Table 5. G6PDd prevalence, testing, and primaquine policies in Asian, Oceania, and Middle East malaria-endemic countries.

Country	Estimated G6PD deficiency prevalence for common variants*	G6PD variants [24]	G6PD deficiency testing before primaquine **	Single-dose primaquine for Pf**	Primaquine use for Pv**
Thailand°	>13%–17% [24]	Mahidol, Viangchan, Canton, Kaiping, Mediterranean, Songklanagarind, Union, Vanua Lava, Chinese‐5, Gaohe, Kerala‐Kalyan, Quing Yan	Yes (adopted 2015) but with poor implementation, PQ administered without testing	Single dose without G6PD deficiency testing as DOT	In G6PDd 0.25 mg/kg daily for 14 days as DOT
Malaysia°	>7%–10% [24]	Andalus, Canton, Chatham, Coimbra, Kaiping, Mediterranean, Namouru, Nankang, Union, Vanua Lava, Viangchan‐Jammu, Chinese‐5, Gaohe, Mahidol, Orissa, Quing Yan [24]	Required since 1993, done routinely	Single dose since 2013; PQ given as DOT	ACT and PQ at 0.5 mg/kg/day for 14 days as DOT; in practice, PQ not given as DOT and only given to non-G6PDd individuals
Myanmar°	>3%–7% [24]	G6PD Mahidol, Canton, Coimbra, Viangchan‐Jammu, Kaiping, Mediterranean, Union, Valladolid, Kerala‐Kalyan [24]	No	Single dose 0.75 mg/kg; PQ given as DOT since 2014	CQ and PQ at 0.5 mg/kg/day for 14 days at health centres and 0.75 mg/kg weekly dose for 8 weeks given by malaria volunteers in the community; PQ given as DOT since 2014
Lao People’s Democratic Republic°	>13%–17% [24]	G6PD Viangchan [24]	Required since 2010 but not available at village level	SLD (0.25 mg/kg)	0.25 mg/kg/day for 14 days in G6PD-normal patients, 0.75 mg/kg/week for 8 weeks for G6PDd
Cambodia°	>13%–17% [24] In Pailin, western Cambodia, N = 938 tested for G6PDd by FST and RDT for 74 samples (7.9%) moderate and severe G6PD deficiency (activity <30%), mostly in male population [62]	G6PD Viangchan, Kaiping, Canton, Valladolid, Mahidol, A- [24]	Required since 2012 Currently, there is no G6PD testing in the field. CareStart test will be piloted for field use at health centre level	Yes since 2014 but not implemented; plan to implement SLD 0.25 mg/kg on first day without G6PD deficiency test	Yes since 2013 but not implemented; upcoming implementation planned (0.75 mg/kg weekly for 8 weeks or 0.25 mg/kg daily for 14 days, depending on predicted patient’s adherence)
Vietnam°	>7%–10% [24] G6PD Viangchan Male outpatients, hospital in southern Vietnam N = 1,104 tested: 25 G6PDd (2.3% prevalence) Genotyping: novel mutation (352T>C or 118Tyr>His, ‘Bao Loc’) with activity <10%; Viangchan commonest (6/19), followed by Canton (5/19), Kaiping (3/19), Gaohe (1/19), Quing Yuan (1/19), and Union (2/19) [63]	Viangchan, Canton, Kaiping, Union, Bao Loc, Coimbra, Chinese‐5, Gaohe, Mahidol, Quing Yan [63]	Not required	Single dose since 2003 on last day of treatment as DOT	CQ and PQ at 0.25 mg/kg/day for 14 days since 2013 as DOT; due to low PQ availability, not many patients take the full dose
Bangladesh°	>3%–7% [24] Patients with confirmed malaria infection (N = 174) tested by spectrophotometry: G6PD deficiency prevalence 3.45%: 1 severe deficiency (<10% activity), 5 mild deficiency [64], 0.7% prevalence by FST in 141 Bengali falciparum malaria patients in southern Bangladesh [65] 6% severe deficiency in Chittagong Hill Districts populations (Marma and Khyang ethnic groups) [65]	Orissa, Kerala-Kalyan, and Mahidol [65,66]	Not required; PQ given with advice to check for side effects of haemolysis; if so, stop PQ and refer the patient to hospital	Single dose 0.75 mg/kg on the first day of treatment	CQ and PQ at 0.25 mg/kg/day for 14 days since 2004
Nepal°	>3%–7% [24]	Mediterranean [24]	Required but not widely available	Single dose 0.25 mg/kg since 2015 but not implemented. SLD 0.25 mg/kg on the first day of treatment	0.25 mg/kg daily for 14 days since 2004
India°	>7%–10% [24] Tribal groups (N = 72 tribes) from 56 districts (data collected by field surveys using different methods) showed G6PD deficiency varying from 2.3%–27%; overall prevalence 7.7% [67]	Mediterranean (most common), Kerala-Kalyan, Odisha [24], Chatham, Coimbra, Namouru, Nilgiri, Orissa [24]	Not required; done in urban areas (approximately 10% patients get tested)	PQ use without G6PD deficiency testing at single dose 0.75 mg/kg on day 2 with ACT	0.25 mg/kg daily for 14 days as DOT since 2007; although DOT not really implemented, health workers get paid for ensuring compliance. Patients are instructed to stop treatment and see a health worker if dark urine or bluish lips occur
Pakistan°	>13%–17% [24]	Mediterranean, Chatham, Orissa [24]	Required since 2009, although rarely available; also lack of consensus regarding risks and benefits	Single dose since 2012	CQ and PQ at 0.25 mg/kg/day for 14 days
