Technical Consultation To Review The Effectiveness Of Rectal Artesunate Used As Pre Referral Treatment Of Severe Malaria In Children

This document is the report of a WHO technical consultation of independent experts convened in October 2022. The aim of the consultation was to conduct a formal evidence review of several studies evaluating the effectiveness of rectal artesunate (RAS) as a pre-referral treatment for severe malaria. In addition to the study published under the Community Access to Rectal Artesunate for Malaria Project, the review included other studies from early-use countries deploying RAS at the programmatic level. The main objective of the technical consultation was to support the development of guidance for the safe and effective implementation of this intervention based on the evidence from areas where RAS has already been implemented.

In 2021, preliminary results of observational studies from the Community Access to Rectal Artesunate for Malaria (CARAMAL) project did not confirm the mortality impact observed in the controlled trial in 2009. Consequently, in January 2022, WHO released an information note on rectal artesunate (RAS), suggesting immediate risk mitigation measures. To provide clarity on the evidence, WHO subsequently convened independent experts to conduct a formal evidence review of the data from the CARAMAL project, as well as data from other studies evaluating the deployment of pre-referral RAS at programmatic level. The outcomes of the review, including results of additional analyses undertaken by the WHO appointed experts, form the basis of this updated information note on the use of RAS as a pre-referral treatment for severe Plasmodium falciparum malaria.

On 18–20 April 2023, the WHO Malaria Policy Advisory Group (MPAG) convened to review updates and progress, and to provide guidance on thematic areas of work by the Global Malaria Programme. The meeting focused on the following topics: 1) the RBM Partnership to End Malaria evaluation of the “High burden to high impact” (HBHI) approach; 2) updates on the vector control, treatment and diagnostic recommendations in the WHO guidelines for malaria; 3) revisiting comparative effectiveness in the context of the arrival of new vector control products; 4) an update on certification of malaria elimination and the E-2025 Global Forum; 5) an update on the RTS,S/AS01 Malaria Vaccine Implementation Programme and WHO evidence review for the R21/Matrix-M vaccine; 6) an update on the work areas of the Strategic Information for Response Unit; 7) a report from the technical consultation on the effectiveness of rectal artesunate (RAS) and field implementation manual; 8) a report from the technical consultation on community-based delivery of intermittent preventive treatment of malaria in pregnancy (IPTp); 9) an update on the WHO/TDR field implementation manual for seasonal malaria chemoprevention (SMC); 10) an update on the Anopheles stephensi regional strategy; 11) an update on histidine-rich protein 2 (HRP2) gene deletions and global response plan; and 12) an update on antimalarial drug resistance in Africa.

Malaria remains an important cause of illness and death in children and adults in countries in which it is endemic. Malaria control requires an integrated approach including prevention (primarily vector control) and prompt treatment with effective antimalarial agents. Malaria case management consisting of prompt diagnosis and effective treatment remains a vital component of malaria control and elimination strategies. Since the publication of the first edition of the Guidelines for the treatment of malaria in 2006 and the second edition in 2010 all countries in which P. falciparum malaria is endemic have progressively updated their treatment policy from use of ineffective monotherapy to the currently recommended artemisinin-based combination therapies (ACT). This has contributed substantially to current reductions in global morbidity and mortality from malaria. Unfortunately resistance to artemisinins has arisen recently in P. falciparum in South-East Asia which threatens these gains. This third edition of the WHO Guidelines for the treatment of malaria contains updated recommendations based on a firmer evidence base for most antimalarial drugs and in addition include recommendation on the use of drugs to prevent malaria in groups at high risk. The Guidelines provide a framework for designing specific detailed national treatment protocols taking into account local patterns of resistance to antimalarial drugs and health service capacity. It provides recommendations on treatment of uncomplicated and severe malaria in all age groups all endemic areas in special populations and several complex situations. In addition on the use of antimalarial drugs as preventive therapy in healthy people living in malaria-endemic areas who are high risk in order to reduce morbidity and mortality from malaria. The Guidelines are designed primarily for policy-makers in ministries of health who formulate country-specific treatment guidelines. Other groups that may find them useful include health professionals and public health and policy specialists that are partners in health or malaria control and the pharmaceutical industry. The treatment recommendations in the main document are brief; for those who wish to study the evidence base in more detail a series of annexes is provided with references to the appropriate sections of the main document.

For more than 50 years, low-cost antimalarial drugs silently saved millions of lives and cured billions of debilitating infections. Today, however, these drugs no longer work against the deadliest form of malaria that exists throughout the world. Malaria deaths in sub-Saharan Africaâ€"currently just over one million per yearâ€"are rising because of increased resistance to the old, inexpensive drugs. Although effective new drugs called "artemisinins" are available, they are unaffordable for the majority of the affected population, even at a cost of one dollar per course. Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance examines the history of malaria treatments, provides an overview of the current drug crisis, and offers recommendations on maximizing access to and effectiveness of antimalarial drugs. The book finds that most people in endemic countries will not have access to currently effective combination treatments, which should include an artemisinin, without financing from the global community. Without funding for effective treatment, malaria mortality could double over the next 10 to 20 years and transmission will intensify.

The Pocket Book is for use by doctors nurses and other health workers who are responsible for the care of young children at the first level referral hospitals. This second edition is based on evidence from several WHO updated and published clinical guidelines. It is for use in both inpatient and outpatient care in small hospitals with basic laboratory facilities and essential medicines. In some settings these guidelines can be used in any facilities where sick children are admitted for inpatient care. The Pocket Book is one of a series of documents and tools that support the Integrated Managem.

"The purpose of this document is to provide comprehensible, global, evidence-based guidelines to help formulate policies and protocols for the treatment of malaria. Information is presented on the treatment of uncomplicated malaria, including disease in special groups (young children, pregnant women, people who are HIV positive, travellers from non-malaria endemic regions) and in complex emergency situations and severe malaria."--Publisher's description.

Malaria continues to be a major health problem in many parts of the world, with over 2,400 million people in 100 countries at risk of infection. This handbook is an updated edition of 'Management of severe and complicated malaria', providing practical guidance on the diagnosis and management of severe falciparum malaria, a form of the disease that can have life-threatening complications if treatment is delayed.