0202609061609
Stakeholders have been involved at different stages of the evidence-to-policy pathway, including identifying evidence needs, informing methodological development, developing and implementing evidence-based recommendations, digitising national guidelines, and informing how guidelines should be disseminated and used. This report focuses on the guideline development work of the consortium. The consortium is designed to promote the translation of evidence of artemisinin and other drug resistance of public health significance to inform better malaria policy and practice before drug resistance increases the number of malaria cases and deaths, and provides technical support to the 18 countries of Southern and East Africa, the area historically first affected by drug resistance. The consortium is led by Karen Barnes. The University of Cape Town is the overall project coordinator and African scientific project lead, with LINQ as the project management partner supporting the University of Cape Town and the whole consortium under Work Package 5. The guideline development work sits within Work Package 4, Implementation into Policy and Practice, which is led by the MAGIC Evidence Ecosystem Foundation. Work Package 4 begins through annual dialogues with evidence review groups, National Malaria Programmes and National Malaria Control Programme implementation partners on the most appropriate responses to any antimalarial evidence generated in Work Packages 1 to 3, and an expedited process is initiated should new evidence of significant antimalarial resistance be identified. Additional technical support is provided to two self-selected National Malaria Programmes that formally commit to their need to update their malaria treatment guidelines to respond to the threat of antimalarial resistance, at least at sub-national level. Their existing malaria guidelines are migrated into MAGICapp and a systematic, transparent process using a GRADE approach is followed to update these guidelines. The needs of primary health care workers are identified and prioritised to inform development of additional MAGICapp functionalities and presentation formats. In Malawi, MARC SE-Africa worked with the Malawi National Malaria Programme, Ministry of Health representatives and the relevant Malaria Technical Committee to update and digitise the Malawi national malaria guideline. The uncomplicated malaria section was specifically updated using systematic evidence synthesis, GRADE standards and methods, and evidence-based guideline-development processes, and included the development of recommendations addressing multiple first-line treatments for uncomplicated malaria. These updated recommendations were developed directly within MAGICapp, enabling recommendations to be presented together with the underlying evidence and certainty assessments. The remainder of the existing Malawi malaria guideline was migrated from the previous PDF guideline into MAGICapp, and those sections were not newly assessed using GRADE as part of this work.
MARC SE-Africa is a 48-month project funded by the Global Health EDCTP3 Joint Undertaking and its members, established under the European Union's research and innovation programme, Horizon Europe.STARDIT ID:
0202609061609State ongoing
Start 2023-04-01
End 2027-09-09
Form updated 2026-09-07
Inputs
MAGIC Evidence Ecosystem Foundation (link)
Task: Leads Work Package 4, Implementation into Policy and Practice
Method: Migration of existing national malaria guidelines into MAGICapp | Updating of guidelines using a GRADE approach
University of Cape Town (link)
Task: Overall project coordinator | African scientific project lead | Coordinating institution | Listed partner in Work Package 4, Implementation into Policy and Practice
Malawi National Malaria Programme
Task: Worked with MARC SE-Africa to update and digitise the Malawi national malaria guideline | Involved in the process of updating and digitising the guideline
Method: Systematic evidence synthesis, GRADE standards and methods, and evidence-based guideline-development processes for the uncomplicated malaria section | Migration of the remaining guideline sections from the previous PDF guideline into MAGICapp
Impact: Malawi stakeholders contributed to the development, review and implementation of the updated guideline
Ministry of Health, Malawi
Task: Ministry of Health representatives were involved in the process of updating and digitising the Malawi national malaria guideline
Impact: Malawi stakeholders contributed to the development, review and implementation of the updated guideline
Malaria Technical Committee, Malawi
Task: Involved in the process of updating and digitising the Malawi national malaria guideline
Impact: Malawi stakeholders contributed to the development, review and implementation of the updated guideline
LSTM (link)
Task: Listed partner in Work Package 4, Implementation into Policy and Practice
UR (link)
Task: Listed partner in Work Package 4, Implementation into Policy and Practice
Per Olav Vandvik (link)
Task: Lead of Work Package 4, Implementation into Policy and Practice | Co-author of the SPICE-GRADE publication
Chief Executive Officer, MAGIC Evidence Ecosystem Foundation. Affiliations listed by MAGIC. Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway. Professor, Faculty of Medicine, University of Oslo, Norway. Researcher, Norwegian Institute of Public Health, Oslo, Norway.
Joaniter Nankabirwa (link)
Task: Named co-lead of Work Package 4, Implementation into Policy and Practice
Affiliation given on the source page as IDRC.
