QuestionsQuestions (DOH ADMINISTRATIVE ORDER NO. 2009-0001)
AO 2009-0001 shifts the first-line treatment of confirmed Plasmodium falciparum malaria from the CQ + SP combination to Artemether-Lumefantrine (AL) combination.
DOH cited high clinical treatment failures of chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) monotherapies/combinations in sentinel sites (exceeding WHO benchmarks), along with evidence that AL has high efficacy, better safety/tolerance, and improved compliance.
Confirmed malaria is malaria diagnosis confirmed by either (1) microscopy (gold standard showing parasites in a Giemsa-stained blood film) or (2) Rapid Diagnostic Test (RDT) kits that pass quality control and detect parasite antigens.
Microscopy is the gold standard. Standards must be maintained through a quality assurance system.
RDTs may be used when: (i) there is no microscopy center; (ii) the client must travel more than 2 hours to reach the nearest microscopy center (e.g., inaccessible coastal/island areas); (iii) there are outbreaks; or (iv) selected hospitals without a trained microscopist in an emergency situation.
All anti-malarial drugs must be selected based on WHO pre-qualification or Good Manufacturing Procedures (GMP) certifications.
Artemether-Lumefantrine (AL) combination is the first-line medicine for both confirmed uncomplicated and severe P. falciparum malaria.
QN + T/D/C for 7 days, where QN is quinine combined with either tetracycline, doxycycline, or clindamycin, regardless of whether the patient is conscious or unconscious, and also in cases of treatment failure.
Artesunate (AS) suppository can be introduced pending transfer to the next level of care.
Direct Observed Treatment (DOT) is adopted, with the first 3-day doses of AL supervised by a trained health worker, Barangay Health Worker (BHW), or treatment partner.
There must be immediate referral as deemed necessary, with pre-referral treatment using appropriate anti-malarials administered by trained health workers—especially for severe malaria and for pregnant patients and children below 5 years old.
BHWs/volunteers must supervise treatment and conduct direct observation of the intake of the first-line anti-malarial medicines of positive cases.
Follow-up smears of positive cases are to be undertaken weekly for one month post-treatment (or longer if necessary), as specified for provincial/district hospitals and rural health units, and also by BHWs.
They must be recorded and reported using the Philippine Malaria Information System (PhilMIS). If PhilMIS is not introduced or not functional, the Field Health Service Information System (FHSIS) is used; both are mainstreamed under PIDSR.
NCDPC leads execution, dissemination, coordination of essential management systems, training/orientation, procurement/distribution coordination of quality drugs, quality assurance (with BFAD/RITM/WHO), sentinel site selection for therapeutic efficacy surveillance, resource advocacy, guideline review, and monitoring CHD compliance.
CHDs cascade and adapt policies, maintain quality assurance and control teams, ensure drug/lab supply availability and distribution, conduct quarterly monitoring of utilization, maintain stock levels for outbreaks/emergencies, facilitate laboratory production centers, mobilize resources, implement advocacy plans, ensure timely reporting/surveillance, investigate adverse reactions, and monitor public/private provider compliance.
The Order takes effect immediately. It also includes a repealing clause: Administrative Order 19 (s. 1996), AO 129 (s. 2002), and other inconsistent issuances are rescinded.