Case Definition

In all patients, clinical diagnosis of severe/complicated malaria should be made in a patient with:

  • fever (history of fever or axillary temperature³ 38.5°C) PLUS
  • any "sign of severe/complicated malaria" from the list below.


In young children, a clinical diagnosis of severe/complicated malaria can also be made if there is;

  • fever (history of fever or axillary temperature ³ 38.5°C) PLUS
  • any "general danger sign in young children" from the list "Signs of Severe/complicated malaria”.


Signs of Severe/Complicated Malaria

Malaria is considered as severe if a patient has any one or combination of the following clinical manifestations and laboratory findings:


Clinical Findings:

  • Altered consciousness (change of behaviour, confusion, delirium, coma persisting for over 30 minutes after convulsion).
  • Repeated generalised convulsions (fits) – 2 or more within 24 hours.
  • Difficulty in breathing or pulmonary oedema.
  • Spontaneous unexplained heavy bleeding (Disseminated Intravascular Coagulation).
  • Marked jaundice (yellowish colouration of the eyes).
  • Prostration i.e. generalised weakness, such that the patient cannot walk or sit without assistance.
  • Hyperpyrexia (axillary temperature ³ 38.5°C).
  • Inability to take fluids or anything orally.
  • Repeated profuse vomiting.
  • Circulatory collapse or shock (cold limbs, weak rapid pulse) (systolic BP of less than 80mmHg in adults and less than 50mmHg in children.


Laboratory Findings:

  • Severe normocytic anaemia (severe anaemia; haematocrit <15% or Hb <5g/dl).
  • Signs of hypoglycemia (sweating, pupillary dilation, abnormal breathing, coldness, blood sugar- <40mg/dl. or 2.2mmol/L).
  • Renal Impairement -Signs of renal failure (passing very little urine)-Serum creatinine >265umol/l.
  • Signs of haemoglobinuria (dark or cola-colored urine).
  • Hyperparasitaemia (250,000 parasites/microlitre).
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