case definition in Leprosy and TB case search Meeting RK39 test recorded in TB and Leprosy Test register
D Case management 20 Treatment facility for Kala-azar (Yes/No) 21 Treatment facility for PKDL (Yes/No) 22 Free transport facility for complicated KA cases (Yes/No) 23 Number of KA cases followed up 1/6/12 months (___ /___ /___ ) (___ /___ /___ ) (___ /___ /___ ) 24 Number of PKDL cases followed up 1/6/12 months (___ /___ /___ ) (___ /___ /___ ) (___ /___ /___ ) 25 Number of deaths among kala-azar cases recorded 26 Number of deaths among known kala-azar cases audited Kala-azar Treatment Protocol should be present at IPD Nursing Station Following 3 NVBDCP Guidelines should be present at BMOH’s Table SOP for KA and PKDL Case Search SOP for Outbreak Investigation and Management Operational Definitions in Kala-azar elimination Program Follow up must be recorded in Treatment card and Line-list register All PKDL patients must be undertaken Eye check up Death Audit report must be attached with Treatment Card Record must be marked in Line List Register
E Integrated Vector Management and IRS 27 Availability of the micro plan for IRS (Yes/No) 28 Number of villages covered under IRS No of houses targeted for IRS No of houses covered for IRS No of squads engaged 29 % of IRS coverage 30 Number of villages with new cases covered by focal IRS 31 Report of pre-IRS vector density available (Yes/No) 32 Report of post IRS vector density available (Yes/No) 33 Any pending incentive for ASHA (Yes/No) 34 Any pending incentive for IRS workers (Squads) (Yes/No) 35 Any pending wage loss compensation for KA/PKDL cases (Yes/No) IRS of each round Microplan should be present VC2 Reports VC1 Reports must be signed by Supervisor Focal IRS Report in prescribed format Must be marked as “Completed” in Line-list register
F Recording and reporting 36 A kala-azar Lab register available (Yes/No) 37 A kala-azar HMIS register available (Yes/No) 38 Online platform for kala-azar program (Yes/No) 39 Data entry is completed in KAMIS (Yes/No) 40 Number of ADR reported under PvPI Name Signature Date Submitted by MOIC Verified by DMO/DVBDO Signature of Civil Surgeon/CMHO At District Level