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close this bookGuidelines for the Treatment of Malaria (WHO; 2006; 266 pages) View the PDF document
View the documentGlossary
View the documentAbbreviations
open this folder and view contents1. Introduction
View the document2. The clinical disease
open this folder and view contents3. Treatment objectives
close this folder4. Diagnosis of malaria
View the document4.1 Clinical diagnosis
View the document4.2 Parasitological diagnosis
View the document4.3 Where malaria transmission is low to moderate and/or unstable
View the document4.4 In stable high-transmission settings
View the document4.5 Malaria parasite species identification
View the document4.6 In epidemics and complex emergencies
open this folder and view contents5. Resistance to antimalarial medicines9
open this folder and view contents6. Antimalarial treatment policy
open this folder and view contents7. Treatment of uncomplicated P. Falciparum malaria10
open this folder and view contents8. Treatment of severe falciparum malaria14
open this folder and view contents9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae19
View the document10. Mixed malaria infections
open this folder and view contents11. Complex emergencies and epidemics
open this folder and view contentsAnnexes
 

4.3 Where malaria transmission is low to moderate and/or unstable

Parasitological confirmation of the diagnosis of malaria is recommended. This should be provided by microscopy or, where not available, RDTs. Low to moderate transmission settings8 include many urban areas in Africa, and the low transmission season in areas with seasonal malaria.

8 Transmission intensity is conventionally expressed in terms of EIR (see section 2). There is as yet no consensus on criteria for determining the thresholds between high, and low to moderate transmission settings. Suggested criteria include: the proportion of all children under 5 years of age with patent parasitaemia, and the incidence of individuals with the spleen palpable below the umbilicus in children aged 2-9 years. The IMCI guidelines recommend that areas in which fewer than 5% of young children with fever have malaria parasitaemia should be considered as low-transmission settings.


In settings where malaria incidence is very low, parasitological diagnosis for all fever cases may lead to considerable expenditure to detect only a few patients who are actually suffering from malaria. In such settings, health workers should be trained to identify, through the history, patients that have been exposed to malaria risk before they conduct a parasitological test.

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