Case study

DFID Research: WHO publishes second edition of guidelines for the treatment of malaria

A Cochrane Review by the DFID-funded Effective Health Care Research Consortium helped to define policies in the new edition of the guidelines

Insecticide-treated bed net.
Insecticide-treated bed net. Picture: Thomas Omondi/DFID

The World Health Organization (WHO) has published a new edition of Guidelines for the Treatment of Malaria, in collaboration with The DFID-funded Effective Health Care Research Consortium (EHCRC). EHCRC was commissioned to assess and synthesise relevant evidence, and to lead the Grading of Recommendations Assessment, Development and Evaluation process within the Guideline Committee. This research was carried out as a large Cochrane Review that compared various artemisinin-based combination therapies (ACTs). ACTs are a relatively new type of treatment that has transformed the treatment of malaria, but if not used properly the medicine can be ineffective.

Peter Olumese from Roll Back Malaria, responsible for organizing WHO’s Malaria Guideline Panel, said “There was so much new research since the last guidelines were published, we needed to commission this specialised team to synthesise them for the panel”.

The Cochrane Review helped to define policies in the new edition of the guidelines. By examining the effects of ACTs it found that dihydroartemisinin plus piperaquine is an effective first line treatment for Plasmodium falciparum malaria. As a result of this research the drug was added to the previous list of recommended medicines and two other drug combinations were dropped.

The Malaria Guideline Panel had not used this method before and the EHCRC briefed and guided the panel through the process and helped the panel formulate evidence based recommendations. This ensured an explicit link between the evidence and the new recommendations included in the guidelines.

The big steps that have been taken since the widespread adoption of ACTs are reflected in this second edition. The first edition in 2006 led to countries abandoning some of the old treatments, which had become increasingly ineffective, in favour of using ACTs. However, it was important to bring together more recent advances using this method in the new edition, as part of the continued effort to further reduce malaria transmission and the risk of the malaria parasite developing further drug resistance.

Published 15 March 2011