The use of rectal artesunate as a pre-referral treatment for severe P. falciparum malaria

The use of rectal artesunate as a pre-referral treatment for severe P. falciparum malaria

This information note on the use of rectal artesunate (RAS) as a pre-referral treatment for severe P. falciparum malaria is based on the findings of a recent study conducted in 3 African countries. 

The reported findings raise significant concerns over the effectiveness of RAS in real-life settings, which are often associated with shortcomings in terms of referral and quality of care. Furthermore, the study documents the potential for harm and increased mortality if pre-referral RAS is not strictly implemented in line with existing WHO guidelines.

The WHO Global Malaria Programme, in consultation with other relevant departments, will conduct a formal evidence review and develop detailed guidance on the conditions under which the use of this tool can be implemented safely and effectively. Such guidance will be shared with countries as soon as it becomes available. 

*The original English version of this document has been translated to into French and Spanish

NOTE: To provide clarity on the evidence, WHO subsequently convened independent experts to conduct a formal evidence review of the data from the CARAMAL project, as well as data from other studies evaluating the deployment of pre-referral RAS at programmatic level. The outcomes of the review, formed the basis of an updated information note (2023).