Registrations till Mar 2021: 25,181

The good news is that the upward trend seen in new Registration which started with 139 in Nov and Dec 2020 has improved to 248 in Feb 2021, and 445 in Mar 2021.

For, Wayand District saw its first cases of COVID-19 in Feb 2020. However, the second wave of COVID-19 that began in late Mar 2021 seemed not to have that dampening an effect on the new registrations, as did the first wave around the same time last year. In additon, the recent resurgence has not had the fear as was present last year.

Furthermore, if resurgence continues delivery of drugs to the houses of the patients would resume, and these will not be documented.

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Registrations across Facility Type: Types = SDH, CHC & PHC

The reason for lesser registrations at the SDH and CHC is that these were converted into COVID-19 First Line Treatment Centers or full-fledged COVID-19 designated centers, and so no NCD clinics were held in these facilities.

Meanwhile, new advisories from the State restarted the NCD program at these facilities with due precautions to reduce COVID-19 transmission. However, strikes by doctors and Health staff has brought documentation to a halt across most facilities. Also, resurgnece of COVID-19, could offset the improvements in registration.

Herein the personal intervention of the DMO, and DNO, on a one-to-one basis with the Medical Officers of the non-documenting facilities, has helped to record an upward trend in registration. Thus, the rising trend in PHCs for the last five months, with the figure of 231 in Feb 2021, and 347 in Mar 2021, could be attributed to this official intervention.

PS: Mouse over the column-graph to see data for each facility type or month.



Treatment Analysis: cards=400


The Missed visits have gone down from 79% in Feb 21 to 50% in Mar 21. Similar small improvement was also seen in the control rates going up to 26% in Mar 21 from 10% in Feb 21. Only if all the visits and BP readings of the hypertensive patients are recorded at the Hospitals the 26% Control rate, will improve to the pre COVID-19 control levels of 40%.

PS: Mouse over the pie- graph to see the data.


Supportive Supervision: n=16 Facilities

Details No. %
Functional Digital BP Monitor 12 75%
Designated Nurse 3 19%
Opportunisitc Screening 1 6%
Card Storage System 16 100%
Defaulter Retrieval System 2 13%
Drugs given for >30 days 16 100%
Facilities with new Regd 28 76%

Areas of immediate improvement are facilities not registering new cases, namely 9 out of 37 facilities. Normally, this must be 0 facilities


No. of facilities with risk of stock-outs: n=37 Facilities

Drugs Nil Stock High-risk
<30 days		 Medium-risk
<60 days		 Low-risk
<90 days
Amlodipine 0 1 1 0
Telmisartan+Losartan 0 1 2 0
HCTZ+Clorthalidone 5 0 2 0


Do note that there are no column graphs for the drugs without stock-outs.

Drug balance best in Amlo with no facilities having nil stock, while five facilities had nil stock in diuretics.

Most of the hospitals having stock out for Chlorthalidone do not have patients who require Chlorthalidone or diuretics.

Also, borrowing between facilities within the district has helped to tide over all deficits so far.

Credit for monitoring this IHCI protocol drug distribution system without stock outs goes to the Pharmacists motivated by the Warehouse Manager.


PS: Mouse over the bar-graphs to see the data.
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Achievements, Recommendations

  1. The upward trend seen in new Registration which started with 139 in Nov and Dec 2020 has improved to 445 in Mar 2021.
  2. % of Facilities recording new registerations despite COVID-19 resurgence has gone up from 68% in Feb to 76% in Mar 2021.
  3. DMO, and DNO discussed on a one-to-one basis with the Medical Officers of the non-documenting facilities, which has helped to record an upward trend in registration.


High & Low Performers

  • The highest registration for Mar 2021 was of 60 new hypertensives from Edavaka Hospital
  • 9 facilities recorded zero registrations. This is an improvement over the previous month, when 12 facilities recorded zero.
  • Accordingly, it would benefit, if these facilities could use the methods of those facilities that got back their clientele.
  • Timely discussions by DMO & DNO is helping NCD clinics in these facilities to restart by mid or end Apr 2021


Facilities without drugs

Diuretics:

Zero Stock: Ambalavayal, Chulliyode, Sughandhagiri, Begur, Vythiri.

There were no stock outs in any facility for ARB and CCB

Notes:

Drug balance best in Amlo with no facilities having nil stock, while five facilities had nil stock in diuretics.

Most of the hospitals having stock out for Chlorthalidone do not have patients who require Chlorthalidone or diuretics

PS: Mouse over the card to see the additional notes.


Facilities with less stock of drugs

Amlo:

Less than 30-day stock: Munderi

ARB:

Less than 30-day stock: Chulliyode

The five facilities with less than 60-day stock was Munderi, Panamaram, Cheeral, Chulliyode, and Vythiri. .

