Guideline

WHO guidelines for malaria, 13 July 2021.

Year of Publication

2021

Issuing Institution

WHO

Links

WHO IRIS

Recommendations

29 included recommendations

Pyrethroid-only long-lasting insecticidal nets (LLINs) prequalified by WHO are recommended for deployment in all malaria-endemic settings

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

WHO suggests deploying pyrethroid-PBO nets instead of pyrethroid-only long-lasting insecticidal nets (LLINs) for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission where the principal malaria vector(s) exhibit pyrethroid resistance.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Indoor residual spraying (IRS): IRS deploying a product prequalified by WHO is recommended in most malaria-endemic settings. DDT has not been prequalified; it may be used for IRS if no equally effective and efficient alternative is available, and if it is used in line with the Stockholm Convention on Persistent Organic Pollutants.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

WHO recommends against combining insecticide-treated nets (ITNs) and Indoor Residual Spraying (IRS) and that priority be given to delivering either ITNs or IRS at optimal coverage and to a high standard, rather than introducing the second intervention as a means to compensate for deficiencies in the implementation of the first intervention.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Moderate

The regular application of biological or chemical insecticides to water bodies (larviciding) is recommended for malaria prevention and control as a supplementary intervention in areas where optimal coverage withinsecticide-treated net (ITNs) or indoor residual spraying (IRS) has been achieved, where aquatic habitats are few, fixed and findable, and where its application is both feasible and cost-effective.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

WHO conditionally recommends against the d eployment of topical repellents for the prevention and control of malaria at the community level in areas with ongoing malaria transmission.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Low

Deployment of insecticide-treated clothing for malaria prevention at the community level is not recommended; however, insecticide-treated clothing may be beneficial as an intervention to provide protection against malaria in specific population groups. Deployment of insecticide-treated clothing for malaria prevention at the community level is not recommended; however, insecticide-treated clothing may be beneficial as an intervention to provide protection against malaria in specific population groups.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Low

Space spraying should not be undertaken for malaria control, and indoor residual spraying (IRS) or insecticide-treated net (ITNs) should be prioritized instead

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Very low

WHO conditionally recommends the use of untreated screening of residential houses for the prevention and control of malaria in children and adults living in areas with ongoing malaria transmission.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In malaria-endemic areas in Africa, provide intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) to all women in their first or second pregnancy (SP-IPTp) as part of antenatal care. Dosing should start in the second trimester and doses should be given at least 1 month apart, with the objective of ensuring that at least three doses are received.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In areas of moderate-to-high malaria transmission of Africa, where sulfadoxine-pyrimethamine (SP) is still effective, provide intermittent preventive treatment with SP to infants (< 12 months of age) (SP-IPTi) at the time of the second and third rounds of vaccination against diphtheria, tetanus and pertussis (DTP) and vaccination against measles.

Status

New

Recommended in favor

Strong

In areas with highly seasonal malaria transmission in the Sahel subregion of Africa, provide seasonal malaria chemoprevention (SMC) with monthly amodiaquine + SP for all children aged < 6 years during each transmission season.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following ACTs: • artemether + lumefantrine • artesunate + amodiaquine • artesunate + mefloquine • dihydroartemisinin + piperaquine • artesunate + sulfadoxine–pyrimethamine (SP).

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Treating uncomplicated P. falciparum malaria (2015) Duration of ACT treatment: ACT regimens should provide 3 days treatment with an artemisinin derivative.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Revised dose recommendation for dihydroartemisinin + piperaquine in young children: Children weighing <25kg treated with dihydroartemisinin + piperaquine should receive a minimum of 2.5 mg/kg bw per day of dihydroartemisinin and 20 mg/ kg bw per day of piperaquine daily for 3 days.

Status

Maintained

Recommended in favor

Strong

Reducing the transmissibility of treated P. falciparum infections: In low-transmission areas, give a single dose of 0.25 mg/kg bw primaquine with ACT to patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) to reduce transmission. Testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency is not required.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

First trimester of pregnancy: Treat pregnant women with uncomplicated P. falciparum malaria during the first trimester with 7 days of quinine + clindamycin.

Status

Maintained

Recommended in favor

Strong

Infants less than 5kg body weight: Treat infants weighing < 5 kg with uncomplicated P. falciparum malaria with ACT at the same mg/kg bw target dose as for children weighing 5 kg.

Status

Maintained

Recommended in favor

Strong

Non-immune travellers: Treat travellers with uncomplicated P. falciparum malaria returning to non-endemic settings with artemisinin-based combination therapy (ACT).

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In areas with chloroquine-susceptible infections, treat adults and children with uncomplicated P. vivax, P. ovale, P. malariae or P. knowlesi malaria with either artemisinin-based combination therapy (ACT) (except pregnant women in their first trimester) or chloroquine.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Treat pregnant women in their first trimester who have chloroquine-resistant P. vivax malaria with quinine.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

To prevent relapse, treat P.vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants aged < 6 months, women breastfeeding older infants unless they are known not to be glucose-6-phosphate dehydrogenase (G6PD) deficient, and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In people with glucose-6-phosphate dehydrogenase (G6PD) deficiency, consider preventing relapse by giving primaquine base at 0.75 mg/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced haemolysis.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

In women who are pregnant or breastfeeding, consider weekly chemoprophylaxis with chloroquine until delivery and breastfeeding are completed, then, on the basis of glucose-6-phosphate dehydrogenase (G6PD) status, treat with primaquine to prevent future relapse.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Treat adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women) with intravenous or intramuscular artesunate for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of artemisinin-based combination therapy (ACT).

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Revised dose recommendation for parenteral artesunate in young children: Children weighing < 20 kg should receive a higher dose of artesunate (3 mg/kg bw per dose) than larger children and adults (2.4 mg/kg bw per dose) to ensure equivalent exposure to the drug.

Status

Maintained

Recommended in favor

Strong

Parenteral alternatives where artesunate is not available: If artesunate is not available, use artemether in preference to quinine for treating children and adults with severe malaria

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Treating cases of suspected severe malaria pending transfer to a higherlevel facility (pre-referral treatment): Where complete treatment of severe malaria is not possible but injections are available, give adults and children a single intramuscular dose of artesunate, and refer to an appropriate facility for further care. Where intramuscular artesunate is not available use intramuscular artemether or, if that is not available, use intramuscular quinine.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Treating cases of suspected severe malaria pending transfer to a higherlevel facility (pre-referral treatment): Where intramuscular injection of artesunate is not available, treat children < 6 years with a single rectal dose (10mg/kg bw) of artesunate, and refer immediately to an appropriate facility for further care. Do not use rectal artesunate in older children and adults.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate