WHO guidelines for malaria - 16 October 2023

Published by World Health Organization (WHO) on Jan 30, 2024

Disclaimer

© World Health Organization 2023 

Some rights reserved. This work is available under the Creative Commons AttributionNonCommercial-ShareAlike 3.0 IGO license (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Under the terms of this license, you may copy, redistribute and adapt the work for noncommercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons license. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.
Any mediation relating to disputes arising under the license shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization.
Suggested 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.
Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.
Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. 
Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.
General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.
The recommendations contained in this publication are based on the advice of independent experts, who have considered the best available evidence, a risk–benefit analysis and other factors, as appropriate. This publication may include recommendations on the use of medicinal products for an indication, in a dosage form, dose regimen, population or other use parameters that are not included in the approved labelling. Relevant stakeholders should familiarize themselves with applicable national legal and ethical requirements. WHO does not accept any liability for the procurement, distribution and/or administration of any product for any use.

Sponsors

Funding for the development and publication of the Guidelines was gratefully received from the Bill & Melinda Gates Foundation, The Global Fund, the Spanish Agency for International Development Cooperation, Unitaid, and the United States Agency for International Development (USAID).

Contact

Abstract

This document is a PDF generated from the WHO guidelines for malaria hosted on the MAGICapp online platform: https://app.magicapp.org/#/guideline/7099. Each time the content of the platform is updated, a new PDF version of the Guidelines will be downloadable on the WHO Global Malaria Programme website to facilitate access where the Internet is not available. Users should note the downloaded PDFs of the Guidelines may be outdated and not contain the latest recommendations. Please consult with the website for the most up-to-date version of the Guidelines (https://www.who.int/teams/global-malaria-programme).
WHO/UCN/GMP/2023.01 Rev. 1

Language

en-gb

PICOS

PICO 1.1

Population
Pregnant women
Intervention
Therapeutic course of SP
Comparator
No medicine
Outcomes

PICO 1.1

Population
Children with severe malaria (malaria-endemic areas)
Intervention
Artesunate
Comparator
Quinine
Outcomes

PICO 1.1

Population
Adults and children residing in a delimited geographical area
Intervention
MDA
Comparator
No MDA, routine service
Outcomes

PICO 1.1

Population
Adults and children in a delimited geographic area
Intervention
Mass testing and treatment
Comparator
No MTaT
Outcomes

PICO 1.1

Population
Adults and children at increased risk of malaria infection relative to the general population living in areas of very low to low transmission or post-elimination settings
Intervention
Targeted drug administration (TDA)
Comparator
no TDA
Outcomes

PICO 1.1

Population
Treating malaria in pregnancy during their first trimester in prospective cohort studies
Intervention
artemisinin derivatives
Comparator
antimalarial not including artemisinin derivative and recommended in the first trimester
Outcomes

PICO 1.1

Population
Patients with uncomplicated P. falciparum malaria (malaria-endemic settings in Africa)
Intervention
Dihydroartemisinin + piperaquine once daily for 3 days
Comparator
Artemether + lumefantrine twice daily for 3 days
Outcomes

PICO 1.1

Population
Adults and children residing with or near a confirmed malaria case or having the same risk of acquiring infection as the index case in areas of very low to low transmission or in post-elimination settings
Intervention
Reactive drug administration
Comparator
No RDA
Outcomes

PICO 1.1

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Pyrethroid-only nets or curtains
Comparator
No nets or curtains
Outcomes

PICO 1.2

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Pyrethroid-only nets or curtains
Comparator
Untreated nets or curtains
Outcomes

PICO 1.2

Population
Adults with severe malaria (malaria-endemic areas)
Intervention
Artesunate
Comparator
Quinine
Outcomes

PICO 1.2

Population
Treating malaria in pregnancy during their first trimester in prospective cohort studies
Intervention
Artemether-lumefantrine
Comparator
Quinine
Outcomes

