Malaria N° 9 - Subject N° 10

THE MANAGEMENT OF SEVERE MALARIA
K. Marsh

SUMMARY
Severe malaria accounts for a large part of the paediatric case load in many African hospitals. It should be suspected as a cause for admission in any severely ill child. Complex definitions have been used for research purposes but for good clinical practice a set of simple clinical criteria allow a useful division of children with malaria into three groups:

• (1) Children who are prostrated or who have impaired consciousness or who have respiratory distress should be regarded as having severe malaria. They require parenteral anti-malarials and full supportive management.
• (2) Children with either severe anaemia or repeated convulsions are often admitted to hospital but in the absence of the above features they form a low mortality group who con usually be managed with oral anti-malarial therapy and standard supportive measures such as oral fluids and anti-pyretics. Children with repeated vomiting form a special case and may need initial parenteral anti-malarials and fluids but can normally be switched to standard management after a short while.
• (3) Children with none of the above features can normally be safely managed as outpatients.

The successful management of severe malaria requires appropriate initial assessment and resuscitation followed by parenteral anti-malarial therapy and the of specific complications. Key issues discussed in this paper include the management of metabolic acidosis, hypoglycaemia, severe anaemia, convulsions and co-existent bacterial infections.