Notes:

Wayanad consistently has shown no stock outs in CCB and ARB

Diuretics:

There are only one or two facilities in Medium Risk which can be managed with intra district transfers given the time and availability of buffer.

PS: Mouse over the card to see the additional notes.


Facilities with least registrations

Zero Registrations:

Panamaram, Porunnannore, Meppady, Periya, Pulpally, Thariode, Poothady, Meenangady, Cheeral.

Zero Registratons:

9 of the 37 facilities mentioned did not register any new cases in the month.

PS: Mouse over the card to see the additional notes.


Staffing

BP apparatus & NCD Nurse

Two CHCs are having designated nurse, and they cover only eight hours in a day.

There is no facility without a digital BP apparatus. However, 12 facilities do not have professional digital BP apparatus and are using the home type digital BP apparatus.

NCD Nurse: continued

In addition:
Some staff nurses are on COVID-19 or vaccination duty, and some others on quarantine.

A designated NCD nurse is a must for NCD and IHCI integration in Wayanad

PS: Mouse over the card to see the additional notes.


Stock of Drugs at Facilities   n=37 Facilities

NoFacility NameRegd till dateAmlo 5mgAmlo 10mgStock in days AmloTelmi 40 mgTelmi 80 mgLosar 25 mgLosar 50 mgStock in days ARBHCTZ 25 mgChlor 12.5 mgStock in Days Diuretics
1Appapara642915009000151100003000 30000110 5800180
2Munderi4918000 1550001400500200008850003700354
3Vazhikatty (Kalpetta)121231335670002413354618400591501461006707970064001421
4Panamaram10584170002090038748000 2500022900121 6500123
5Porunnannore4722080001000043031600 5000060000379 245001036
6Meppady15702660006000159260001000 90000117 300039
7Vengapally448105600900024649000 15005000188 3000134
8Periya764136000 15962400400010000 152125006600500
9Pulpally4171850001300045298000 24000100004432596092001686
10Noolpuzha13612650001200018836000 200081500133200111200192
11Ambalavayal10503009001200027632000  490054  0
12Thariode505219650 38863000 800029500294 4000158
13Poothady6732410006000336118000   2701600 48
14Meenangady135921120022000168110000 3700060000213200028000442
15Vellamunda9852160001800022864000 2300120000289 23200471
16Varadoor487123300300023733600 1810010000166 3200131
17Pozhuthana680131000 17237200100075002000014215006000221
18Thondernad66811600070001732000200093502890091500013200542
19Cheeral11242669501300023386500   118 597001062
20Pakkom193106500600054822500 4000150003152000156001824
21Kappukunnu2092000010009415600 5000200002805001500191
22Padinjarathara413165000700040050000 300022000283 9000450
23Valad56784000200013949000 200002280022248004200317
24Vazhavatta10201920001800020060000  10000106 15500304
25Chulliyode733200000500025620004000 300027  0
26Sughandhagiri1013500 3110000 10003000206600 0
27Chethalayam2801000001700042753000 100002000042910007500607
28Mullankolly183196000170001098360003000100002500059211005500706
29Kottathara253126000600048717500   106 7000553
30Kurukanmoola243126000200047827000300020007000260 5000412
31Edavaka871120100900014217000100002800170071 21600496
32Nallurnad13880000 51825000  27700588350045001159
33Begur739120100440015618200800100002000093  0
34Moopainad506181000600034150001000 120005830004800308
35Bathery11222900002000026389900 207009080026275008000276
36Mananthavady118531470030000282128400 2040049800245 11000186
37Vythiri4592082501360045880003000 995080  0
Facilities Total2518164546063319002521881861456003633001098550199159261337900395
Stock at district warehouse5175504300021540300660007510022436004670072
District Total25181697215637490027424221615220036330011736502372,02,861384600467
NoFacility NameRegd till dateAmlo 5mgAmlo 10mgStock in days AmloTelmi 40 mgTelmi 80 mgLosar 25 mgLosar 50 mgStock in days ARBHCTZ 25 mgChlor 12.5 mgStock in Days Diuretics
The brown color used for background in cells of this table indicate that the particular stock of the drug was less than the required Stock in patient days (SID) for that facility.

Click on the triangle on left to see 'What is Stock in Patient Days?'

The Stock in Patient Days or Stock in Days(SID) is the number of days that the present stock of the protocol drug would last for the number of patients registered in the program.


Drugs Stock Summary:

Available stock on last day of Feb 2021 versus requirement for next three months is shown in the following table:

SummaryAmlodipineARBDiuretics
Available stock
Three months requirement

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IHCI
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