For the prevention of drug resistance, and in keeping with good clinical practice, countries should intensify their efforts to scale-up testing of suspected malaria cases before treatment with antimalarials. Presumptive treatment of malaria should be phased out as soon as possible. Each country is encouraged to develop its own operational plan, with, appropriate targets and timelines, and submit this plan to the HANMAT/ PIAMNET network. Resources to be secured from national or donor resources.
Countries of HANMAT and PIAmnet should urgently review and update their antimalarial drug policy taking into consideration the following:
– include single dose primaquine as a gametocytocidal drug (for P. falciparum) for all EMR countries and for Ethiopia and Eritrea in AFR;
– include injectable artesunate as first option for treatment of severe malaria ;
– include radical treatment of PV/PO with primaquine (14 day or 8 weeks regimen);
– Indicate the treatment of mixed infections, according to WHO guidelines.
WHO Somalia should organize a meeting with all stakeholders for urgent review and update of the drug policy, in response to the 2011 study, where high failure rates with AS+SP were observed in Jamame, and the high proportion of SP quintuple mutations found in Jowhar and Jamame. The drug policy should consider the efficacy of ART+ LUM observed during the 2013 study in Jowhar and Janale. The meeting should also review the policy of intermittent preventive treatment in pregnancy (IPTp) and its current value in Somalia, given the decrease in the prevalence observed during the MIS survey in 2013.
Countries (especially Sudan, Pakistan, Djibouti) should take strong actions and enforce regulations to ban the use of injectable artemether for the treatment of uncomplicated malaria. Country offices should follow up and update the Regional office on action taken
Countries to continue activities for monitoring in vivo efficacy of first- and second-line drugs and other potential medicines for treating falciparum malaria, and collect filter papers for day zero (preferably 2 papers) to perform molecular marker analysis of mutations associated with SP resistance as well as K13 mutations for artemisinin resistance .
Countries with a high proportion of vivax malaria, to include monitoring the efficacy of CQ for vivax malaria and efficacy of other potential alternatives.
NAMRU-3 to continue to cooperate in molecular analysis. Subsequent to retrieving ethical clearance from local authorities, Day 0 samples from 2013 studies can be analysed for K13 mutations.
WHO to have standard protocol to survey the prevalence of G6PDd and support research studies to update this information. A meeting to be conducted to involve all partners working for mapping G6PDd, relevant researchers and programme staff to develop a joint action plan.
Countries are encouraged to share the results of the drug efficacy studies in international journals, WHO will support countries in developing the manuscripts and in publications .