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Guidelines for the treatment of malaria – 2 edition

7.8.1 Home-based management of malaria
Home-based management of malaria (HMM) is one of the strategies recommended by
WHO to improve access to prompt and effective treatment of malaria episodes through
trained community members living as close as possible to where the patients live. Recently,
evidence has been produced on the feasibility, acceptability and effectiveness of ACTs
used within the context of HMM, supporting HMM as a public health strategy as well as
adding to the evidence base for scaling up implementation of HMM with ACTs. 10,11 Home
management of malaria allows for coverage of the health services for malaria to extend
beyond the reach of health facilities. It requires that effective and appropriate treatment
with first-line ACTs, as well as guidance on referral criteria are provided at the community
level through trained community-based providers, such as community health workers,
mother coordinators and private vendors. The inclusion of pre-referral treatment with
rectal artesunate and RDTs is recommended, where feasible. Further operational research
is needed to optimize the use of RDTs within the context of HMM. HMM is now being
integrated within the overall platform of the Community Case Management of childhood
illnesses (CCM).

7.8.2 Health education
At all levels, from the hospital to the community, education is vital to optimizing
antimalarial treatment. Clear guidelines in the language understood by the local users,
posters, wall charts, educational videos and other teaching materials, public awareness
campaigns, education and provision of information materials to shopkeepers and other
dispensers can all improve the understanding of malaria. This will increase the likelihood
of improved prescribing and adherence, and appropriate referral, and will minimize the
unnecessary use of antimalarials.

7.8.3 Adherence to treatment
Patient adherence is a major determinant of the response to antimalarials, as most
treatments are taken at home without medical supervision. To achieve the desired
therapeutic effectiveness, a medicine must be efficacious and it must be taken in the
correct doses at the proper intervals. Studies on adherence suggest that 3-day regimens
of medicines such as ACTs are adhered to reasonably well, provided that patients or
caregivers are given an adequate explanation at the time of prescribing and/or dispensing.
Prescribers, shopkeepers and vendors should, therefore, give a clear and comprehensible
explanation of how to use the medicines. Co-formulation is probably a very important
contributor to adherence. User-friendly packaging (e.g. blister packs) also encourages
completion of the treatment course and correct dosing.
10 Ajayi IO et al. Feasibility and acceptability of artemisinin-based combination therapy for the home management
of malaria in four African sites. Malaria Journal, 2008, 7:6. doi:10.1186/1475-2875-7-6
11
Ajayi IO et al. Effectiveness of artemisinin-based combination therapy used in the context of home management
of malaria: A report from three study sites in sub-Saharan Africa. Malaria Journal 2008, 7:190. doi:10.1186/1475-
2875-7-190
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