Rhona Mijumbi (link)
Task: Named co-lead of Work Package 4, Implementation into Policy and Practice | Lead of Work Package 1, Network, Landscape and Gap Analysis
Affiliation given on the source page as LSTM.
Karen Barnes (link)
Task: Leads the MARC SE-Africa consortium | Named contributor to Work Package 1, Network, Landscape and Gap Analysis | Named contributor to Work Package 3, Detailed Action Plan to Respond to Antimalarial Resistance | Co-author of the SPICE-GRADE publication
Affiliation given on the source page as UCT. Named in the report authorship as Karen I. Barnes.
Prashanti Eachempati (link)
Task: First author of the SPICE-GRADE publication | Prepared this STARDIT report
Consultant Senior Researcher on the MARC-SE project. Affiliations listed by MAGIC. MAGIC Evidence Ecosystem Foundation. Co-convenor, Cochrane Priority Setting Methods Group. Trainer for Cochrane Malaysia. Clinical Lecturer and Year 3 Program Lead, Peninsula Dental School, University of Plymouth, United Kingdom. Adjunct Professor, Faculty of Dentistry, Manipal University College Malaysia.
Malaria researchers and infectious disease experts within MARC SE-Africa
Task: Contributed expertise concerning emerging artemisinin resistance and Plasmodium falciparum Kelch13 (K13) mutations
Impact: These perspectives highlighted a gap between early molecular indicators of resistance and the evidence required to support treatment-policy decisions, and contributed to methodological work examining how multiple sources of direct and indirect causal evidence could be considered together
Researchers considered K13 mutations important early indicators of emerging artemisinin resistance.
Policymakers and those responsible for malaria treatment policy
Task: Identified an evidence need to understand whether and how early resistance markers translated into downstream clinically and programmatically important outcomes, particularly recrudescence and treatment failure
Method: Involvement through MARC SE-Africa work packages
Impact: These perspectives highlighted a gap between early molecular indicators of resistance and the evidence required to support treatment-policy decisions, and contributed to methodological work examining how multiple sources of direct and indirect causal evidence could be considered together
National Malaria Programmes
Task: Engaged with the project leadership regarding their evidence and policy needs | Participated in annual dialogues on the most appropriate responses to any antimalarial evidence generated by the consortium
Method: Annual dialogues
Additional technical support is provided to the two self-selected National Malaria Programmes that formally commit to their need to update their malaria treatment guidelines to respond to the threat of antimalarial resistance, at least at sub-national level.
Evidence review groups
Task: Participated in annual dialogues on the most appropriate responses to any antimalarial evidence generated by the consortium
Method: Annual dialogues
National Malaria Control Programme implementation partners
Task: Participated in annual dialogues on the most appropriate responses to any antimalarial evidence generated by the consortium
Method: Annual dialogues
Evidence synthesis and GRADE methodologists
Task: Developed SPICE-GRADE, Simultaneous Processing of Indirect Causal Evidence in Complex Pathways using GRADE
Method: Structured consideration of direct evidence linking K13 mutations with recrudescence alongside indirect causal evidence through ring-stage survival and delayed parasite clearance
Impact: The approach allowed evidence across coherent causal pathways to contribute transparently to the overall certainty assessment rather than relying exclusively on limited direct evidence
The methodological challenge identified by researchers and policymakers contributed to the development of SPICE-GRADE.
Healthcare professionals
Task: Took part in an online survey and a focus group discussion exploring experiences and preferences regarding clinical practice guidelines, including the devices, channels, products and formats they considered most useful for clinical practice
Method: Online survey | Focus group discussion
Communication: Online survey | Focus group discussion
Impact: Findings are informing the MARC SE-Africa dissemination strategy and the development of accessible knowledge-translation products, including graphical materials and concise resources that provide rapid access to recommendations while allowing users who require more information to access the complete digital guideline and underlying evidence
Participants were particularly those working in malaria-related fields, although other healthcare professionals also participated. Participants represented several African countries, including Malawi, Uganda, South Africa, Nigeria and Tanzania. Participants indicated preferences for mobile phones as an important device for accessing guidance, apps and email as useful dissemination channels, clinical protocols and presentations as useful guideline products, simple and graphical formats rather than unnecessarily complex presentations, and readily accessible products including posters and similar visual resources that could be used easily in day-to-day clinical environments. Participants emphasised the importance of guidance being easy to understand, rapidly accessible and practical for routine clinical use.
Primary health care workers
Task: Their needs are to be identified and prioritised to inform development of additional MAGICapp functionalities and presentation formats
Global Health EDCTP3 Joint Undertaking (link)
ID: 101103076
MARC SE-Africa is supported by the Global Health EDCTP3 Joint Undertaking and its members. The Joint Undertaking was established under the European Union's research and innovation programme, Horizon Europe. The project is described as a 48-month project running from April 2023.
