Fevers in children are very commonly due to malaria (Malawi is a malaria endemic area, there are seasonal peaks, but it occurs all throughout the year). The most common species in Malawi is Plasmodium falciparum. The most common symptoms are fever, headache and malaise. There may be vomiting, diarrhoea, cough, anaemia or convulsions.

Malaria parasites can be tested by microscopy

Monday-Friday Weekend
A&E under 5 7 am - 4 pm 7 am - 12 pm (Saturday only)
MLW 7 am - 9 pm (in malaria season)
7 am - 7 pm (in non-malaria season)
7 am - 4 pm

!!! Always document if the child has received any previous treatment for malaria (when, which drug, how many doses, and the strength [in mg] of the doses). The malaria rapid diagnostic test (mRDT) most commonly used in Malawi is based on the parasite protein HRP2, and this protein persists in the blood long after effective treatment. As a result, the mRDT can stay positive for up to 28 days after a malaria episode. When possible, verify a positive mRDT with a blood smear for parasites.

Uncomplicated Malaria


0-14 kg: 1 tablet = 20 mg Artemether and 120 mg Lumefantrine
15-24 kg: 2 tablets = 40 mg Artemether and 240 mg Lumefantrine
25-34 kg: 3 tablets = 60 mg Artemether and 360 mg Lumefantrine
> 35 kg: 4 tablets = 80 mg Artemether and 480 mg Lumefantrine
NB: adult tablets available, check dosing!

Children in need of second review should be admitted to Short Stay Ward:

Complicated/Severe Malaria

Cerebral malaria

No physical signs are pathognomonic for coma due to malaria, and incidental parasitaemia is common in endemic areas, so other causes of coma must always be sought and treated e.g. bacterial meningitis, septic shock, encephalitis (especially patients with no evidence of malarial retinopathy).

Malaria with severe anaemia

Beyond the blood: Treat all severe malaria anaemias with Albendazole STAT, investigate for HIV and prescribe Ferrous Sulphate on discharge (2 mg/kg/day for 3 months) to account for additional causes of that anaemia.

Transfusion criteria (preferably transfuse whole blood):



Dose Artesunate:
< 20 kg 3 mg/kg
> 20 kg 2.4 mg/kg
A full IV/IM course of Artesunate is given at 0, 12, 24 hours and then OD for 2/7 (= 5 doses in total).
BUT you should switch from IV/IM Artesunate to oral LA for 3/7 as soon as patient can keep oral medication down

IV-dose in mls:
0.3 mls/kg if < 20kg;
0.24 mls/kg if > 20kg

IM-dose in mls:
0.15 mls/kg if < 20kg;
0.12 mls/kg if > 20kg

Rectal: 10 mg/kg

(documentation in health passport is mostly in mls, refer to conversion above)

Supportive care in severe malaria

Discharge and Follow Up

Prophylaxis with monthly SP