Page 23 - 80 guidelines for the treatment of malaria_opt

6. Diagnosis of malaria

alternative antimalarial medicine for use at public health level within the context of
national treatment guidelines, should be based on an average cure rate of > 95%, as
assessed in clinical trials.

6. diaGnosis of malaria

Prompt and accurate diagnosis of malaria is part of effective disease management. The
diagnosis of malaria is based on clinical suspicion and on the detection of parasites in the
blood (parasitological or confirmatory diagnosis). High sensitivity of diagnosis in malaria-
endemic areas is particularly important for the most vulnerable population groups, such
as young children and the non-immune population, in whom the disease can be rapidly
fatal, while high specificity will reduce unnecessary treatment with antimalarials and
improve diagnosis of other febrile illnesses in all settings. Thus, high quality malaria
diagnosis is important in all settings. Further information on the diagnosis of malaria
is provided in Annex 5.

6.1 clinical diagnosis

The signs and symptoms of malaria are nonspecific. Malaria is clinically suspected mostly
on the basis of fever or a history of fever. Diagnosis based on clinical features alone has
very low specificity and results in over-treatment. Other possible causes of fever and the
need for alternative or additional treatment must always be carefully considered. The
WHO recommendations for clinical diagnosis/suspicion of uncomplicated malaria in
different epidemiological settings are as follows:
4
■ in settings where the risk of malaria is low, clinical diagnosis of uncomplicated malaria
should be based on the possibility of exposure to malaria and a history of fever in the
previous three days with no features of other severe diseases;
■ in settings where the risk of malaria is high, clinical diagnosis should be based on a
history of fever in the previous 24 h and/or the presence of anaemia, for which pallor
of the palms appears to be the most reliable sign in young children.

In all settings, clinical suspicion of malaria should be confirmed with a parasitological
diagnosis. However, in settings where parasitological diagnosis is not possible, the decision
to provide antimalarial treatment must be based on the prior probability of the illness
being malaria. Other possible causes of fever and need for alternative treatment must
always be carefully considered.

4 WHO Expert Committee on Malaria. Twentieth report. Geneva, World Health Organization, 2000 in WHO
Technical Report Series, No. 892.
9