Summary W.H.O Guidelines for Malaria

Pyrethroid-pyriproxyfen ITNs vs pyrethroid-PBO ITNs (2023) Pyrethroid-pyriproxyfen ITNs are not recommended for deployment over pyrethroid-PBO ITNs for prevention of malaria in adults and children in areas with pyrethroid resistance. Remark: The conditionality of the recommendation against the deployment of pyrethroid-pyriproxyfen ITNs instead of pyrethroidPBO ITNs is based on the GDG’s judgement that the balance of effects favours pyrethroid-PBO ITNs over pyrethroidpyriproxyfen ITNs and that, based on current cost and efficacy data, pyrethroid-PBO ITNs are more cost-effective. The GDG acknowledged that evidence to support this recommendation is derived from only a single trial in Africa. Strong recommendation for , High certainty evidence Insecticide-treated nets: Humanitarian emergency setting (2022) Insecticide-treated nets (ITNs) should be deployed for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission affected by a humanitarian emergency. Remark: This recommendation is limited to classes of ITNs currently recommended by WHO. As with ITNs deployed in more stable settings, WHO recommends that ITNs that are prequalified by WHO be selected for use in humanitarian emergencies. When considering deployment of ITNs in humanitarian emergencies, the infrastructure, access, logistical capacity and resources available must be taken into account, as these may influence the feasibility and cost of procuring and deploying nets. Good practice statement Achieving and maintaining optimal coverage with ITNs for malaria prevention and control (2019) To achieve and maintain optimal ITN coverage, countries should apply mass free net distribution through campaigns, combined with other locally appropriate delivery mechanisms such as continuous distribution using antenatal care (ANC) clinics and the Expanded Programme on Immunization (EPI). Recipients of ITNs should be advised (through appropriate communication strategies) to continue using their nets, irrespective of the condition and age of the net, until a replacement net is available. Good practice statement Management of old ITNs (2019) Old ITNs should only be collected where there is assurance that: i) communities are not left without nets, i.e. new ITNs are distributed to replace old ones; and ii) there is a suitable and sustainable plan in place for safe disposal of the collected material. If ITNs and their packaging (bags and baling materials) are collected, the best option for disposal is hightemperature incineration. They should not be burned in the open air. In the absence of appropriate facilities, they should be buried away from water sources and preferably in non-permeable soil. Recipients of ITNs should be advised (through appropriate communication strategies) not to dispose of their nets in any water body, as the residual insecticide on the net can be toxic to aquatic organisms (especially fish).