Government of Sierra Leone Ministry of Health and Sanitation National Malaria Control Programme Guidelines for Case Management of Malaria Fourth Edition 2015 1 | P a g e 2 | P a g e 3 | P a g e Table of Contents EXECUTIVE SUMMARY ................................................................................................................................................................ 6 1.0 INTRODUCTION .................................................................................................................................................................. 7 1.1 EPIDEMIOLOGICAL SITUATION AND PARASITE DISTRIBUTION ............................................................................. 7 1.2 NATIONAL DRUG RESISTANCE PATTERN ...................................................................................................................... 7 1.3 GENERAL OBJECTIVE .......................................................................................................................................................... 9 1.4 SPECIFIC OBJECTIVE ........................................................................................................................................................... 9 1.5 TARGET GROUP .............................................................................................................................................................. 9 1.6 HEALTH CARE LEVELS ................................................................................................................................................. 9 2.0 DIAGNOSIS OF MALARIA ............................................................................................................................................. 9 2.1. CLINICAL DIAGNOSIS OF MALARIA ............................................................................................................................. 10 2.1.1 UNCOMPLICATED MALARIA ............................................................................................................................... 10 2.1.2 SEVERE MALARIA .................................................................................................................................................. 10 2.2 PARASITOLOGICAL DIAGNOSIS ............................................................................................................................... 11 3.0 MANAGEMENT OF UNCOMPLICATED MALARIA ................................................................................................. 11 3.1 CASE DEFINITION ......................................................................................................................................................... 11 3.2. TREATMENT OBJECTIVES ............................................................................................................................................... 12 3.3. TREATMENT RECOMMENDATIONS ............................................................................................................................ 12 3.3.1 FIRST LINE TREATMENT: .......................................................................................................................................... 12 3.3.2 RECURRENT FALCIPARUM MALARIA .................................................................................................................... 14 Treatment Failure .......................................................................................................................................................................... 14 3.3.3 SUPPORTIVE TREATMENT ........................................................................................................................................ 14 3.3.4 CRITERIA FOR REFERRAL .................................................................................................................................... 16 4.0 MANAGEMENT OF SEVERE MALARIA .................................................................................................................... 16 4.1 CASE DEFINITION ............................................................................................................................................................... 17 4.2 TREATMENT OBJECTIVES .............................................................................................................................................. 17 4.3 TREATMENT RECOMMENDATIONS ............................................................................................................................... 17 4.4.1 Initial emergency treatment ......................................................................................................................................... 18 4.4.2. SPECIFIC ANTIMALARIAL TREATMENT ............................................................................................................... 19 5.0 TREATMENT OF MALARIA CAUSED BY OTHER SPECIES ......................................................................................... 20 6.0 DISEASE MANAGEMENT AT THE DIFFERENT LEVELS ............................................................................................. 20 6.1 MANAGEMENT OF UNCOMPLICATED MALARIA AT THE DIFFERENT LEVELS .................................................. 20 6.1.1 Community level .............................................................................................................................................................. 20 6.1.2 Management of uncomplicated malaria at the Maternal and Child Health Post (MCHP) ............................................... 21 6.1.3 Management of uncomplicated malaria at the Community Health Post (CHP) ............................................................... 21 6.1.4 Management of uncomplicated malaria at the Community Health Centre (CHC)........................................................... 21 6.1.5 Management of uncomplicated malaria in hospital ......................................................................................................... 21 6.2 Management of Severe Malaria at Different Levels ............................................................................................................... 21 6.2.1 Community level .............................................................................................................................................................. 21 6.2.2 Management of severe malaria at the Maternal and Child Health Post (MCHP) ............................................................ 22 6.2.3 Management of Severe malaria at the Community Health Post (CHP) ........................................................................... 22 6.2.4 Management of Severe malaria at the Community Health Centers (CHC)...................................................................... 22 6.2.5 Management of severe malaria at Hospital .................................................................................................................... 22 7.0 MALARIA CHEMPROPHYLAXIS ................................................................................................................................. 23 7.1 CHEMOPROPHYLAXIS FOR NON-IMMUNE VISITORS .......................................................................................... 23 7.3 ANNEXES .................................................................................................................................................................................. 24 List of Tables Table 1:Therapeutic efficacy of artesunate+amodiaquine in four sites and artemether+lumefantrine in four sites, Sierra Leone. PCR corrected responses. .................................................................................................................................... 8 Table 2:Therapeutic efficacy of artesunate + amodiaquine in two sites and artemether+lumefantrine in two sites, Sierra Leone. PCR uncorrected responses. .............................................................................................................................................. 8 Table 3: Clinical features of uncomplicated and Severe malaria ............................................................................................... 10 Table 4: Dosage schedule for fixed combination of ASAQ treatment ........................................................................................... 13 Table 5: Treatment schedule for Paracetamol tablets 500mg ......................................................................................................... 15 Table 6 : PARACETAMOL SYRUP 125mg/5ml. ....................................................................................................................... 15 Table 7: NUMBER OF PARACETAMOL TABLETS 100MG. ................................................................................................. 15 Table 8: Treatment schedule for Acetylsalicylic acid tablets 300mg (Aspirin tablets) .................................................................. 16 4 | P a g e List of Boxes Box 1: Initial Management of Severe Malaria .................................................................................................................................. 18 Box 2: Parenteral Artesunate dosage schedule ................................................................................................................................. 19 Box 3: Treatment using parenteral Artemether ...............................................................................................................................