Key recommendations
- A reliable malaria surveillance system should be established as soon as possible. The system should detect cases and monitor trends, based upon laboratory confirmation of Plasmodium falciparum infection in persons with fever. This may require strengthening existing systems.
- Use of Rapid Diagnostic Tests (RDTs) at peripheral health facilities will be important to target appropriate treatment, differentiate malaria from other causes of febrile illness, and help define the local epidemiology.
- If an increase in the number of malaria cases is detected, targeted vector control strategies based on an entomologic assessment should be implemented; active case detection may be useful, including screening (using RDTs) of febrile individuals living in the same household as the index case.
- If there is a large malaria epidemic, mass RDT-screening by mobile teams of all individuals in the region of the outbreak and treatment of persons with positive tests (regardless of symptoms) may be indicated. If it is operationally difficult to obtain laboratory confirmation for each case, presumptive treatment of malaria/fever cases based on a standard case definition could be considered to reduce morbidity and mortality.
- Because P. falciparum malaria has non-specific symptoms, can be fatal, and is easily treated if therapy is begun promptly, it is important to include malaria in the differential diagnosis of febrile illnesses. Unless there is another obvious cause of illness, all cases of fever should be tested for malaria and treated based on the results.
- Entomologic assessments should be done to assess levels of insecticide resistance and to monitor mosquito abundance. The latter helps to measure the impact of vector control interventions such as larviciding, spraying, or deploying insecticide-treated materials.