Table 2.

Summary of WHO and Uganda Ministry of Health Guidelines for Management of Severe Malaria in Children

Recommendations for All Patients with Severe Malaria

Laboratory Evaluation

Thick and thin blood films or rapid diagnostic test to confirm diagnosis of malaria

Haemoglobin or haematocrit

Blood glucose level

Blood culture if feasible

General Management

Admit patients to highest level of care available

Minimum 3 doses IV artesunate at admission, 12 h, and 24 h   3 mg/kg for children < 20 kg, 2.4 mg/kg for children ≥ 20 kg   Following the parenteral course, patients should complete a full 3-day oral antimalarial course

Empiric treatment for likely bacterial co-infection with broad-spectrum antibiotics   If bacterial co-infection cannot be ruled out by blood culture/CSF analysis, complete an empiric course

Correct dehydration and monitor urine output

Administer paracetamol to maintain core temperature < 39C

Recommendations for Patients with Altered Mental Status

Provide oxygen

Assess for and correct hypoglycaemia if present with 5 ml/kg of 10% dextrose

Insert nasogastric tube to prevent aspiration

Position in lateral or semi-prone position and turn every 2 h   If concerns for increased intracranial pressure, position supine with head raised about 30°

Perform analysis of CSF

Recommendations for Patients with Seizure Activity

Provide Oxygen

Assess for and correct hypoglycaemia if present with 5 ml/kg of 10% dextrose

Treat seizures with IV or rectal diazepam up to 2 doses 10 min apart   If seizures persist, load with phenytoin or phenobarbital

Recommendations for Patients with Severe Anaemia

Provide Oxygen

Give blood transfusions to correct severe anaemia   10 ml/kg of packed red blood cells or 20 ml/kg of whole blood

Recommendations for Patients with Poor Perfusion

Provide Oxygen

Assess for anaemia and give blood transfusion if appropriate   10 ml/kg of packed red blood cells or 20 ml/kg of whole blood

Assess for and correct dehydration and monitor urine output