UNCOMPLICATED MALARIA

Dr. Kumbakumba Elias

Department of Paediatrics and
Child Health
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Definition:
• Malaria is a clinical disease (collection of
symptoms and signs) due to infection by
asexual forms of the parasites Plasmodium
falciparum, P. vivax, P. ovale, P. malariae.
• Gametocytes do not cause disease.

Aetiology (Uganda):
• P. falciparum 95%
• Other species 5%
• P. falciparum causes severe forms of malaria
•
Importance:
• Number of cases:
- 41% of the world’s population live in areas where
malaria is transmitted
- An estimated 700,000-2.7 million persons die of
malaria each year, 75% of them African children,
70,000 – 100,000 per year in Uganda alone.
- In areas of Africa with high malaria transmission, an
estimated 990,000 people die of malaria - over 2700
deaths per day, or 2 deaths per minute, mostly
children under five years.
- In Uganda, 39% of outpatient visits and 35% of
inpatient admissions and 9 – 14% of inpatient deaths
are due to malaria.
• Problem of diagnosis:
- Presentation of malaria is often similar to that of
many other diseases.
• Rapid progression:
- e.g in 2 days to cerebral malaria
• Lack of facilities for diagnosis and treatment where
malaria is most prevalent.

People at Risk:
• Children between 3 months and 5 years
• Pregnant women
• Adults in hypoendemic areas
• Non immune immigrants into the area
• Red cell abnormalities e.g. SCD, G6PD deficiency
Life Cycle:
Clinical Features:

• Symptoms: Children under 5 years:

- Fever (related to rupture of parasitised RBCs)
- Loss of appetite
- Vomiting
- Weakness
- Lethargy
- Irritability
- Diarrhoea
- Convulsions
• Symptoms: Older children:
- Fever
- Loss of appetite
- Nausea
- Vomiting
- Headache
- Joint pains
- Muscle aches
- Weakness
- Lethargy
Common signs:
- Pyrexia ( Temp above 37.50 C)
- Mild pallor of palms and mucous membranes
- Dehydration
- Enlarged spleen
Differential diagnosis:
- Acute respiratory tract infections
- Urinary tract infection
- Meningitis
- Septicemia
- Typhoid/Enteric fever
- Brucellosis
- Other causes of fever
 L
Investigations:
• Microscopic examination of a blood
smear:
- Gold standard
- Thick blood film: detection and quantification
of parasites
- Thin blood film: species identification
• A negative BS does not necessarily rule out
Malaria.
• Peripheral blood e.g. from finger pulps
should be used.
• Other investigations are guided by history and
physical exam to rule out DDx. They may
include:
- Full blood count
- Urinalysis
- CSF analysis
- Stool analysis
- Blood culture
- Chest X-ray.
Treatment:
• First Line: Artemesinin-based Combination Therapy
(ACT)
- Artemether+Lumefantrine (Coartem)- MoH choice
- Artesunate+Amodiaquine (Artequin)- as an
alternative
Note: Chloroquine and Fansidar have been substituted
due to widespread resistance of Plasmodium against
these drugs.
• Second line treatment is oral Quinine and is given
when:
- Treatment fails with first line drugs
- Patient is allergic or intolerant to first line drugs
- First line drugs are contraindicated .g children < 5kg
or < 4 months
 Dosage of Coartem:
20mg Artemether/120mg Lumefantrine per Tablet
Weight Age Day 1 Day 2 Day 3 Colour
(kg) code
4 – 14 4 mo – 1tab 1tab 1tab Yellow
3years 12hourly 12hourly 12hourly

15 - 24 3 years – 2tablets 2tab 2tab Blue

7years 12hourly 12hourly 12hourly

25 - 34 7years – 3 tablets 3 tablets 3 tablets Brown

12years 12hourly 12hourly 12hourly

>35 12 years 4 tablets 4 tablets 4 tablets Green

and above 12hourly 12hourly 12hourly
Supportive Mgt:
- Lower temperature with Paracetamol 10mg/kg
every 8 hours for 3 days, tepid sponging,
fanning;
- Increase fluid intake and feeding
- Give the medicines orally unless the child
vomits repeatedly
- Monitor the child’s vital signs and check for
evidence of complications
- Counsel the child and the attendant on the
illness, adherence, features of complications.
Uncomplicated malaria is treated on outpatient
basis.
Prevention of Malaria:
• Reduce human-mosquito contact:
- use insecticide treated materials e.g. bed nets
- carefully select house sites avoiding mosquito
infested areas
- destroy adult mosquitoes by residual spraying of
dwellings with insecticide or use of knock-down sprays
- wear clothes which cover the arms and legs; use
repellent mosquito coils and creams/sprays on skin
when sitting outdoors at night.
• Control breeding sites:
- eliminate collections of stagnant water where
mosquitoes breed e.g. in empty cans/containers,
potholes, old car tyres, plastic bags, footprints,
etc by disposal, covering with soil, etc
- destroy mosquito larvae by dosing stagnant
water bodies with insecticides or with biological
methods (e.g. larvae eating fish).
• Give effective treatment and prophylaxis:
- early diagnosis and effective treatment of
patients
- Chemoprophylaxis to vulnerable groups e.g.
in sickle cell disease, non immune travellers
visitors or tourists.
• Give public health education on the above
measures.