[health-vn] New WHO guidelines on malaria

[vern weitzel]

From: "Neil Pakenham-Walsh" <neil.pakenham-walsh at ghi-net.org>
Date: 1 August 2010 8:46:37 AM PDT
To: "CHILD2015 - Child Healthcare Information and Learning Discussion-group" <CHILD2015 at dgroups.org>
Subject: [CHILD2015] New WHO guidelines on malaria
Reply-To: "CHILD2015 - Child Healthcare Information and Learning Discussion-group" <CHILD2015 at dgroups.org>

Dear CHILD2015 colleagues,

In March 2010, the World Health Organization published new guidelines for malaria:
http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html

The guidelines are discussed in two articles in the BMJ (24 July 2010). In the first [*1], an editorial, Hugh Reyburn of the London School of Hygiene and Tropical Medicine says: 'The single most important operational change in the new guideline is the replacement of "presumptive treatment" in young children (treatment of any childhood fever with no obvious alternative cause as malaria, a cornerstone of WHO policy for the past 20 years) with parasitological diagnosis wherever possible... the question now has to shift from whether we are ready to abandon presumptive treatment to how we can provide a quality assured parasitological diagnosis where infrastructure is weak and the burden of disease is high... the limited evidence available suggests that the quality of slide results in routine care in Africa is poor, with estimates of sensitivity and specificity often falling below 70% (WHO sets a minimum standard of 90% specificity and 95% sensitivity). Although quality assurance schemes for routine slide microscopy in Africa exist in policy, they rarely operate in practice, and major efforts are urgently needed to correct this.'

The second article [*2], by Robert Newman, director of the global malaria programme at WHO Geneva, says: 'The case for this policy change is clear and compelling. As transmission falls, so does the proportion of fevers that are attributable to malaria. By treating all cases of fever as malaria, we not only overuse artemisinin combinations - our precious first line and currently best weapon against malaria - but we also fail to provide appropriate care for people with other causes of fever. Expansion of the use of rapid diagnostic tests may allow us to reverse these long entrenched practices. However, malaria tests alone will not be enough. In the absence of rapid tests for other common causes of fever, training and supervision to reinforce the differential diagnosis skills of healthcare workers will be essential. Otherwise, there is a risk that patients with negative test results will still be given antimalarials.'

I would be interested to hear CHILD2015 members' comments. Do you have plans to apply these guidelines in your country? If you are doing so already, what challenges are you facing?

With thanks,

Neil Pakenham-Walsh

CHILD2015 profile: Neil Pakenham-Walsh is the coordinator of the HIFA2015 campaign and co-director of the Global Healthcare Information Network. He started his career as a hospital doctor in the UK, and has clinical experience in rural Ecuador and Peru.  For the last 18 years he has been committed to improving the availability of healthcare information for health workers in developing countries. He has worked with the World Health Organization, the Wellcome Trust, and INASP.  neil.pakenham-walsh AT ghi-net.org

1. Reyburn H. New WHO guidelines for the treatment of malaria. BMJ 2010;341:161-2 (24 July 2010)
http://www.bmj.com/cgi/content/full/340/may28_1/c2637  (restricted access)

2. Newman R. Malaria control beyond 2010. BMJ 2010;341:182-3 (24 July 2010)
http://www.bmj.com/cgi/content/full/340/jun11_1/c2714  (restricted access)



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