Case Management of Malaria

Strategies for case management of malaria are usually an integral part of the national malaria control program in countries where malaria is endemic (WHO 2015). Malaria can quickly escalate in severity and, if untreated, lead to severe anemia and death. Early diagnosis should be followed by prompt, effective treatment within 24–48 hours of the onset of symptoms. For the malaria species Plasmodium falciparum, the recommended first line treatment for uncomplicated malaria is a fixed-dose artemisinin-base combination therapy, although pregnant women in the first trimester and other special risk groups may require different treatments or dosing regimens. Treatment of complicated malaria should start with intravenous or intramuscular injections of artesunate until the patient can tolerate oral therapy with artemisinin-base combination therapy.

Infection by other species may require different treatments, depending on antimalarial resistance in the area¹. Antimalarial drug resistance—a growing concern—has led to increases in malaria cases and treatment failures in Asia (Tilley et al. 2016).

Measurement and data sources

Population-based surveys typically report the percentage of children under age 5 who have experienced fever in the two weeks preceding data collection. For those children, the survey collects information on the percentage for whom advice or treatment was sought, who had blood taken from a finger or heel for testing, and who took any artemisinin-base combination therapy.

Surveys that collect information related to coverage of malaria case management include—

• Demographic and Health Surveys
• Malaria Indicator Surveys
• Multiple Indicator Cluster Surveys
• Knowledge, Practice, and Coverage Surveys
• other research or evaluation activities.

Information related to malaria treatment is sometimes available through the country’s health monitoring information system. Consider the usage of health care services in your context when interpreting findings, because not all people suffering from malaria will seek services at the facility. However, in Africa, careseeking for fever is generally high for children under 5 years of age.

Methodological issues

• Always consider seasonality when interpreting malaria data, especially for population-based surveys. Generally, survey reports indicate when the survey was conducted so that data are interpreted appropriately. Malaria transmission rates—(and the resulting stock flows) at the time of data collection— will affect the comparability of these estimates over time and across studies. For instance, Demographic and Health Surveys often avoid the rainy season, given the difficulties inherent with data collection at this time, while Malaria Indicator Surveys are deliberately scheduled during the rainy season to capture indicators during a season of high malaria transmission.