Intended for healthcare professionals


Bridging the quality gap in diagnosis and treatment of malaria

BMJ 2020; 369 doi: (Published 22 April 2020) Cite this as: BMJ 2020;369:m1176
  1. Daniel J Ikeda, senior programme manager1,
  2. Roly Gosling, director2,
  3. M James Eliades, Asia malaria elimination director3,
  4. Amanda Chung, associate director2,
  5. Joseph Murungu, Southern Africa regional director1,
  6. Bruce D Agins, director1
  1. 1HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, CA, USA
  2. 2Malaria Elimination Initiative, Institute for Global Health Sciences, University of California, San Francisco, CA, USA
  3. 3Population Services International, Yangon, Myanmar
  1. Correspondence to: daniel.j.ikeda{at}

Controlling and eliminating malaria will require intensified efforts to improve the quality of diagnosis and treatment argue Daniel Ikeda and colleagues

The rapid scale-up of malaria prevention and treatment over the past two decades has led to significant reductions in its related morbidity and mortality worldwide. In sub-Saharan Africa, where over 90% of global cases are reported, an estimated 663 million new cases and five million deaths have been averted since 2000.1 Despite these impressive gains, global control and elimination remain challenging.2 Billions of people worldwide are at constant risk of infection; resistance to insecticides and treatment regimens continues to spread; year on year reductions in incidence and mortality have stalled; and over 400 000 people die from malaria each year.3

Approaches to service delivery have assumed that increasing the coverage of services, such as vector control, treatment, and surveillance, is sufficient to achieve optimal outcomes. But to achieve the ambitious aim of eradicating malaria worldwide by 2050, the global response can no longer rely on coverage alone. The biggest gap in treatment remains the ability of a febrile patient to access healthcare, but once a patient enters the health system, delivery of high quality care is essential (table 1).

View this table:
Table 1

Defining high quality malaria care*

In this analysis, we highlight significant gaps in the quality of diagnosis and treatment of malaria and health systems with limited capacity to respond nimbly to these gaps. We contend that to maintain the gains of malaria control and elimination, health systems need to routinely monitor the quality of the diagnosis and treatment of malaria and develop sustainable approaches to bridge gaps in quality using quality improvement principles.

Significant gaps in the quality of diagnosis and treatment of malaria

Early identification and treatment are fundamental to preventing malaria related morbidity and mortality. Despite clear guidelines and the availability of appropriate diagnostic tests, the …

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