Malaria
Publication Date: October 15, 2023
Last Updated: October 19, 2023
Summary of Recommendations
Pyrethroid-only nets (2019)
Pyrethroid-only long-lasting insecticidal nets (LLINs) should be deployed for the prevention and control of malaria in children and adults living in areas with ongoing malaria transmission. (S, H)
620
Pyrethroid-PBO ITNs (2022)
Pyrethroid-PBO ITNs instead of pyrethroid-only LLINs can be deployed 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. (C, M)
620
Pyrethroid-chlorfenapyr ITNs vs pyrethroid-only LLINs (2023)
Pyrethroid-chlorfenapyr ITNs should be deployed instead of pyrethroid-only LLINs for prevention of malaria in adults and children in areas with pyrethroid resistance. (S, M)
620
Pyrethroid-pyriproxyfen ITNs vs pyrethroid-PBO ITNs (2023)
Pyrethroid-pyriproxyfen ITNs are not recommended for deployment over pyrethroid-PBO ITNs for prevention of malaria in adults and children in areas with pyrethroid resistance. (C, M)
620
Insecticide-treated nets: Humanitarian emergency setting (2022)
Insecticide-treated nets (ITNs) should be deployed for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission affected by a humanitarian emergency. (S, H)
620
Achieving and maintaining optimal coverage with ITNs for malaria prevention and control (2019)
To achieve and maintain optimal ITN coverage, countries should apply mass free net distribution through campaigns, combined with other locally appropriate delivery mechanisms such as continuous distribution using antenatal care (ANC) clinics and the Expanded Programme on Immunization (EPI). Recipients of ITNs should be advised (through appropriate communication strategies) to continue using their nets beyond the three-year expected lifespan, irrespective of the condition and age of the net, until a replacement net is available. (U, U)
620
Management of old ITNs (2019)
Old ITNs should only be collected where there is assurance that: i) communities are not left without nets, i.e. new ITNs are distributed to replace old ones; and ii) there is a suitable and sustainable plan in place for safe disposal of the collected material. If ITNs and their packaging (bags and baling materials) are collected, the best option for disposal is high-temperature incineration. They should not be burned in the open air. In the absence of appropriate facilities, they should be buried away from water sources and preferably in non-permeable soil. Recipients of ITNs should be advised (through appropriate communication strategies) not to dispose of their nets in any water body, as the residual insecticide on the net can be toxic to aquatic organisms (especially fish). (U, U)
620
Indoor residual spraying (2023)
IRS should be deployed for the prevention and control of malaria in children and adults living in areas with ongoing malaria transmission. (S, VL)
620
Indoor residual spraying: Humanitarian emergency setting (2022)
IRS can be deployed for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission affected by a humanitarian emergency. (C, VL)
620
Prioritize optimal coverage with either ITNs or IRS over combination (2019)
The co-deployment of ITNs and IRS is not recommended for prevention and control of malaria in children and adults in areas with ongoing malaria transmission. Priority should 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. (C, M)
620
Access to ITNs or IRS at optimal coverage levels (2019)
Access to effective vector control using ITNs or IRS at optimal coverage levels should be ensured for all populations at risk of malaria in most epidemiological and ecological settings. (U, U)
620
No scale-back in areas with ongoing local malaria transmission (2019)
In areas with ongoing local malaria transmission (irrespective of both the pre-intervention and current level of transmission), vector control interventions should not be scaled back. Ensuring access to effective malaria vector control at optimal levels for all inhabitants of such areas should be pursued and maintained. (U, U)
620
Insecticide-treated clothing (2019)
Deployment of insecticide-treated clothing is not recommended for the prevention and control of malaria at the community level in areas with ongoing malaria transmission; however, insecticide-treated clothing may be beneficial as an intervention to provide personal protection against malaria in specific population groups. (C, L)
620
Spatial/Airborne repellents (2019)
No recommendation can be made because the evidence on the effectiveness of spatial/airborne repellents for the prevention and control of malaria was deemed to be insufficient. (C, L)
620
Space spraying (2019)
Space spraying is not recommended for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission; IRS or ITNs should be prioritized instead. (C, VL)
620
House screening (2021)
Screening of residential houses can be used for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission. (C, L)
620
Seasonal malaria chemoprevention (2022)
In areas of seasonal malaria transmission, children belonging to age groups at high risk of severe malaria should be given antimalarial medicines during peak malaria transmission seasons to reduce disease burden. (S, M)
620
Intermittent preventive treatment of malaria in school-aged children (2022)
School-aged children living in malaria-endemic settings with moderate to high perennial or seasonal transmission can be given a full therapeutic course of antimalarial medicine at predetermined times as chemoprevention to reduce disease burden. (C, L)
620
MDA for burden reduction in emergency settings (2022)
During emergencies or periods of health service disruption, antimalarial medicine can be used for mass drug administration (MDA) in defined geographical areas to provide short-term reductions in the burden of disease caused by P. falciparum. (C, L)
620
MDA to reduce transmission of P. falciparum in very low to low transmission settings (2022)
In areas with very low to low levels of P. falciparum transmission, antimalarial medicine can be given as chemoprevention through mass drug administration (MDA) to reduce transmission. (C, L)
620
Mass relapse prevention (MRP) to reduce transmission of P. vivax (2022)
Mass treatment with an 8-aminoquinoline medicine alone to reduce the transmission of P. vivax is not recommended. (C, VL)
620
Malaria vaccine (2021)
