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

The note follows the recommendations from the October 2021 Malaria Policy Advisory Group meeting:

• Countries that have not yet introduced pre-referral RAS but are considering doing so should withhold implementation and await further guidance from WHO on the criteria that need to be met to ensure the safe and efficacious use of RAS.
   
• Countries that have already adopted and are deploying pre-referral RAS should urgently review in detail the conditions under which it is currently being used. This includes all three steps along the cascade of care: (i) diagnosis and administration of RAS; (ii) immediate referral; and (iii) complete treatment with at least 24 hours of injectable artesunate and a three-day ACT. Countries that have already adopted pre-referral RAS are encouraged to withhold further expansion of its use until further guidance from WHO.