Table 5. Malaria Control Policy Recommendations and Outcome of Evidence Synthesis by the Malaria Policy Brief Group .

Policy Options Recommended Before Evidence Synthesis	Outcome of Evidence Synthesis of Policy Options Recommended	Group Conclusion and Final Recommendation
(1) Environmental manipulation, modification, and management (provision of good drainage system)	No available evidence as a feasible strategy for malaria control policy. Alternative: Larval source management under vector control feasible. Key Reference: Tusting et al40	Policy option rejected. Alternative accepted as policy recommendation.
(2) Proper refuse disposal	No available evidence as a feasible strategy for malaria control policy.	Policy option rejected.
(3) Sanctions for environmental sanitation violators	No available evidence as a feasible strategy for malaria control policy.	Policy option rejected.
(4) Private sector involvement in management of waste disposal	No available evidence as a feasible strategy for malaria control policy.	Policy option rejected.
(5) Distribution of ITNs to be more effective, proper orientation on the usage	There is sufficient evidence to show it is an effective strategy for malaria control policy. Key reference: Gamble et al41	Policy option accepted.
(6) Use of drugs to eradicate the parasite in the population (mass chemotherapy with gametocidal agent)	There is evidence to show that it is an effective strategy for malaria control. However there are serious implementation challenges especially with the sustainability of this strategy. Its feasibility as a policy recommendation for Ebonyi is doubtful. Key reference: Poirot et al42	Policy option rejected.
(7) Provision of portable water	No available evidence as a feasible strategy for malaria control policy.	Policy option rejected.
(8) Laboratory diagnosis of malaria to be considered along clinical assessment before treatment of malaria should be considered	There is sufficient evidence to show it is an effective strategy for malaria control policy. Key reference: Odaga et al43	Policy option accepted.
(9) Restriction of antimalarial prescription as an OTC drug to prevent resistance (strengthen PHCC in rural areas)	There is insufficient evidence to show that it can be an effective strategy for malaria control. There can be serious implementation challenges especially with the sustainability of this strategy. Its feasibility as a policy recommendation for Ebonyi is doubtful, except if the PHCC is greatly strengthened. Alternative: Chemists to perform RDT before giving antimalarials. Key reference: Abuya et al44	Policy option rejected. Alternative accepted as policy recommendation.
(10) ACTS recommended but quality control must be ensured	There is sufficient evidence to show it is an effective strategy for malaria control policy. Key reference: Ogbonna and Uneke45	Policy option accepted.
(11) Improvement of incentives to the rural health workers	No available evidence as a feasible strategy for malaria control. Beyond the scope of malaria policy alone. This is a health sector general problem.	Policy option rejected.
(12) More funding for research on indigenous malaria drugs	There is sufficient evidence to show it is an effective strategy for malaria control policy. Key reference: Amoa Onguéné et al46	Policy option accepted.
(13) Vector control using indoor residual spraying and larval source management	There is sufficient evidence to show it is an effective strategy for malaria control policy. Key references: Tusting et al40; Pluess et al47	Policy option accepted.

Abbreviations: OTC, over the counter; ITN, insecticide treated bed-net; PHCC, primary health care centre; RDT, rapid diagnostic test for malaria; ACT, artemisinin combination therapy.