The use of rectal artesunate as a pre-referral treatment for severe Plasmodium falciparum malaria, 2023 update

In 2021, preliminary results of observational studies from the Community Access to Rectal Artesunate for Malaria (CARAMAL) project did not confirm the mortality impact observed in the controlled trial in 2009. Consequently, in January 2022, WHO released an information note on rectal artesunate (RAS), suggesting immediate risk mitigation measures. 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, including results of additional analyses undertaken by the WHO-appointed experts, form the basis of this updated information note on the use of RAS as a pre-referral treatment for severe Plasmodium falciparum malaria.