PICO 1.2

Population
Patients with uncomplicated P. falciparum malaria (malaria-endemic settings in Africa)
Intervention
Dihydroartemisinin + piperaquine once daily for 3 days
Comparator
Artesunate + mefloquine once daily for 3 days
Outcomes

PICO 1.3

Population
Patients with uncomplicated P. falciparum malaria (malaria-endemic settings in Africa)
Intervention
Dihydroartemisinin + piperaquine
Comparator
Artemether + lumefantrine
Outcomes

PICO 1.3

Population
Adults and children in areas with ongoing malaria transmission and high insecticide resistance
Intervention
ITNs treated with both piperonyl butoxide (PBO) and pyrethroid
Comparator
ITNs treated with pyrethroid only
Outcomes

PICO 1.4

Population
Patients with uncomplicated P. falciparum malaria (malaria-endemic settings in Africa)
Intervention
Dihydroartemisinin + piperaquine
Comparator
Artesunate + mefloquine
Outcomes

PICO 1.4

Population
Adults and children in areas with ongoing malaria transmission and high insecticide resistance
Intervention
ITNs treated with both piperonyl butoxide (PBO) and pyrethroid
Comparator
ITNs treated with pyrethroid only
Outcomes

PICO 1.5

Population
Adults and children with uncomplicated P. falciparum malaria (malaria-endemic settings)
Intervention
Artemisinin + naphthoquine; 1-day course
Comparator
Artemether + lumefantrine twice daily for 3 days
Outcomes

PICO 1.5

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Pyrethroid-chlorfenapyr ITNs for prevention of malaria
Comparator
Pyrethroid-only ITNs for prevention of malaria
Outcomes

PICO 1.6

Population
Adults and children with uncomplicated P. falciparum malaria (malaria-endemic settings)
Intervention
Artemisinin + naphthoquine; 1-day course
Comparator
Dihydroartemisinin + piperaquine; 3-day course
Outcomes

PICO 1.6

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Pyrethroid-chlorfenapyr ITNs for prevention of malaria
Comparator
Pyrethroid-PBO ITNs for prevention of malaria
Outcomes

PICO 1.7

Population
Adults and children with uncomplicated P. falciparum malaria in malaria transmission settings
Intervention
Artesunate-pyronaridine
Comparator
artemether-lumefantrine
Outcomes

PICO 1.7

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Pyrethroid-pyriproxyfen nets for prevention of malaria
Comparator
Pyrethroid-only nets for prevention of malaria
Outcomes

PICO 1.8

Population
Adults and children with uncomplicated P. falciparum malaria (malaria transmission settings)
Intervention
Artesunate-pyronaridine
Comparator
Artesunate-amodiaquine
Outcomes

PICO 1.8

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Pyrethroid-pyriproxyfen nets for prevention of malaria
Comparator
Pyrethroid-PBO nets for prevention of malaria
Outcomes

PICO 1.9

Population
Adults and children with uncomplicated P. falciparum malaria (malaria transmission settings)
Intervention
Artesunate-pyronaridine
Comparator
Mefloquine plus artesunate
Outcomes

PICO 1.9

Population
Refugees and IDP adults and children affected by humanitarian emergencies living in areas with ongoing malaria transmission
Intervention
Insecticide-treated nets
Comparator
No insecticide-treated nets
Outcomes

PICO 1.10

Population
Adults and children in areas with ongoing malaria transmission
Intervention
IRS
Comparator
No IRS
Outcomes

PICO 1.10

Population
Adults and children with uncomplicated malaria (high and low transmission settings for P. falciparum and P. vivax malaria)
Intervention
Artesunate-pyronaridine
Comparator
other antimalarials for all malaria subtypes (safety outcomes only)
Outcomes

PICO 1.11

Population
Refugees and IDP adults and children affected by humanitarian emergencies living in areas with ongoing malaria transmission
Intervention
Indoor residual spraying
Comparator
No indoor residual spraying
Outcomes

PICO 1.12

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Pyrethroid-pyriproxyfen nets for prevention of malaria
Comparator
Pyrethroid-only nets for prevention of malaria
Outcomes

