The National Guidelines for Malaria Diagnosis and Treatment are a revised and updated
version of similar Guidelines that were issued in the year 2000. The year 2000 version was
revised following a major change in drug policy whereby the former first line drug
Chloroquine was replaced with Sulfadoxine-Pyrimethamine (SP). The change was also
accompanied with the reintroduction of Amodiaquine as second line drug and Quinine
retained its position as the drug of choice for treatment of severe malaria. This shift was
necessary following research results, which indicated very high malaria parasite resistance
to chloroquine that averaged 60%. By then the parasite resistance to Amodiaquine and SP
averaged 6% and 10% respectively. The World Health Organization recommends changing
a drug when parasite resistance against it reaches 25%. The lesson learnt was that we
would have to establish a system to monitor the performance of the drugs as we implement
the new policy in order to ensure effective malaria treatment over time.
In a period of five years since the change of policy, monitoring has indicated that malaria
parasite resistance to SP has gone up to an average of 25.5% in the sentinel sites (from 7.8
to 60.5%). For Amodiaquine the resistance went up to an average of 11.5% (from 6.3 to
18.2%). A decision for another change was therefore unavoidable.
The Ministry therefore, had to look for a suitable, highly efficacious replacement drug to SP.
Currently, new developments in malaria treatment recommend the use of a combination of
drugs that contain one of the Artemesinin compounds (ACTs). The Artemesinin class of
compounds have exhibited very high cure rates for malaria and so far no parasite resistance
against them has been reported. Having them combined with other suitable antimalarial
drugs offers new prospects for achieving high cure rates, delay of development of parasite
resistance and achieving a much longer therapeutic life.
The Ministry after several drug efficacy studies and other important considerations has come
up with these updated Malaria Treatment Guidelines. From now on,
Artemether/Lumefantrine (ALu) is the first line drug for treatment of uncomplicated malaria
for all age groups with the exception of pregnant women during the first trimester and
children weighing below five kilograms whom Quinine would still be the drug of choice.
Quinine is second line drug as well as drug of choice for treatment of severe malaria.
Sulfadoxine/Pyrimethamine (SP) remains the drug of choice for Intermittent Preventive
Treatment (IPT) of malaria in pregnancy. The aim of IPT is to prevent the worst effects of
malaria infection in pregnancy rather than to ensure clinical cure and since no suitable
alternative to SP is currently available, a drug with lower efficacy is acceptable.
It is expected that adherence to these new guidelines both in the public and private health
sectors will eventually lead to much reduced malaria mortality and morbidity. It has to be
emphasized that although proper malaria case management is the cornerstone for malaria
control, prevention of malaria by mass usage of insecticide treated nets, environmental
management and other proven measures has to be undertaken. Therefore, public education
is quite important and has to be undertaken.
The Ministry would like to thank all those who participated in the preparations of these
guidelines.