Outputs and impacts
End 2026-04-25
Interoperability (format): Structured, multilayered digital format in MAGICapp
The Malawi digital malaria guideline was published on 25 April 2026, World Malaria Day. The uncomplicated malaria section was specifically updated using systematic evidence synthesis, GRADE standards and methods, and evidence-based guideline-development processes, and included the development of recommendations addressing multiple first-line treatments for uncomplicated malaria. Those updated recommendations were developed directly within MAGICapp, enabling recommendations to be presented together with the underlying evidence and certainty assessments. The remainder of the existing Malawi malaria guideline was migrated from the previous PDF guideline into MAGICapp, and those sections were not newly assessed using GRADE as part of this work. Their migration transformed the guideline from a conventional PDF into a more structured, multilayered digital format. The resulting digital guideline combined newly updated, GRADE-based recommendations for uncomplicated malaria with the remaining national guidance migrated into a structured digital platform.
SPICE-GRADE, Simultaneous Processing of Indirect Causal Evidence in Complex Pathways using GRADE, was published as an exploratory methodological approach. It provided a structured approach for considering direct evidence linking K13 mutations with recrudescence alongside indirect causal evidence through ring-stage survival and delayed parasite clearance, allowing evidence across coherent causal pathways to contribute transparently to the overall certainty assessment rather than relying exclusively on limited direct evidence. Citation as given in the source. Eachempati P, Guyatt G, Vandvik PO, Guerin PJ, Dahal P, Barnes KI, Agoritsas T. SPICE-GRADE, simultaneous processing of indirect causal evidence in complex pathways using GRADE, an exploratory case study. Journal of Clinical Epidemiology, 2026, volume 194, article 112219.
Method: Online survey and focus group discussion
Access method: Online survey and focus group discussion
An online survey and focus group discussion were conducted with healthcare professionals, particularly those working in malaria-related fields, although other healthcare professionals also participated. Participants represented several African countries, including Malawi, Uganda, South Africa, Nigeria and Tanzania. The survey and focus group explored experiences and preferences regarding clinical practice guidelines, including the devices, channels, products and formats considered most useful for clinical practice.
Findings from the survey and focus group discussion are informing the MARC SE-Africa dissemination strategy and the development of accessible knowledge-translation products. These include graphical materials and concise resources that provide rapid access to recommendations while allowing users who require more information to access the complete digital guideline and underlying evidence.
The needs of primary health care workers are to be identified and prioritised to inform development of additional MAGICapp functionalities and presentation formats. The project anticipates the need to develop a mobile-friendly version of MAGICapp that can be used both online and offline, given a high prevalence of cell phones in South-East Africa but with low bandwidth internet connectivity.
The impact of this work is to be evaluated in two national, sub-national or cross-border regions.
STARDIT report information
prashanti@magicevidence.org
Main report author. Consultant Senior Researcher, MAGIC Evidence Ecosystem Foundation and MARC SE-Africa.
Additional contributor and report author
Free text
Report status: Draft. This report has not been validated.
Sources used
- MARC SE-Africa, Activities — https://www.marcse-africa.org/activities
- MAGIC Evidence Ecosystem Foundation, MARC-SE project page — https://www.magicevidence.org/marc-se/
- MARC SE-Africa STARDIT report first draft, prepared by Prashanti Eachempati with Per Olav Vandvik and Karen I. Barnes.
What this report does not state
The following were left blank because no value was explicitly stated in the sources above. They are recorded here so that missing data is not mistaken for absent activity.
- Compensation for every contributor listed. No source states whether any contributor was paid, was a volunteer, or contributed as part of funded employment.
- Competing interests for every contributor listed. No competing interest statements were located in the sources used.
- Ethics approval for the online survey and focus group discussion. The source draft records this as still to be added.
- The public MAGICapp link for the Malawi national digital malaria guideline. The source draft records this as still to be added.
- Numbers of participants in the online survey and focus group discussion, and the dates on which they were conducted.
- The identity of the second self-selected National Malaria Programme. Work Package 4 describes technical support to two programmes and only the Malawi programme is named in the sources used.
- Start and end dates for Work Package 4 as distinct from the parent project.
- Expansions of the consortium partner abbreviations LSTM, UR and IDRC, which are recorded as written on the source page.
- A DOI for the SPICE-GRADE publication.
- Report author contact preferences and ORCIDs.
- Validator. No one has yet checked this report.