Updated WHO recommendations for chemoprevention and elimination of malaria
WHO published today in the consolidated report malaria guidelines a set of new and updated recommendations in a number of technical areas – from malaria chemoprevention and mass drug administration to elimination. The guidelines encourage countries to tailor recommendations to local disease settings for maximum impact.
Clear, evidence-based recommendations from WHO guide managers of national malaria control programs when developing policies and strategic plans to control the disease; they support decisions about “what to do”. WHO is also developing implementation guidelines, such as operational and field manuals, to advise countries on “how” to deliver the recommended tools and strategies.
How to access WHO advice on malaria
In February 2021, WHO launched the malaria guidelines, bringing together, for the first time, all of the Organization’s malaria guidance on a single web platform. The consolidated guidelines are currently available in English, French and Arab, with further language versions planned in the coming year. WHO recommendations on malaria can also be found in a mobile app. Learn more about the how to access WHO advice on malaria.
New and updated guidance
Intermittent preventive treatment of malaria in pregnancy (ITPp)
Malaria infection during pregnancy poses substantial risks not only to the mother, but also to her fetus and newborn. Available evidence continues to show that intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a safe and highly cost-effective strategy to reduce the burden of illness in pregnancy as well as adverse pregnancy outcomes. pregnancy and childbirth.
In updated guidelines released today, WHO reaffirmed its strong recommendation for the use of IPTp-SP in moderate to high risk areas. P. falciparum transmission of malaria. The recommendation does not limit the provision of IPTp-SP to antenatal care facilities (ANC); where there are inequities in access to antenatal care services, other delivery methods, such as the use of community health workers, can be explored. IPTp-SP is now recommended for all pregnant women, regardless of the number of pregnancies; previously it was only recommended for a woman’s first and second pregnancies.
Perennial Malaria Chemoprevention (PMC) and Seasonal Malaria Chemoprevention (SMC)
The WHO has also updated its recommendations for 2 key malaria chemoprevention strategies: seasonal malaria chemoprevention (SMC) and perennial malaria chemoprevention (CMP – formerly known as intermittent preventive treatment in infants, or IPTi). When given to young children, malaria chemoprevention has been shown to be a safe, effective and cost-effective strategy to reduce the burden of disease and save lives.
Updated WHO recommendations on SMC and CMP, released today, are less restrictive than the original recommendations; they do not specify strict age groups, transmission intensity thresholds, numbers of doses or cycles, or specific drugs. As such, they will support wider use of preventive chemotherapy in young children at high risk of severe malaria in areas of seasonal transmission and throughout the year.
Intermittent preventive treatment of malaria in school-aged children (IPTsc)
WHO is also issuing a new recommendation for the use of intermittent preventive treatment for malaria in school-aged children (IPTc) living in settings with moderate to high, perennial or seasonal malaria transmission. The IPTp strategy and regimen should cover children aged 5–15 years, and its introduction should not compromise chemoprevention interventions for children under 5 years of age, who are most at risk of severe malaria.
Post Discharge Malaria Chemoprevention (PDMC)
WHO is today releasing a recommendation for post-discharge malaria chemoprevention (PDMC). It is a strategy to prevent malaria in children with severe anemia living in areas of moderate to high transmission after discharge from hospital, when they are at high risk of readmission or death . Through PDMC, children receive comprehensive antimalarial treatment at regular intervals.
Massive drug administration
The WHO has also released new guidelines on mass drug administration (MDA), another chemoprevention strategy. With MAID, all individuals in a target population receive antimalarial treatment, whether or not they are infected with malaria. The drug treats all existing malarial infections as well as new infections for a specific period of time.
The new recommendations on malaria MDA provide specific guidance for rapidly reducing the burden of malaria in emergencies and in areas of moderate to high transmission. They also provide guidance on using DMM to reduce P. falciparum malaria in very low to low transmission settings, and to reduce P. vivax transmission. The full set of MDA recommendations and supporting evidence can be found in the consolidated guidelines.
The WHO Global Malaria Strategy urges all malaria-endemic countries to accelerate progress towards the elimination goal. In settings close to elimination, interventions will be more effective in reducing transmission if they are designed to detect and treat residual foci of malaria transmission.
The WHO has published a new set of recommendations for the final phase of malaria elimination. Some of the recommendations are also relevant for areas that have achieved elimination and are working to prevent re-establishment of transmission. Based on the available evidence, some recommendations are in favor of specific interventions (positive recommendations) and others versus specific interventions (negative recommendations). The recommendations are divided into 3 categories:
“mass” strategies applied to the entire population of a defined geographical area, whether it is a hamlet, a commune or a district, including: mass drug administration (described above); mass screening and treatment (MTaT); and mass relapse prevention (MRP).
“targeted” strategies applied to people at increased risk of infection compared to the general population, including: targeted drug delivery (TDA); targeted testing and treatment (TTaT); routine screening and treatment at points of entry (border screening); and malaria screening of organized or identifiable groups arriving or returning from malaria-endemic areas.
“reactive” strategies triggered in response to individual cases, including: reactive drug delivery (RDA); reactive case detection and treatment to reduce malaria transmission (RACDT); and reactive indoor spraying (IRS).
Additional details can be found in the consolidated document WHO guidelines for malaria.
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