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11. Complex emergencies and epidemics

such circumstances, treatment based solely on the clinical history (mass fever treatment,
see Section 11.2.1) may be necessary for a proportion of patients. This course of action
should only be followed when it has been established that the epidemic is due to malaria
and not to some other infectious disease. It is important to monitor the clinical response
to such symptom-based treatment, because other infections may also be present. In all
circumstances, parasite-based diagnosis is needed to:
• diagnose malaria as the cause of an epidemic of febrile illness;
• monitor the epidemic curve and confirm the end of an epidemic;
• follow progress in infants, pregnant women, those with severe malaria, the severely
malnourished, and suspected treatment failures.
The latter can only be done with microscopy. Microscopy capacity is also needed for
field quality control of rapid diagnostic tests and it is, therefore, necessary to build this
capacity as soon as possible.

11.1.2 Use of rapid diagnostic tests
Rapid diagnostic tests offer the advantage of being quick to perform with less need for
skilled laboratory technicians in epidemic situations. However, heat stability may be a
problem and false-negative results may be seen. Current experience with RDTs indicates
that they are useful for confirming the cause and end-point of malaria epidemics.

11.2 management of uncomplicated falciparum malaria

Most malaria patients in epidemics and emergencies are non-immune, partially immune,
or otherwise vulnerable to severe disease. An active search should be made for febrile
patients to ensure that as many patients as possible receive adequate treatment, rather
than relying on patients to come to a fixed clinic. The principles of treatment are the same
as elsewhere (see Section 7). The antimalarials to be used for treatment must be highly
efficacious (> 95% cure), safe and well tolerated so that adherence to treatment is high.
Complete courses of treatment should always be given in all circumstances. Artemeter-
15
lumefantrine is the default ACT in the Interagency Emergency Health Kit (IEKH 2006)
malaria module. Alternatively, ACT as per the national policy can be used.

11.2.1 Mass fever treatment
Mass fever treatment is the treatment of suspected malaria cases on clinical grounds
without laboratory confirmation for each patient. This may be a temporary operational
necessity in epidemics and in complex emergency situations when medical staff are
dealing with overwhelming malaria case-loads during a confirmed malaria epidemic.

15 http://www.who.int/making_pregnancy_safer/documents/wb1052006in/en/
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