**5. Treatment of uncomplicated malaria caused by** *P. falciparum*

Uncomplicated malaria is defined as a patient having symptoms of malaria and a positive parasitological test (microscopy or RDT) but with no clinical manifestation of severe malaria. The clinical goals of treating uncomplicated malaria are to seek to the total elimination of all parasites from the body as rapidly as possible followed by preventing progression to severe disease. The public health goals of treatment are to prevent onward transmission of the infection to others, prevent the emergence and spread of resistance to antimalarial medicines [46].

The WHO recommends that children and adults with uncomplicated *P. falciparum* malaria (except pregnant women in their first trimester) are to be treated with one of the following recommended ACTs:


The duration of ACT treatment regimens should provide 3 days' treatment with an artemisinin-derivative [46].

Pregnant women with uncomplicated *P. falciparum* malaria during the first trimester are to be treated for 7 days with quinine + clindamycin. Also, infants weighing less than 5 kg are to be treated with an ACT at the same mg/kg body weight target dose as for children weighing 5 kg. In addition, people with HIV/AIDS and having uncomplicated *P. falciparum* malaria, should avoid artesunate + SP if they are also receiving co-trimoxazole, also, they are to avoid artesunate + amodiaquine if they are also receiving efavirenz or zidovudine [46].

#### **6. Treatment of uncomplicated malaria caused by** *P. vivax*

The utilization of artemether-lumefantrine, atovaquone-proguanil, or quinine sulfate with doxycycline or tetracycline (or clindamycin for pregnant women and children <8 years old), are recommended treatment for uncomplicated malaria caused by *P. vivax*. Also, mefloquine can be used if no other options are available. In addition, primaquine phosphate can be used in combination with any of the medication options for treatment of the acute phase of infection [46].

#### **7. Treatment of severe malaria**

Patients with clinical manifestations and features of severe malaria; coma, hemoglobin of less than 7 g/dL, acute kidney injury, acute respiratory distress syndrome, shock, acidosis, jaundice should be treated promptly and aggressively with parenteral antimalarial therapy regardless of the species of malaria noted. All patients with severe malaria, regardless of infecting species, should be treated with intravenous (IV) artesunate [47].

The objective of management of severe malaria infection is to prevent deaths from the direct effect of the disease or its complications through the use of appropriate emergency supportive measures, diagnostics and the recommended antimalaria medications. The goals of management of severe/complicated malaria are to provide:


#### **8. Mass drug administration**

Mass drug administration (MDA) is defined as the provision of a therapeutic dose of an effective anti-malarial medication to the entire target population, irrespective of infection status or symptoms. The MDA is a strategy recommended by the WHO for the elimination of *Plasmodium falciparum* malaria in areas approaching interruption of transmission, as well as where multidrug resistance is present,

given the prerequisites of good access to case management, effective vector control and surveillance, and limited potential for reintroduction [48].
