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Care priority and warning signs
Care priority
Routine Management / Treat with ACT
Red flags
- Development of any danger sign or stiff neck (indicates progression to severe malaria/disease).
- Persistent vomiting preventing oral medication.
- Fever persisting after 3 days of treatment.
Assessment
- Ask: Does the child have fever (by history, feels hot, or temperature ≥37.5°C)?
- Confirm absence of General Danger Signs.
- Confirm absence of Stiff Neck.
- Perform Malaria Test (RDT or Microscopy) - Result is POSITIVE.
Classification
- Fever present AND Malaria test POSITIVE AND No signs of Very Severe Febrile Disease -> MALARIA
Key features
- Fever (current or recent history).
- Positive malaria diagnostic test.
- Absence of any general danger sign or stiff neck.
- Requires treatment with oral Artemisinin-based Combination Therapy (ACT).
Management
Non-pharmacological management
- Advise adequate fluid intake.
- Advise tepid sponging for comfort if high fever (optional, do not use cold water).
- Continue feeding.
Pharmacological treatment
- Give first-line oral Artemisinin-based Combination Therapy (ACT): Artemether-Lumefantrine (AL) OR Artesunate-Amodiaquine (AS+AQ).
- AL Dosing (Coartem® 20/120mg tablets, give dose twice daily for 3 days at 0, 8, 24, 36, 48, 60 hours): Weight 5-<15kg (Age 4m-<3y): 1 tablet per dose. Weight 15-<25kg (Age 3-<9y): 2 tablets per dose. Weight 25-<35kg (Age 9-<14y): 3 tablets per dose. Weight >=35kg (Age >14y): 4 tablets per dose. Give with food/fatty drink.
- AS+AQ Dosing (Fixed dose combination, give once daily for 3 days): Refer to specific product dosing based on age/weight bands.
- Give Paracetamol (10-15 mg/kg) if high fever (≥38.5°C axillary) - see dosage on page 15.
- If fever persists every day for more than 7 days, refer for further assessment.
Follow-up
- Follow-up in 3 days IF fever persists.
- At follow-up: Reassess child fully. If danger signs or stiff neck, treat as Very Severe Febrile Disease and refer. If malaria is only cause of persistent fever, treat with second-line antimalarial (e.g., Quinine) or refer. If other cause identified, treat accordingly.
- If fever has been present > 7 days total, refer for assessment.
Counselling points
- Explain the diagnosis (malaria) and the need for antimalarial tablets.
- Teach how to give the full course of ACT correctly: dose, timing (especially for AL's 8-hour second dose), duration (3 days), importance of giving with food for AL.
- Teach how to give Paracetamol for high fever.
- Advise on increasing fluids and continuing feeding.
- Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs (cannot drink, vomits everything, convulsions, lethargy), develops stiff neck, becomes sicker.
- Advise to return in 3 days if fever persists, or sooner if condition worsens.
Differential diagnosis
- Very Severe Febrile Disease (especially Severe Malaria)
- Fever - No Malaria (viral illness, other bacterial infection)
- Pneumonia
- Urinary Tract Infection
- Typhoid fever
- Other febrile illnesses
Complications
- Progression to severe malaria
- Anaemia
- Febrile convulsions
- Dehydration
Prevention
- Sleeping under an Insecticide Treated Net (ITN) every night.
- Indoor residual spraying (IRS) where implemented.
- Prompt diagnosis and effective treatment of malaria episodes.
- Intermittent Preventive Treatment in pregnancy (IPTp) and infancy (IPTi)/Seasonal Malaria Chemoprevention (SMC) where applicable.
References
IMCI Chart Booklet - Page 4, Page 15 (AL/AS+AQ, Paracetamol), Page 23 (Follow-up)