Uncomplicated Malaria In Children

Malaria is a mosquito borne protozoal infection caused by Plasmodium species. In Kenya, Plasmodium falciparum is the dominant cause of severe disease.

Young children in endemic areas are particularly vulnerable because protective immunity is incomplete.

Severe disease can evolve rapidly through cerebral involvement, hypoglycaemia, severe anaemia, metabolic acidosis and multiorgan dysfunction.

Confirm malaria with:

• Malaria rapid diagnostic test

• Microscopy using thick and thin blood films

Microscopy allows parasite detection, species identification and quantification.

A negative test should prompt active assessment for an alternative diagnosis.

When severe malaria remains strongly suspected despite an initial negative blood film, repeat high quality microscopy because parasitaemia can occasionally be initially missed.

Check:

• Bedside glucose
• Haemoglobin
• FBC
• Renal function
• Electrolytes
• Blood gas or lactate in severe disease

Do not attribute every fever in a malaria endemic setting to malaria merely because malaria exposure is common.

For uncomplicated confirmed falciparum malaria, give an appropriate artemisinin based combination therapy.

A commonly used first line regimen is artemether lumefantrine, given as 6 doses over 3 days according to weight band.

Ensure the child can tolerate oral medication.

Give fluids and feeding appropriately.

Treat fever and vomiting symptomatically.

Assess haemoglobin when anaemia is suspected.

Failure to improve requires reassessment for:

• Poor adherence
• Vomiting or inadequate absorption
• Severe malaria
• Alternative infection
• Antimalarial resistance
• Incorrect initial diagnosis

Any child developing severe features while receiving oral therapy should immediately be converted to parenteral severe malaria treatment.

Clinical toolsCalculators

BMI GCS EDD Parkland Formula

Corrected Sodium Corrected Calcium Anion Gap Creatinine Clearance Insulin Calculations qSOFA Wells PE Wells DVT CHA₂DS₂-VASc HAS-BLED CURB-65 Centor/McIsaac

Measles

Measles is a highly contagious systemic viral infection caused by measles virus. Transmission is airborne and the virus can remain infectious in air or on surfaces for up to approximately 2 hours. Infectiousness begins several days before rash onset and continues for several days afterward.

Severe disease is more likely in young children, malnourished children and those with immunodeficiency.

The prodrome typically includes:

• High fever
• Cough
• Coryza
• Conjunctivitis

Koplik spots may appear on the buccal mucosa before the rash.

The rash:

• Begins on the face and hairline
• Spreads downward to trunk and limbs
• Becomes confluent in severe disease
• Fades in the same general order

Complications include:

• Pneumonia
• Otitis media
• Diarrhoea and dehydration
• Keratitis and corneal ulceration
• Encephalitis
• Severe malnutrition
• Subacute sclerosing panencephalitis years later

There is no routine specific antiviral treatment.

Give supportive care:

• Fluids
• Nutrition
• Oxygen where required
• Treatment of dehydration
• Antibiotics only for secondary bacterial infection

Give vitamin A to children with measles:

Under 6 months: 50,000 IU PO once daily for 2 days

6 to 11 months: 100,000 IU PO once daily for 2 days

12 months and older: 200,000 IU PO once daily for 2 days

A further dose 4 to 6 weeks later is appropriate when clinical vitamin A deficiency or ocular complications are present.

Use airborne infection control precautions.

Uncomplicated Malaria In Children

Overview

Clinical Features

Diagnosis

Management

Overview

Clinical Features

Diagnosis

Management