The following is a summarized National Guidelines on Malaria Diagnosis and Treatment:
1. All suspected case i.e patient presenting with fever must have parasitology test done (mRDT or microscopy)
2. Only confirm cases of malaria should be treated with ACTs to avoid resistance.
3. Assessment is either i) uncomplicated malaria or ii) severe malaria.
4. Uncomplicated malaria is fever, joint pain, headache, etc. PLUSE positive parasitology test.
5. Severe malaria is all of the above PLUS any of the following; loss of consciousness, multiple convulsion, severe anaemia, severe dehydration, hyperthermia, hyperparasitamia, haemoglobinuria, hypoglycaemia, prostration, etc.
6. National Guidelines recommends AL (first line) or AA for Uncomplicated malaria.
7. AL is prescribed as follows; stat, second dose 8hrs after first dose, third dose 24hrs after first dose, then 12hrly up to 3/7. AA is given once daily for 3 consecutive days.
8. Severe malaria is treated with IV Artesunate 3mg/kg for patient < or = 20kg or 2.4mg/kg for patient > or =20kg up to 60kg (max. of 144mg per dose) given at 0hr, 12hr and 24hr, then daily until patient can tolerate orally. If patient can tolerate orally, continue ACTs as above.
9. Artesunate should be reconstituted using 1ml of HCO3 first then 5mls of water for injection giving a total of 6mls for IV route (1ml = 10mg) or 2mls water for injection giving a total of 3mls for IM route (1ml = 20mg)
10. For severe malaria do microscopy 8hly to ensure the parasite density is reducing
11. For uncomplicated malaria ensure patient comes back after in 3days for repeat microscopy to ensure his/her blood is cleared of MP
12. Babies <5kg can also take same dose of AL as 5kg -14kg – update
13. Pregnant women should take first dose of IPT (SP) after quickening, then 4weekly until delivery – update.
14. All patient on Co-trmoxazole do not need Sulfadoxine/Pyrimethamine (SP) as Co-trmoxazole is also preventive against malaria.
Take note of the following:
1. Do not prescribe Artesunate or ACTs with vitamin C, multivitamin containin vitamin C, fruit juice, and oranges.
2. Do not reuse reconstituted artesunate after 2hrs.
3. mRDT can remain positive up to 4/52 or more after treatment. That doesn’t mean treatment failure.
Thank you for your time.
For more information on this subject, get the book: Malaria War (The Winning Strategies) by Livy-Elcon Emereonye.