ALGORITHM IN THE DIAGNOSIS AND TREATMENT OF MALARIA

The following outlines the flow and steps in the diagnosis and treatment of malaria.
Residents of/Travelers From Endemic Areas With Fever/History of Fever (>37.5 oC)

Fever With Afebrile Periods With Any of the Following Signs/Symptoms Fever Alone or Fever
Regardless of Pattern Plus Any
Of the Following

A - signs and symptoms in “A” Plus any of the

following:
- sore throat/pain in swallowing
- chills • extreme weakness or inability to sit/stand
- ear pain/discharge
- sweating unaided - skin rashes
- headache • hyperthermia - enlarged/painful lymph nodes
- enlarged spleen • severe pallor - abdominal pain
• jaundice/yellowish discoloration of eyes/skin - diarrhea
• delirium - painful urination
• coma - boils/abscess
• reddish/coffee colored urine - infected wounds
• weak pulse - joint pains
• difficulty of breathing - nose/gum bleeding

Uncomplicated Severe Malaria

Fever due to other causes

Take blood film or perform RDT and give first dose

of Parenteral Quinine infusion or artesunate Refer URGENTLY to hospital
suppository if hospital is not accessible w/n 4 hours

Uncomplicated Uncomplicated

Negative Positive Treat as appropriate Positive Negative

Pf and other
Pf Pv or Po Pm Pv and PM
Check species refer to higher level of
for other care
AL CQ + PQ CQ
causes AL + CQ +
+ Or +
PQ PQ If child, follow IMCI
PQ AL + PQ PQ
protocol

Follow-up Blood Film on Days 3, 7, 14, 21, 28

Negative If with asexual parasitemia and/or symptoms reappear, persist or patient

Improve (adequate clinical Refer to the higher level of care and validate/repeat blood film
and parasitological
response)
Positive Negative, check for other causes

If condition
does not Uncomplicated Severe/Complicated
improve, refer Refer to
to higher level Quinine + D/C/T higher level
Start Parenteral Quinine infusion OR artesunate
of care of care
suppository (if hospital is not accessible w/n 4 hours)