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

or

• 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.

Uncomplicated Malaria In Children

Overview

Clinical Features

Diagnosis

Management