PICO 2.1

Population
Children up to 24 months living in malaria-endemic areas
Intervention
PMC
Comparator
No intervention, or alternative medicines
Outcomes

PICO 2.1

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Pyrethroid-like indoor residual spraying (IRS) plus insecticide-treated nets (ITNs)
Comparator
ITNs
Outcomes

PICO 2.1

Population
Adults and children residing with or near a confirmed malaria case or having the same risk of acquiring infection as the index case in areas nearing elimination or in post-elimination settings
Intervention
Reactive case detection and treatment
Comparator
No RACDT
Outcomes

PICO 2.1

Population
Adults and children with uncomplicated malaria (malaria-endemic settings)
Intervention
Artesunate 4 mg/kg bw once daily for 3 days plus sulfadoxine–pyrimethamine on day 1
Comparator
Artesunate 4 mg/kg bw once daily for 1 day plus sulfadoxine–pyrimethamine on day 1
Outcomes

PICO 2.1

Population
Adults and children at increased risk of malaria infection relative to the general population living in very low to low or post-elimination transmission settings
Intervention
Targeted testing and treatment
Comparator
No TTaT
Outcomes

PICO 2.1

Population
All ages during emergencies or periods of health service disruption
Intervention
MDA
Comparator
No MDA, routine service
Outcomes

PICO 2.1

Population
Adults with severe malaria (malaria-endemic countries)
Intervention
Intramuscular artemether
Comparator
Intravenous or intramuscular artesunate
Outcomes

PICO 2.2

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
IRS
Comparator
ITNs
Outcomes

PICO 2.2

Population
Children with severe malaria (malaria-endemic countries)
Intervention
Intramuscular artemether
Comparator
Intravenous or intramuscular quinine
Outcomes

PICO 2.3

Population
Adults with severe malaria (malaria-endemic countries)
Intervention
Intramuscular artemether
Comparator
Intravenous or intramuscular quinine
Outcomes

PICO 3.1

Population
People with symptomatic malaria in malaria-endemic areas
Intervention
Short-course primaquine plus malaria treatment including an artemisinin derivative
Comparator
Malaria treatment with an artemisinin derivative alone
Outcomes

PICO 3.1

Population
Adults and children arriving at points of entry (land, sea or air)
Intervention
Testing and treatment at points of entry
Comparator
no intervention
Outcomes

PICO 3.1

Population
Children aged < 5 years with severe malaria (rural settings in Africa and Asia where parenteral treatment is not available)
Intervention
Rectal artesunate plus referral for definitive treatment
Comparator
Placebo plus referral for definitive treatment
Outcomes

PICO 3.1

Population
Adults and children residing with or near a confirmed malaria case in areas nearing elimination or in post-elimination settings
Intervention
Reactive indoor residual spraying
Comparator
no Reactive IRS
Outcomes

PICO 3.1

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Larviciding
Comparator
No larviciding
Outcomes

PICO 3.1

Population
Adults and children in delimited geographical area with very low to low transmission of P. falciparum
Intervention
Mass drug administration (MDA)
Comparator
no MDA
Outcomes

PICO 3.1

Population
Children ≥5 months of age living in countries in sub-Saharan Africa with moderate to high malaria transmission
Intervention
A minimum of four doses of RTS,S/AS01 (given as a three-dose initial series; first dose should be provided between 5 and 17 months of age) with a minimal interval between doses of four weeks
Comparator
Malaria interventions currently in place without malaria vaccination
Outcomes

PICO 3.1

Population
Children aged ≤10 years in areas of seasonal transmission
Intervention
Full treatment doses of antimalarial medicines monthly during the malaria transmission season
Comparator
No intervention, or alternative medicines
Outcomes

PICO 3.2

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Larval habitat manipulation (water management using spillways across streams)
Comparator
No larval habitat manipulation
Outcomes

PICO 3.2

Population
Children aged > 6 years and adults with severe malaria (rural settings where parenteral treatment is not available)
Intervention
Rectal artesunate plus referral for definitive treatment
Comparator
Placebo plus referral for definitive treatment
Outcomes

