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1. Introduction

The development, preparation and printing of the guidelines is exclusively funded by the
WHO Global Malaria Programme. No external sources of funding either from bilateral
technical partners, or from industry, was solicited or used.

1.3.1 Method

The GRADE methodology involves a four-step process:
■ identification of the clinical questions, and the critical and important outcomes to
answer these questions;
■ systematic reviews of the evidence (using Cochrane methodology) focusing on these
outcomes;
■ construction of GRADE tables to summarize the data and to assess the quality (or
robustness) of the evidence;
■ interpretation of the GRADE tables and the formulation of recommendations.

The first meeting of the Malaria Treatment Guidelines Panel identified several key areas
for review of existing recommendations:
■ consider adding dihydroartemisinin plus piperaquine to the recommended list of
artemisinin-based combination therapies (ACTs) for uncomplicated malaria;
■ consider removing amodiaquine plus sulfadoxine-pyrimethamine from the list of
recommended antimalarials for uncomplicated malaria;
■ reconsider the recommendation of artesunate plus mefloquine in Africa, with specific
concerns regarding toxicity/vomiting in children;
■ consider the relative effectiveness of IV artesunate instead of quinine for severe malaria;
■ assess the role of ACTs in vivax malaria in areas with chloroquine-resistant P. vivax;
■ consider the best treatment for radical cure of P. vivax malaria.

A sub-group of the panel – the “GRADE sub-group” – was formed that prepared and
evaluated appropriate, up-to-date systematic reviews and developed GRADE profiles
related to these questions.

The quality of the evidence, as assessed by GRADE, is rated on a four-point scale:
■ HIGH quality: further research is very unlikely to change the confidence in the estimate
of effect;
■ MODERATE quality: further research is likely to have an important impact on the
confidence in the estimate of effect and may change the estimate;
■ LOW quality: further research is very likely to have an important impact on the
confidence in the estimate of effect and is likely to change the estimate;
■ VERY LOW quality: uncertainty about the estimate.

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