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Malaria in Pregnancy, Diagnosis and Treatment (Green-top Guideline No. 54B)

Published: 28/04/2010

This is the first edition of this guideline.

Update February 2017: Following a review of the guidelines in December 2016, minor amendments have been made. The version available here is the most up to date. The date on the guideline has not been changed since no amendments were made to the content.

Update December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.

Update August 2010: In August 2010 a very minor amendment was made to this guideline (see table 1 on page 8, regarding Primaquine). This amendment does not impact on the overall recommendations within the guideline.

Malaria is the most important parasitic infection in humans and is the tropical disease most commonly imported into the UK, with approximately 1500 cases reported each year and rising, apart from 2008. Immigrants and second- and third-generation relatives returning home assuming they are immune from malaria are by far the highest-risk group. They may take no prophylaxis or may be deterred by the cost, may not adhere to advice, may receive poor advice or some combination of these factors. 

In the UK, the prevalence of imported malaria in pregnancy is unknown. A review of the burden of malaria in pregnancy estimated that about one in four women in sub-Saharan Africa in areas of stable transmission has malaria at the time of birth. Online and telephone enquiries with the Health Protection Agency and Eurosurveillance archives and reviews of published reports failed to uncover a report of maternal death from malaria in UK for the past 10 years. Maternal deaths from malaria are unlikely to be reported when they occur in endemic countries.

The aim of this guideline is to provide clinicians with up-to-date, evidence-based information on the diagnosis and treatment of malaria in pregnancy, in situations that are likely to be encountered in UK medical practice. Initial rapid assessment and management is covered in Appendix 1. Prevention of malaria is covered in Green-top Guideline No. 54A: The prevention of malaria in pregnancy.