Afghanistan°	7%–10% [24] High prevalence of G6PD Mediterranean, overall 5.6%; in the Pashtun/Pashai group 8.9%, compared to 2% in the rest of the population [68]	G6PD Mediterranean [24]	Required since 2010; however, there is very low availability of G6PD deficiency tests	Single dose DOT since 2014; however, PQ may be given to take at home on day 3	CQ and PQ as DOT at 0.75 mg/kg weekly for 8 weeks; Pv weekly regimen mostly unobserved
Yemen	5%–6% in male population [69]	No published G6PD types	Required	Single dose implemented recently	CQ and PQ at 0.25 mg/kg/day for 14 days
Iran°	>10%–13% [24]	G6PD Mediterranean [70] and Chatham [71] and Cosenza [72]	Not required	Use without G6PD deficiency testing as single dose as DOT on day 3	0.75 mg/kg weekly for 8 weeks as DOT
Saudi Arabia	>10%–13% [24]	G6PD Mediterranean (most common), G6PD-Med-like, Aures, Chatham, Kaiping, S. Antioco, Union, Viangchan [24]	Required since 1985	Single dose	CQ and PQ at 0.25 mg/kg/day for 14 days
China°	>3%–7% [24] In southern China (Jiangxi province) among Chinese Hakka (N = 2,331) screened by a fluorescent test, 3.60% G6PD deficiency prevalence was found [73]. In Chaozhou region of eastern Guangdong Province, 3.36% (142/4224) G6PDd overall—2.33% (47/2013) males and 4.3% (95/2208) females [74]	Kaiping, Canton, Gaohe, Chinese-5, and Quing Yan Chinese‐1, Coimbra, Fushan, Haikou, Hechi, Liuzhou, Miaoli, Nankang, Songklanagarind, Taipei, Taipei‐Hakka, Union, Valladolid, Viangchan, A‐, Guangzhou, Keelung, Mahidol, Nanning, Quing Yan, Ube Konan [24,75,76]	Not required in central China, where G6PD deficiency is very low (2–5 per million); only in Yunnan and Hainan provinces (G6PDd 1%–10%, PQ not used before 2010) there will be G6PD deficiency testing for Pv cases	Single dose as DOT since 2013; however, not implemented due to the absence of Pf local transmission	Without G6PD deficiency testing as DOT at 0.75 mg/kg for 8 days in central China, and in Yunnan and Hainan provinces, G6PDd cases will be treated with 0.75 mg/kg weekly for 8 weeks
Bhutan	>3%–7% [24]	None published	Not required	Single dose since 2012	CQ and PQ at 0.25 mg/kg/day for 14 days without observation [77]
Indonesia°	>7%–10% in Indonesia [24] N = 2,033 residents of 3 separate districts in western Sumba (eastern Indonesia); 104 (5.1%) G6PDd by activity measured by commercial kit [77]. In western Sumba Island by quantitative assay, 7.2% (44/610) G6PDd overall, 9.2% males (24/260), 5.7% (20/350) females [78]	Vanua Lava, Viangchan, Chatham, Canton, Coimbra, Kaiping, Mediterranean, Surabaya, Union, Bajo Maumere, Chinese‐5, Gaohe, Mahidol [77]	Not required	Single dose 0.75 mg/kg is implemented widely; policy will change to the SLD 0.25 mg/kg in 2017	0.25 mg/kg/day for 14 days with ACT
Timor-Leste	No published estimates	None published	Required since 2016	No policy	CQ and PQ at 0.75 mg/kg once weekly for 8 weeks as DOT
Philippines°	>1%–3% [24]	Union [24]	Required since 2009—poor implementation, PQ administered without testing	Single dose since 2006; PQ given as DOT since 2010	CQ and PQ at 0.5 mg/kg/day for 14 days (but usually given at 0.25 mg/kg/day); as DOT since 2010
Papua New Guinea°	>7%–10% [24]	G6PD Viangchan [24]	Not required	Not used, guidelines are being updated to include SLD 0.25 mg/kg given on first day of treatment	0.25 mg/kg/day for 14 days with ACT
Vanuatu	6.8% in males [79]	Namouru, Naone, Union, Vanua Lava [24]	Required	No policy	CQ and PQ at 0.25 mg/kg/day for 14 days
Solomon Islands	15.7%–30.9%[24]	Union [24]	Required	No policy	CQ and PQ at 0.25 mg/kg/day for 14 days
Republic of Korea	>0%–1% [24] In a vivax malaria endemic region, from N = 1,044 tested quantitatively, none were G6PDd [80]	Sporadic reports of uncommon variants [81]	Not required	No policy—there is no Pf malaria in the country	CQ and PQ at 0.25 mg/kg/day for 14 days
Democratic People’s Republic of Korea	>0%–1% [24]	None published	Not required	No policy—there is no Pf malaria in the country	CQ and PQ at 0.25 mg/kg/day for 14 days as DOT

Abbreviations: Pv, Plasmodium vivax; Pf, Plasmodium falciparum; G6PD, Glucose-6-phosphate dehydrogenase; G6PDd, G6PD deficient; CQ, chloroquine; PQ, primaquine; DOT, directly observed treatment; RDT, rapid diagnostic test; FST, fluorescent spot test; SLD, single low dose (0.25 mg/kg); ACT, artemisinin combination therapy.

*Prevalences shown from reference [24] correspond to national-level allele frequencies modelled as described therein; other estimates shown are mostly from G6PD quantitative surveys.

**Policies from WHO World Malaria Report 2016 were updated with the WHO 2017 report after this paper was reviewed [28]. Primaquine is currently contraindicated in young infants and pregnant and breastfeeding women; ‘single dose’ refers to a dose that may be 0.25 mg/kg or 0.75 mg/kg.

° Policies from the WHO 2016 report were checked with these countries; corresponding updates are shown in italics.

Cells shaded in grey indicate countries are in the elimination phase.