The RTS,S/AS01 malaria vaccine should be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO. (S, H)
620
Duration of ACT treatment (2015)
ACT regimens should provide 3 days’ treatment with an artemisinin derivative. (S, H)
620
Revised dose recommendation for dihydroartemisinin + piperaquine in young children (2015)
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. (S, U)
*Not evaluated using the GRADE framework
620
Reducing the transmissibility of treated P. falciparum infections (2015)
In low-transmission areas, a single dose of 0.25 mg/kg bw primaquine should be given with an ACT to patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) to reduce transmission. G6PD testing is not required. (S, L)
620
Non-immune travellers (2015)
Travellers with uncomplicated P. falciparum malaria returning to non-endemic settings should be treated with an ACT. (S, H)
620
Hyperparasitaemia (2015)
People with P. falciparum hyperparasitaemia are at increased risk for treatment failure, severe malaria and death and should be closely monitored, in addition to receiving an ACT. (U, U)
620
Blood stage infection (2015)
If the malaria species is not known with certainty, adults and children should be treated as for uncomplicated P. falciparum malaria. (U, U)
620
Blood stage infection (2015)
In areas with chloroquine-susceptible infections, adults and children with uncomplicated P. vivax, P. ovale, P. malariae or P. knowlesi malaria should be treated with either an ACT or chloroquine. In areas with chloroquine-resistant infections, adults and children with uncomplicated P. vivax, P. ovale, P. malariae or P. knowlesi malaria should be treated with an ACT. (S, H)
620
Blood stage infection (2015)
The G6PD status of patients should be used to guide administration of primaquine for preventing relapse. (U, U)
620
Preventing relapse in P. vivax or P. ovale malaria (2015)
To prevent relapse, children and adults (except pregnant women, infants aged < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient, and people with G6PD deficiency) should be treated with a 14-day course of primaquine in all transmission settings. (S, H)
620
Treating severe malaria (2015)
Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women) should be treated 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, treatment should be completed with 3 days of an ACT. (S, H)
620
Treating severe malaria in children (2015)
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. (S, U)
*Not evaluated using the GRADE framework; recommendation based on pharmacokinetic modelling
620
Parental alternatives when artesunate is not available (2015)
If artesunate is not available, artemether should be used in preference to quinine for treating children and adults with severe malaria. (C, L)
620
Pre-referral treatment options (2015)
Where complete treatment of severe malaria is not possible, but injections are available, adults and children should be given a single intramuscular dose of artesunate, and referred to an appropriate facility for further care. Where intramuscular artesunate is not available, intramuscular artemether or, if that is not available, intramuscular quinine should be used. Where intramuscular injection of artesunate is not available, children < 6 years should be treated with a single rectal dose (10mg/kg bw) of artesunate, and referred immediately to an appropriate facility for further care. Rectal artesunate should not be used in older children and adults. (S, M)
620
Mass testing and treatment to reduce transmission of malaria (2022)
Mass testing and treatment (MTaT) to reduce the transmission of malaria is not recommended. (C, M)
620
Targeted drug administration to reduce transmission of malaria (2022)
In areas with very low to low transmission or post-elimination settings preventing re-establishment of transmission, antimalarial medicine can be given as chemoprevention to people with increased risk of infection relative to the general population to reduce transmission. (C, VL)
620
Targeted testing and treatment to reduce transmission of malaria (2022)
Testing and treatment of people with an increased risk of infection relative to the general population to reduce the transmission of malaria is not recommended. (C, VL)
620
Reactive case detection and treatment to reduce transmission of malaria (2022)
In areas approaching elimination or post-elimination settings preventing re-establishment of transmission, all people residing with or near a confirmed malaria case and all people who share the same risk of infection (e.g. co-travellers and co-workers) can be tested for malaria and treated if positive. (C, VL)
620
Reactive indoor residual spraying (2022)
In areas approaching elimination or post-elimination settings preventing re-establishment of transmission, indoor residual spraying of insecticide can be conducted in in the houses of confirmed cases and neighbours to prevent or reduce transmission of malaria. (C, M)
620
Topical repellents (2023)
The deployment of topical repellents in areas with ongoing malaria transmission is not recommended if the aim is to prevent and control malaria at the community level. (C, L)
620
Recommendation Grading
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Overview
Title
Malaria
Authoring Organization
World Health Organization
Publication Month/Year
October 15, 2023
Last Updated Month/Year
April 1, 2024
Supplemental Implementation Tools
Document Type
Guideline
Country of Publication
Global
Document Objectives
The WHO Guidelines for malaria supersedes 2 previous WHO publications: the Guidelines for the treatment of malaria, third edition and the Guidelines for malaria vector control. Recommendations on malaria will continue to be reviewed and, where appropriate, updated based on the latest available evidence. Any updated recommendations will always display the date of the most recent revision in the MAGICapp platform. With each update, a new PDF version of the consolidated guidelines will also be available for download on the WHO website.
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Assessment and screening, Treatment, Management
Diseases/Conditions (MeSH)
D008288 - Malaria
Keywords
malaria
Source Citation
WHO guidelines for malaria, 16 October 2023. Geneva: World Health Organization; 2023 (WHO/UCN/GMP/ 2023.01 Rev.1). License: CC BY-NC-SA 3.0 IGO