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Guidelines for the treatment of malaria – 2 edition

The following search terms were used:
• malaria (free text),
• malaria (controlled vocabulary, MESH or EMTREE).

The terms were used in combination with the search strategy for retrieving randomized
and controlled clinical trials developed by The Cochrane Collaboration. Key words
relative to currently available antimalarial drugs were used for each section of the
review. Where indicated, specific authors and research groups were contacted for more
information on published work and work in progress.

For the 2009 update (second edition) of these guidelines, only new recommendations
have been subjected to the GRADE process. The sub-committee developing the GRADE
profiles met in October 2008 to develop the GRADE tables based on the systematic
reviews and to formulate recommendations. Conclusions were based on universal
consensus, and areas of disagreements were extensively discussed and consensus reached.
The need for vote casting did not arise (see below for details of the grading process and
methodology).
A second technical consultation meeting of the Technical Guidelines Development
Group was convened in November 2008, at which time recommendations formulated
by the GRADE sub-committee were reviewed and adopted. A drafting committee was
established with timelines for the drafting of the accepted guidelines.

The revised draft of the guidelines was sent out for external peer review. Inputs
from the external reviewers were shared with the committee. There were no areas of
major disagreement, so, in lieu of another meeting, the minor issues were resolved
electronically.
The GRADE approach to guidelines development, which was formally adopted by WHO
in 2007, is a uniform approach that is becoming adopted globally. It aims to make explicit
the link between research evidence and formulation of recommendations, as well as the
value judgements and preferences involved.

The GRADE approach involves a four-step process:
1. Identification of the clinical questions, and the critical and important outcomes to
answer these questions;
2. Systematic reviews of the evidence (using Cochrane methodology) focusing on these
outcomes;
3. Construction of GRADE tables to summarize the data and assess the quality (or
robustness) of the evidence; and
4. Interpretation of the GRADE tables and formulation of recommendations.

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