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Guidelines for the treatment of malaria – 2 edition

regions), and in epidemics and complex emergency situations; and
■ severe malaria.

The guidelines provide a framework for the development of specific and more detailed
national treatment protocols that take into account local antimalarial drug resistance
patterns and health service capacity in the country (see Annex 2). They are not intended
to provide, or to be used, as a comprehensive clinical management guide/manual for the
treatment of malaria.

1.2.2 Target audience

These guidelines are primarily targeted at policy-makers in ministries of health, who
formulate country specific treatment guidelines. However, the following groups should
also find them useful:
■ public health and policy specialists working in hospitals, research institutions, medical
schools, nongovernmental organizations and agencies working as partners in health or
malaria control, the pharmaceutical industry and primary health-care services; and
■ health professionals (doctors, nurses and paramedical officers).

1.3 methods used in developing the guidelines and recommendations

In the first edition of the WHO Guidelines for the treatment of malaria (2006), the
methodology for identifying the questions, search and review of evidence is similar to
that used in this current update. However, the Grading of Recommendations Assessment,
Development and Evaluation (GRADE) methodology was not applied then, rather in
formulating recommendations, evidence was graded in order of priority as follows:
■ formal systematic reviews, such as Cochrane reviews, including more than one
randomized control trial;
■ comparative trials without formal systematic review;
■ observational studies (e.g. surveillance, pharmacological data);
■ expert opinion/consensus.

Since the release of the first edition of the guidelines, the WHO’s standard methods
for guidelines development has evolved and, thus, this second edition was developed
in accordance with the updated WHO standard methods for guideline development.
This methodology incorporates a transparent link between research evidence and
recommendations. The GRADE system, which has been incorporated into this update,
is a uniform approach that is being widely adopted. It employs explicit methods,
developed by the GRADE Working Group, to formulate and to evaluate the strength of
a recommendation based on the robustness of the evidence relating to a specific clinical
question. For this second edition of the guidelines, only new recommendations have been
subjected to the GRADE process (see Annex 1).
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