Treatment

Early treatment of malaria will shorten its duration, prevent complications and avoid a majority of deaths. Because of its considerable drag on health in low-income countries, malaria disease management is an essential part of global health development. Treatment aims to cure patients of the disease rather than to diminish the number of parasites carried by an infected person.

The best available treatment, particularly for P. falciparum malaria, is a combination of drugs known as artemisinin-based combination therapies (ACTs). However, the growing potential for parasite resistance to these medicines is undermining malaria control efforts (see below). There are no effective alternatives to artemisinins for the treatment of malaria either on the market or nearing the end of the drug development process.

WHO recommends:

• prompt treatment for all episodes of disease (within 24 hours of the onset of symptoms if possible);
• use of insecticide-treated nets for night-time prevention of mosquito bites;
• for pregnant women in highly endemic areas, preventive doses of sulfadoxine–pyrimethamine (IPT/SP) to periodically clear the placenta of parasites;
• indoor residual spraying to kill mosquitoes that rest on the walls and roofs of houses.

WHO guidelines for the treatment of malaria | FAQ

Drug Resistance

Drug resistance to commonly used antimalarial drugs has spread very rapidly. In order to avoid this for artemisinins, they should be used in combination as ACTs, and artemisinin monotherapy (use of one artemisinin drug versus the more effective combination pill) should not be used. The less effective single-drug treatment increases the chance for parasites to evolve and become resistant to the medicine. Intensive monitoring of drug potency is essential to protect against the spread of resistant malaria strains to other parts of the world.

WHO recommends continuous monitoring and is assisting countries as they work to strengthen drug observation efforts.

Prevention

Prevention focuses on reducing the transmission of the disease by controlling the malaria-bearing mosquito. Two main interventions for vector control are:

• use of mosquito nets treated with long-lasting insecticide, a very cost-effective method;
• indoor residual spraying of insecticides.

These core interventions can be locally complemented by other mosquito vector control methods (for example, reducing standing water habitats where insects breed, among other approaches).

Insecticide resistance

Mosquito control efforts are being strengthened in many areas, but there are significant challenges, including:

• increasing mosquito resistance to key insecticides DDT and pyrethroids, particularly in Africa;
• a lack of alternative, effective insecticides;
• changing behaviours of local malaria-bearing mosquitoes, which can result from vector control efforts (as insects move to more hospitable areas).

There are no equally effective and efficient insecticide alternatives to DDT and pyrethroids, and the development of new pesticides is an expensive, long-term endeavour. Vector management practices that enforce the sound management of insecticides are essential.

Insecticide resistance detection should be a routine feature of national control efforts to ensure that the most effective vector control methods are being used.

For more information on Vector Control: PAHO | WHO

Economic impact

Beyond the human toll, malaria wreaks significant economic havoc in high-rate areas, decreasing Gross Domestic Product (GDP) by as much as 1.3% in countries with high levels of transmission. Over the long-term, these aggregated annual losses have resulted in substantial differences in GDP between countries with and without malaria (particularly in Africa).

Malaria’s health costs include both personal and public expenditures on prevention and treatment. In some heavy-burden countries, the disease accounts for:

• up to 40% of public health expenditures
• 30% to 50% of inpatient hospital admissions
• up to 60% of outpatient health clinic visits.

Malaria disproportionately affects poor people who cannot afford treatment or have limited access to health care, and traps families and communities in a downward spiral of poverty.

Elimination

Recent data shows that large-scale use of WHO recommended strategies could rapidly reduce malaria, especially in areas of high transmission such as Africa. WHO and Member States have made significant gains in malaria elimination efforts. For example, the Maldives, Tunisia and the United Arab Emirates have eliminated malaria. Country successes are due to intense national commitments and coordinated efforts with partners.