Secretary Francisco T. Duque, III, MD, MSc, of the Department of Health-Philippines signed the Administrative Order 2009-0001 also known as the “Revised Policy and Guidelines on the Diagnosis and Treatment for Malaria” last January 13, 2009 in Manila. The new policy has six guiding principles: a. provision of effective diagnosis and treatment; b. primary health care approach; c. universal access; d. integrated service delivery; e. health system support; and f. multi-sectoral collaboration. In general, this policy aims to ensure early and correct diagnosis and effective treatment of all malaria cases in the country. Specifically, it aims to: guide health workers and medical practitioners in implementing the updated diagnosis and treatment of malaria; promote the compliance and adherence of the DOH offices, the LGUs and private sector to the revised diagnosis and treatment guide; generate the support of other stakeholders in facilitating the implementation of the revised diagnosis and treatment guidelines in all localities nationwide.
1. The diagnosis of malaria will be done as follows:
1.1 Microscopy will continue to be the "gold standard" for diagnosing malaria. All areas with a functional laboratory will at all times employ this standard. Microscopy standards will be maintained by a quality assurance system"`.
1.2 Diagnosis Through Rapid Diagnostic Test kits that have passed quality control tests will be used in the following situations: (i) there is no microscopy center; (ii) requires client more than 2-hours travel to the nearest microscopy centers as in inaccessible coastal or island areas; (iii) areas where there are outbreaks; and (iv) selected hospitals without a trained microscopist in emergency situation;
2. Treatment of malaria shall follow the recommended therapeutic regimen:
2.1 The Artemether-Lumefantrine (AL) combination will be the first line medicine in the treatment of
confirmed uncomplicated and severe Plasmodium falciparum malaria, replacing CQ+SP combination;
2.2 If AL is not available, whether the patient is conscious or unconscious, and in case of treatment failure, quinine (QN) in combination with either tetracycline or doxycycline or clindamycin (QN+T/D/C x 7 days), will be the second-line treatment.
2.3 In severe malaria cases wherein the patient is unconscious, and the facility has no capacity to adequately manage the patient (e.g. naso-gastric tube or intravenous therapy), Artesunate (AS) suppository can be introduced pending transfer of patient to the next level of care."
2.4 ACT can be used for all Plasmodium species and mixed infections;
2.5 All anti-malarial drugs will be selected based on pre-qualifications by WHO or Good Manufacturing Procedures (GMP) certifications
3. Direct Observed Treatment (DOT) will be adopted as the mode of treatment of all patients, with the first 3-day doses of AL treatment supervised by a trained health worker, BHW or treatment partner;
4. Immediate referral of patients will be done as deemed necessary with pre-referral treatment of appropriate anti-malarials administered by trained health workers especially of cases with severe malaria and in patients who are pregnant and children below 5 years old;
5. Competent health care providers will carry out diagnosis and treatment of malaria. Re-orientation and re-training will be conducted especially in endemic areas;
6. Diagnosis and treatment of malaria will be supported with adequate and quality drugs and other logistics required. The DOH shall provide for the national requirements of anti-malarial medicines while the provision of laboratory supplies shall be a shared responsibility between the DOH-Centers for Health Development (CHDs) and the LGUs. Anti-malarial drugs will be made available to all public and private health facilities. Upon effectively of this issuance, remaining unexpired stocks of sulfadoxine-pyrimethamine (SP) must be used before shifting to AL.
7. Malaria cases must be appropriately recorded and reported using the Philippine Malaria Information System (PhilMIS). In areas where PhilMIS has not been introduced or not yet functional, the regular Field Health Service Information System (FHSIS) will be used. PHILMIS and FHSIS will be mainstreamed under the Philippine Integrated Disease Surveillance and Response (PIDSR).
8. The compliance and adherence of all concerned entities to the revised policy and guide will be monitored on a regular basis.
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