Guideline

WHO guidelines for malaria, 30 November 2024.

Year of Publication

2024

Issuing Institution

WHO

Links

DOI,WHO IRIS,DOI

Recommendations

51 included recommendations

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.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

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.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Pyrethroid-chlorfenapyr ITNs should be deployed instead of pyrethroid-only LLINs for prevention of malaria in adults and children in areas with pyrethroid resistance.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Pyrethroid-chlorfenapyr ITNs can be deployed instead of pyrethroid-PBO ITNs for prevention of malaria in adults and children in areas with pyrethroid resistance.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Pyrethroid-pyriproxyfen ITNs can be deployed instead of pyrethroid-only LLINs for prevention of malaria in adults and children in areas with pyrethroid resistance.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

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.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Moderate

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.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Indoor Residual Spraying (IRS) should be deployed for the prevention and control of malaria in children and adults living in areas with ongoing malaria transmission.

Status

Retired

Recommended in favor

Strong

Certainty of evidence

Low

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.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Prioritize optimal coverage with either insecticide-treated nets (ITNs) or Indoor Residual Spraying (IRS) over combination (2019): WHO suggests not co-deploying ITNs and 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

Insecticides can be regularly applied to water bodies (larviciding) for the prevention and control of malaria in children and adults as a supplementary intervention to insecticide treated nets (ITNs) and Indoor residual spraying (IRS) in areas with ongoing malaria transmission where aquatic habitats are few, fixed and findable

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

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.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Low

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.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Low

Space spraying is not recommended for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission; insecticide treated nets (ITNs) and Indoor residual spraying (IRS) should be prioritized instead.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Very low

Screening of residential houses can be used for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In malaria-endemic areas, pregnant women of all gravidities should be given antimalarial medicine at predetermined intervals to reduce disease burden in pregnancy and adverse pregnancy and birth outcomes.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

In areas of moderate to high perennial malaria transmission, children belonging to age groups at high risk of severe malaria can be given antimalarial medicines at predefined intervals to reduce disease burden.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

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.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

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.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Children admitted to hospital with severe anaemia living in settings with moderate to high malaria transmission can be given a full therapeutic course of an antimalarial medicine at predetermined times following discharge from hospital to reduce re-admission and death.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Antimalarial medicine can be given as chemoprevention through mass drug administration (MDA) in areas of moderate to high transmission of P. falciparum to provide short-term reductions in disease burden.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

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.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

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.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In areas with moderate to high levels of P. falciparum transmission, providing antimalarial medicine through mass drug administration (MDA) to reduce transmission is not recommended.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

In areas with P. vivax transmission, antimalarial medicine can be given as chemoprevention through mass drug administration (MDA) to reduce transmission.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Mass treatment with an 8-aminoquinoline medicine alone to reduce the transmission of P. vivax is not recommended.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Very low

WHO recommends the use of malaria vaccines for the prevention of P. falciparum malaria in children living in malaria-endemic areas, prioritizing areas of moderate and high transmission

Status

Updated

Recommended in favor

Strong

Certainty of evidence

High

Artemisinin-based combination therapy Treat children and adults with uncomplicated P. falciparum malaria with one of the following ACTs*: • artemether-lumefantrine (AL) • artesunate-amodiaquine (AS+AQ) • artesunate-mefloquine (ASMQ) • dihydroartemisinin-piperaquine (DHAP) • artesunate + sulfadoxine-pyrimethamine (AS+SP) • artesunate-pyronaridine (ASPY) (2022)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Artesunate-pyronaridine (ASPY) is recommended as an artemisinin-based combination therapy option for the treatment of uncomplicated P. falciparum malaria.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Artemisinin-based combination therapy (ACT) regimens should provide 3 days’ treatment with an artemisinin derivative.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

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) to reduce transmission. Glucose-6-phosphate dehydrogenase testing is not required.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Low

Treatment in the first trimester of pregnancy: Treat pregnant women with uncomplicated P. falciparum malaria with artemether-lumefantrine during the first trimester

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Travellers with uncomplicated P. falciparum malaria returning to non-endemic settings should be treated with an ACT.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

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.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Qualitative near-patient tests for glucose-6-phosphate dehydrogenase (G6PD) deficiency should be used to inform administration of specific treatment regimens to prevent relapses of P. vivax and P. ovale. G6PD non-deficient individuals can receive 0.5 mg/kg/day primaquine for 14 days or 0.5 mg/kg/day primaquine for 7 days.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Semi-quantitative near-patient tests with fixed standard thresholds for deficient, intermediate and normal glucose-6-phosphate dehydrogenase (G6PD) activity should be used to inform administration of specific treatment regimens. The dose of 1 mg/kg/day primaquine for 7 days or single dose tafenoquine should only be given to those above the threshold that corresponds to >70% of normal G6PD activity; and 0.5 mg/kg/day primaquine for 14 days or 0.5 mg/kg/day primaquine for 7 days can be given to those with a threshold that corresponds to > 30% of normal G6PD activity to prevent relapses of P. vivax and P. ovale.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Tafenoquine is recommended as an alternative to primaquine (3.5 mg/kg total dose) for preventing relapses of P. vivax in patients ≥ 2years of age, who have ≥ 70% glucose-6-phosphate dehydrogenase (G6PD) activity and who receive chloroquine treatment.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

To prevent relapse, children and adult (except pregnant women, infants aged < 1 months and women breastfeeding infants aged < 1 months, and people with glucose-6-phosphate dehydrogenase (G6PD) deficiency), primaquine should be given at a high total dose (7 mg/kg) at 0.5 mg/ kg/day for 14 days or 1 mg/kg/day for 7 days for prevention of relapses in patients with uncomplicated P. vivax or P. ovale malaria.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Preventing relapse in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency (2015): In people with G6PD deficiency, primaquine base at 0.75 mg/kg bw once a week for 8 weeks can be given to prevent relapse, 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, weekly chemoprophylaxis with chloroquine can be given until delivery and breastfeeding are completed, then, on the basis of G6PD status, primaquine can be given to prevent future relapse.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

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 artemisinin-based combination therapy (ACT).

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

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.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

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.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Mass testing and treatment (MTaT) to reduce the transmission of malaria is not recommended.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Moderate

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.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

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.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Very low

Routine malaria testing and treatment of people arriving at points of entry (land, sea or air) to reduce importation is not recommended.

Status

Maintained

Recommended against

Conditional

Certainty of evidence

Very low

Malaria testing and treatment of organized or identifiable groups arriving or returning from malariaendemic areas (2022) In areas approaching elimination or post-elimination settings preventing re-establishment of transmission, organized or identifiable groups arriving or returning from malaria-endemic areas can be tested and treated soon after entry to reduce importation of malaria. Relatively easy access to these groups within a short time after entry is required for this strategy to be feasible and acceptable. This strategy may be particularly critical to areas in post-elimination that are working to prevent re-establishment of transmission.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Reactive drug administration for reducing malaria transmission (2022): In areas approaching elimination or post-elimination settings preventing re-establishment of transmission, antimalarial medicine can be given as chemoprevention to 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) to prevent or reduce malaria transmission.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

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

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

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.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate