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close this bookManagement of Severe and Complicated Malaria - A Practical Handbook (WHO - OMS, 2000, 69 p.)
View the document(introduction...)
View the documentPreface
View the documentIntroduction
View the documentSevere and complicated malaria
Open this folder and view contentsGeneral management
Open this folder and view contentsSalient clinical features and management of complications
Open this folder and view contentsSpecial clinical features of severe malaria and management of common complications in children
Open this folder and view contentsSpecial clinical features and management of severe malaria in pregnancy
Open this folder and view contentsDiagnosis of malaria
View the documentPrognostic indicators
View the documentCommon errors in diagnosis and management
View the documentSelected further reading
View the documentAnnex 1. Notes on antimalarial drugs
View the documentAnnex 2. The Glasgow coma scale
View the documentAnnex 3. Measurement of central venous pressure
View the documentBack cover

Back cover

Malaria continues to be a major health problem in many parts of the world, with over 2000 million people in some 100 countries at risk of infection. Delay in treating falciparum malaria - the most serious form of the disease - can result in a severe deterioration in the patient’s condition, together with the development of a number of life-threatening complications.

This handbook provides practical guidance on the diagnosis and management of severe and complicated malaria. After outlining the general nursing care needed by these patients, it considers in turn the possible complications, including anaemia, renal failure, hypoglycaemia, and pulmonary oedema, and gives specific and concise advice on their management. While intended primarily for physicians and other responsible health staff working in hospitals and health centres with inpatient facilities in malaria-endemic countries, it will also be of practical use to physicians in nonendemic areas, who are increasingly having to deal with patients infected during visits to malarious areas.

Global status of chloroquine resistance

© World Health Organization

Summary of the management of severe and complicated falciparum malaria


Immediate managementa

1. Coma (cerebral malaria)

Maintain airway; nurse on side; exclude other treatable causes of coma (e.g. hypoglycaemia, bacterial meningo-encephalitis). Give prophylactic anticonvulsant (10 mg of phenobarbital sodium per kg of body weight intramuscularly). Avoid harmful adjuvant treatments such as corticosteroids, heparin and epinephrine (adrenaline).

2. Convulsions

(Prevent with intramuscular phenobarbital sodium, see above.) Maintain airway; treat with diazepam given intravenously or per rectum (0.15 mg/kg to a maximum of 10 mg) or intramuscular paraldehyde injection (0.1 ml/kg from a glass syringe).

3. Severe anaemia

Transfuse fresh whole blood or packed cells.

4. Acute renal failure

Exclude dehydration; maintain strict fluid balance; carry out peritoneal dialysis (or haemodialysis if available).

5. Hypoglycaemia

Measure blood glucose, give 50% glucose injection 50 ml (1 ml/kg for children) followed by 5% or 10% glucose infusion.

6. Metabolic acidosis

Exclude or treat hypoglycaemia, hypovolaemia and Gram-negative septicaemia. Give oxygen. Correct arterial pH to 7.2 or above.

7. Acute pulmonary oedema

Prevent by avoiding excessive rehydration. Prop patient up; give oxygen. If the pulmonary oedema is due to overhydration, stop intravenous fluids, give diuretic (furosemide 40 mg intravenously) and withdraw 250 ml of blood by venesection into a donor bag.

8. Shock, algid malaria

Suspect Gram-negative septicaemia; take blood samples for culture. Give parenteral antimicrobials; correct haemodynamic disturbances.

9. Spontaneous bleeding and coagulopathy

Transfuse fresh whole blood or clotting factors; give vitamin K injection.

10. Hyperpyrexia

Use tepid sponging and fanning; give antipyretic (paracetamol 15 mg/kg of body weight).

11. Hyperparasitaemia

Give initial dose of parenteral antimalarial therapy. If parasitaemia in a severely ill patient exceeds 10%, carry out exchange or partial exchange transfusion.

12. Malarial haemoglobinuria

Continue antimalarial treatment; transfuse fresh blood to maintain haematocrit above 20%; give furosemide 20 mg intravenously.

13. Aspiration pneumonia

Give parenteral antimicrobials; change position of patient; give physiotherapy; give oxygen.

a In all cases infusion of an appropriate antimalarial drug should be started immediately.

ISBN 92 4 154436 8