Table 2 Malawi’s experience in decision-making for PDMC drug choice

In May 2023, stakeholders in Malawi (including the Ministry of Health) held a co-design workshop to determine the preferred delivery strategy and ACT for PDMC. A key output of that workshop was the decision to re-frame PDMC as ‘post-discharge malaria continuum of care (PDMCC)’ to reconcile the tension between WHO guidance on PDMC and implementation feasibility. Under this strategy, Malawi has opted to use DP for PDMC, which is also going to be the first-line treatment for uncomplicated malaria and the drug with which children will be discharged from hospital. The rationale was that it would ensure a continuum of care—with caregiver and healthcare providers already familiar with DP dosing. In addition, using DP post-discharge would likely create fewer procurement and supply chain complications