The SA Department of Health has released updated national guidelines for the treatment of malaria.
Since 2000, the burden of malaria morbidity and mortality has been reduced substantially. Implementing more effective treatments for uncomplicated malaria (artemether- lumefantrine) and severe malaria (intravenous artesunate), as well as strengthening of mosquito vector control and malaria information systems, were among the measures that contributed to improved malaria control. These advances paved the way toward the South African Department of Health refocusing its efforts to work towards malaria elimination.
Achieving the ambitious target of malaria elimination depends on all healthcare workers in malaria endemic and non-endemic areas optimising their management of malaria cases, including 1) encouraging early treatment seeking within 24 to 48 hours; 2) maintaining a high index of suspicion to ensure prompt diagnostic testing of all patients with malaria symptoms who are resident in, or have recently travelled to, a malaria area; 3) in those who test malaria positive, assessing disease severity and starting effective treatment immediately depending on disease severity; 4) notifying each and every case (including all imported cases in non-endemic areas) and 5) monitoring adequacy of response to treatment.
For severe malaria, survival rates are significantly greater following parenteral artesunate than parenteral quinine treatment in both adults and children, so artesunate is the preferred treatment whenever available promptly. Follow-up treatment with primaquine (a section 21 product) is essential to ensure radical cure of P. ovale and P. vivax malaria.
These guidelines have been compiled using both international and local information. The relentless development of drug resistance in malaria parasites, most notably in P. falciparum, has necessitated on-going updates of treatment and chemoprophylaxis policies globally. While recommended treatments are currently considered highly effective in South Africa, the rapid spread of resistance to all available antimalarials in South East Asia is a major concern. New information arising from on-going monitoring of malaria prevalence and distribution, as well as resistance to antimalarial drugs, will inform future guidelines.