District hospital level Severe | Malaria is a Medical Emergency
BMC Medicine (2015) 13:42 DOI 10.1186/s12916-014-0263-6
The document titled "Checklist for Assessing Management of Severe Malaria" is part of the MalariaCare Toolkit. It provides a structured tool for supervisors conducting outreach training and supportive supervision (OTSS) visits in healthcare facilities. The checklist is designed to evaluate and guide... the clinical management of severe malaria cases, including diagnostics, treatment planning, complication management, patient monitoring, and the administration of injectable artesunate. It also includes sections for direct observation of clinical procedures and supervisor feedback to help improve healthcare worker performance and adherence to national treatment guidelines.
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These are two parallel guidelines, one for small hospitals and another one for large hospitals. In view of heavy burden of malaria and prevalence of drug resistant falciparum malaria in the South-East Asia Region, the guidelines were developed for use by medical personnel who treat severe malaria pa...tients, referred from lower-level health facilities. The guidelines were developed by the WHO Regional Office for South-East Asia and the WHO Collaborating Centre for the Clinical Management of Malaria, Faculty of Tropical Medicine, Mahidol University, Thailand. The guidelines are based on a review of current evidence, existing WHO guidelines and experience in the management of malaria in the Region.
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hese are two parallel guidelines, one for small hospitals and another one for large hospitals. In view of heavy burden of malaria and prevalence of drug resistant falciparum malaria in the South-East Asia Region, the guidelines were developed for use by medical personnel who treat severe malaria pat...ients, referred from lower-level health facilities. The guidelines were developed by the WHO Regional Office for South-East Asia and the WHO Collaborating Centre for the Clinical Management of Malaria, Faculty of Tropical Medicine, Mahidol University, Thailand. The guidelines are based on a review of current evidence, existing WHO guidelines and experience in the management of malaria in the Region
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Prompt, effective antimalarial treatment, and supportive care can substantially reduce the rate of mortality from severe malaria. However, many children in malaria-endemic countries do not have access to health facilities or a qualified health care provider and do not receive the necessary care in a... timely fashion. Without rapid detection of danger signs and access to effective treatment, including pre-referral treatment that can be administered in the community level, many of these children with severe malaria die.
In situations where there is no immediate access to a health care facility, WHO recommends the administration of a standard dose of an effective antimalarial medicine as pre-referral treatment before referral to a facility at which complete treatment can be administered.
Rectal artesunate is the WHO-recommended pre-referral intervention in situations where artesunate injection are not feasible for children under the age of 6 years with suspected severe malaria. The intervention reduces the risk of death or permanent disability by up to 50% provided the child is referred to a health facility at which complete treatment can be administered.
This field guide is aimed at supporting the effective deployment of RAS as pre-referral treatment of suspected severe malaria in line with the WHO malaria guidelines.
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Information note. 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 recta...l 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
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Since December 2010, Malaria Consortium has been implementing an innovative approach to community management of severe acute malnutrition, together with an existing integrated community case management (ICCM) programme in South Sudan. This learning paper considers Malaria Consortiums experience of t...his combined approach in a highly complex context and shows whether the management of severe acute malnutrition is an effective, acceptable and feasible component of ICCM programming
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DIAGNOSIS, MANAGEMENT OF UNCOMPLICATED AND SEVERE MALARIA
Where malaria transmission is seasonal, notably in Africa’s Sahel region, children of all ages most at risk of severe malaria are protected through SMC. This intervention consists of full antimalarial treatment courses of sulfadoxine-pyrimethamine and amodiaquine (SPAQ), administered monthly (28 d...ays) during the high-transmission period (typically the rainy season), generally for up to five months per year. SMC can be deployed relatively easily across a large population and is highly cost-effective at only USD $0.30-0.40/dose,3 making it an important tool for malaria control
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The faltering of progress towards malaria elimination follows a plateauing in international financing since 2010. Despite calls for increased international financing, this will be hard to achieve. Both developed country donors and developing countries with malaria face severe fiscal constraints in e...xpanding malaria funding in the next few years. Simply exhorting countries to spend more is unlikely to be successful, just as the Abuja declaration was not, and the developing countries with most malaria burden suffer from weaker economic growth and less capacity to increase domestic financing.
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The MSF malaria guidelines provide practical, evidence-based recommendations for diagnosing, treating, and preventing malaria, especially in low-resource settings. They cover uncomplicated and severe cases, recommend rapid tests and artemisinin-based therapies, and include special guidance for vulne...rable groups like children and pregnant women.
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In the context of the Support to National Malaria Control Programme (SuNMaP), demand creation is the strategic combination of advocacy, communication and mobilisation approaches that seek to achieve increased community awareness of, and demand for, effective malaria prevention and treatment services.... For malaria treatment, demand creation focuses on promoting improved testing, prompt and proper use of artemisinin combination therapy (ACT) treatment for individual cases of malaria, and effective home management of fever, together with referrals of severe cases to a higher-level health facility.
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Malaria in children presents significant clinical challenges, with variations in presentation based on the malaria parasite involved and the child's underlying health conditions. The World Health Organization reports high incidence rates, particularly in sub-Saharan Africa, and emphasizes the import...ance of effective treatment strategies. First-line treatment often involves Artemether-Lumefantrine (ALu), while severe malaria requires careful management and the use of intravenous Quinine. Management protocols emphasize early diagnosis and the monitoring of severe complications to reduce mortality.
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The CDC webpage on the clinical features of malaria outlines the disease's presentation, categorizing it into uncomplicated and severe forms, and emphasizes that prompt and accurate diagnosis and treatment can lead to a cure.
The document titled "Classification and Referral Algorithm – iCCM South Sudan", published by Malaria Consortium in 2012, provides a practical tool for community health workers to assess, classify, and manage common childhood illnesses in South Sudan. It outlines step-by-step procedures for identif...ying danger signs and symptoms related to malaria, pneumonia, diarrhoea, and severe acute malnutrition. Based on clinical findings, the algorithm guides health workers in making decisions about immediate treatment, referral to higher-level health facilities, and caregiver counseling. The aim is to support timely and appropriate care at the community level through the Integrated Community Case Management (iCCM) strategy.
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WHO has updated it recommendations for 3 key malaria prevention strategies: seasonal malaria chemoprevention (SMC), perennial malaria chemoprevention (PMC – previously known as intermittent preventive treatment in infants, or IPTi) and intermittent preventive treatment of malaria in pregnancy (IPT...p). When given to the young children and pregnant women who are most vulnerable to malaria, preventive chemotherapy has been shown to be a safe, effective and cost-effective strategy for reducing the disease burden and saving lives.
The updated recommendations on SMC, PMC and IPTp, published today in the WHO Guidelines for malaria, will support the broader use of chemoprevention among young children at high risk of severe malaria in areas with both seasonal and year-round transmission and promote expanded access to preventive chemotherapy in pregnancy.
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The "Integrated Management of Malaria Training – Health Worker’s Manual" is a practical guide developed by Uganda’s Ministry of Health to train healthcare workers at all levels in the effective diagnosis, treatment, prevention, and management of malaria. It aligns with national malaria treatme...nt guidelines and aims to improve the quality of care and reduce malaria-related illness and death. The manual covers key topics such as clinical assessment of fever, use of rapid diagnostic tests (RDTs), case management of uncomplicated and severe malaria, malaria in pregnancy, co-infections like HIV, as well as community engagement and proper documentation. It includes structured training sessions, case studies, and job aids designed to strengthen the skills of health workers in both public and private sectors, and to ensure standardized, evidence-based malaria care across the country.
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