The World Health Organization (WHO) malaria guideline received a pair of notable updates earlier this month. The two major changes involved indoor spraying and spatial emanators. Below you will find the updated recommendations along with an overview of each recommendation.

Clinicians should always emphasize malaria risks for travelers visiting endemic areas. Patients need awareness of prevention strategies, including those outlined in the WHO's malaria guideline. Clear communication and guidance help ensure patient safety and reduce transmission rates.

WHO Malaria Guideline Summary

Key Elements of the 2025 Update:

1. Indoor Residual Spraying Recommendation:

  • Indoor residual spraying (IRS) should be deployed for the prevention and control of malaria in children and adults living in areas with ongoing malaria transmission.
  • Recommendation level: Strong, Very Low Certainty of Evidence


2. Spatial Emanators Recommendation:

  • Spatial emanators can be deployed for the prevention and control of malaria in children and adults in areas with ongoing malaria transmission.
  • Recommendation level: Conditional, moderate certainty of evidence.
New Recommendations Overview

Regarding the IRS recommendation, WHO recommends that the products it classifies as insecticides be used, as it’s a list of prequalified products, with consideration of the insecticide’s effects based on the local malaria vector(s).

WHO considers IRS appropriate when the malaria vector primarily feeds/rests indoors, if people sleep outdoors at night, if the malaria transmission pattern is such that one or two rounds of IRS a year is protection enough, or if the majority of structures are suitable for spraying.

Regarding spatial emanators, the WHO guideline update states that malaria prevention programs should ensure that targeted coverage levels of interventions recommended for large-scale deployment are met and upheld, and only indoor use of spatial emanators was assessed in the development of the recommendation. WHO recommends choosing spatial emanators that are prequalified by WHO for use. 

When planning for spatial emanators, WHO states that malaria programs should plan for the additional costs of resources and monitor the deployment to collect information for analysis.

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