Options for malaria control according to the risk of malaria

Criteria	High risk areas with multidrug resistance	Moderate or High risk areas with no drug resistance	Low risk or no risk areas
Access to prompt and effective treatment	All cases of fever in the health facilities should be investigated for malaria. Microscopy in catchments area of 30,000 population. RDT in centers with a catchments area of 5000 population In remote areas , fever cases to be treated for P falciparum using case definition since laboratory diagnosis is not available. Ensure regular supply of good quality drugs that are approved by the national policy. Injectable quinine or artmesinin derivatives for the treatment of severe malaria Choice of drugs to be based on the national policy and findings of therapeutic efficacy Ensure compliance with treatment to prevent emergence of drug resistance	In remote areas, fever cases to be treated on the basis of case definition since laboratory diagnosis is not available. Provide full course of antimalarials. Microscopy for laboratory diagnosis of malaria in catchment’s area of 30,000 population Ensure regular supply quality antimalarial drugs Use the recommended first line drugs of good quality and ensure compliance Ensure compliance	Diagnosis of fever cases based on case definition.* in areas where laboratory diagnosis is not available Microscopy in catchments area of 30,000 population Ensure regular supply of first line antimalarial drugs. Ensure compliance * The case definition of malaria is different in the low risk areas as compared with high risk area
Monitor therapeutic efficacy of drugs	Monitor therapeutic efficacy of currently used drugs or combinations to update and revise drug policy and decide the choice of antimalarials.	Monitor therapeutic efficacy to recognize the appearance of drug resistance early
Prediction early recognition and control of epidemics	Strengthen existing surveillance Prediction through meteorological data Set up early warning system using the software available Monitor population migration and breakdown in health system Train district rapid response teams Analysis and follow up of rumors and media reports Review of entomological data Establish stocks of medicines and supplies for managing epidemics Follow the guidelines issued for the control of epidemics Provide training, tools and guidelines as a part of epidemic preparedness Post epidemic control measures
Promotion of ITNs	ITNs should be used if the vector is Exophilic or exophagic. To supplement IRS. Strategy to mobilize targeted communities which accept nets (ITNs) Promote ITNs in targeted communities which do not accept nets. Consider various options including social marketing Provide ITNs to poor and marginalised people, free of cost Consider providing long lasting nets (LLINs) for people living in remote areas where regular re-treatment of the nets may be difficult Ensure a minimum of 80% coverage of the targeted population	ITNs should be used if the vector is Exophilic or exophagic Strategy to mobilize communities which accept nets (ITNs) Promote ITNs in communities in the targeted population. Consider various options including social marketing Target high risk groups (children below five and pregnant women) Ensure 80% coverage to get the impact on transmission
Monitoring progress on malaria control	Quality microscopy and RDT Regular flow of information, its analysis and feedback Case fatality rates in severe malaria in hospitals Change in therapeutic efficacy of antimalarial drugs Number of cases of fever reporting within 24 hours of occurrence Proportion of cases of fever diagnosed as malaria and treated within 24 hours of occurrence of fever Regular reporting of information and feedback	Quality microscopy Regular flow of information, its analysis and feedback Change in parasite type Case fatality rates in severe malaria in selected hospitals Monitoring of emergence of drug resistance Changes in number of malaria cases reported	Occurrence of focal epidemics Change in parasite type Change reported in malaria cases Response to treatment Regular reporting of information
Indoor residual spray and other vector control measures	Selective IRS and larvicidal measures Reduction in density of vector	Selective IRS and larvicidal measures Reduction in density of parasite	Adoption of relevant measures in impending epidemic
Community participation	Promote early recognition and treatment seeking in febrile cases Encourage referral compliance to reduce deaths in severe malaria Ensure treatment compliance Adoption of ITNs and its correct use Enlist cooperation in IRS and biological control measures	Promote early recognition and treatment seeking Encourage referral compliance Ensure treatment compliance Promote adoption of ITNs IRS and other vector control measures	Inform and mobilize the community for early care seeking treatment and referral compliance.