PICO 3.3

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Larval habitat manipulation (water management using floodgates on a dam across a stream) and annual IRS
Comparator
Annual IRS
Outcomes

PICO 3.4

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Larvivorous fish
Comparator
no larvivorous fish
Outcomes

PICO 3.5

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Topical repellent
Comparator
placebo or no topical repellent
Outcomes

PICO 3.6

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Topical repellent
Comparator
Placebo or no topical repellent
Outcomes

PICO 3.7

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Insecticide-treated clothing
Comparator
placebo or untreated clothing
Outcomes

PICO 3.8

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Spatial/airborne repellents
Comparator
placebo or no malaria prevention intervention
Outcomes

PICO 3.9

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Space spraying
Comparator
no space spraying
Outcomes

PICO 3.10

Population
Adults and children living in areas with ongoing malaria transmission
Intervention
Screening of windows, ceilings, doors and eaves with untreated material
Comparator
No house screening
Outcomes

PICO 4.1

Population
School-aged children
Intervention
Therapeutic course of an antimalarial medicine
Comparator
No intervention
Outcomes

PICO 4.1

Population
Adults and children in a delimited geographic area with moderate to high transmission of P. falciparum
Intervention
Mass drug administration (MDA)
Comparator
no MDA
Outcomes

PICO 5.1

Population
Post-discharge children hospitalized with severe anaemia
Intervention
Therapeutic courses of an antimalarial medicine
Comparator
Placebo or no intervention
Outcomes

PICO 5.1

Population
Adults and children with uncomplicated P. vivax malaria (Malaria-endemic areas in which chloroquine is still effective for the first 28 days)
Intervention
Artemisinin-based combination therapy
Comparator
Chloroquine
Outcomes

PICO 5.1

Population
Adults and children in a delimited geographical area with transmission of P. vivax
Intervention
Mass drug administration (MDA)
Comparator
no MDA
Outcomes

PICO 5.2

Population
Adults and children with uncomplicated P. vivax malaria (Settings with high transmission of P. vivax (chloroquine resistance is also reported as high))
Intervention
Dihydroartemisinin + piperaquine
Comparator
Alternative ACTs
Outcomes

PICO 5.3

Population
People with P. vivax malaria
Intervention
Primaquine (0.25 mg/kg bw) for 14 days plus chloroquine (25 mg/kg bw for 3 days)
Comparator
Chloroquine alone (25 mg/kg bw for 3 days)
Outcomes

PICO 5.4

Population
People with P. vivax malaria
Intervention
Primaquine (0.25 mg/kg bw) for 14 days plus chloroquine (25 mg/kg bw for 3 days)
Comparator
Primaquine (0.25 mg/kg bw) for 7 days plus chloroquine alone (25 mg/kg bw for 3 days)
Outcomes

PICO 5.5

Population
Malaria-endemic areas
Intervention
Chloroquine prophylaxis
Comparator
Placebo
Outcomes

PICO 5.6

Population
Adults and children with confirmed clinical and parasitological P. vivax malaria (in India, Peru and Brazil)
Intervention
0.5 mg/kg/day primaquine for 7 days (adult dose 30 mg/day, total dose 210 mg)
Comparator
Standard 14-day course of primaquine (0.25 mg/kg/day, adult dose 15mg/day; total dose 210mg) 14 days
Outcomes

PICO 5.7

Population
Adults and children with confirmed clinical and parasitological P. vivax malaria (in Afghanistan, Ethiopia, Indonesia, Thailand and Viet Nam)
Intervention
1.0 mg/kg/day primaquine for 7 days (adult dose 60 mg/day; total dose 420 mg)
Comparator
High-standard 14-day course primaquine (0.5 mg/kg/day, adult dose 30 mg/day; total dose 420 mg) 14 days
Outcomes

PICO 6.1

Population
Adults and children in a delimited geographical area with transmission of P. vivax
Intervention
Mass relapse prevention
Comparator
No MRP
Outcomes