Uncomplicated malaria is defined as symptomatic malaria without signs of severity or evidence (clinical or laboratory) of vital organ dysfunction.
Diagnostic Criteria
- Fever
- Headache
- Joint pains
- Malaise
- Vomiting
- Diarrhea
- Body ache, body weakness
- Poor appetite
- Pallor, enlarged spleen
Investigations
The clinical features listed above are not specific for malaria and can be found in several other febrile conditions. Therefore, it is necessary to confirm malaria parasites infection and investigate for other causes of febrile illness. Parasite-based diagnosis is recommended for all patients presenting with signs and symptoms of malaria. The recommended investigations are:
- Quality malaria microscopy or
- Quality malaria Rapid Diagnostic Tests (mRDTs)
Note: It is compulsory to test and confirm all suspected malaria patients. Give antimalarial only to those who test positive
Non-Pharmacological Management
- Continue with feeding and fluid intake
- Followed up immediately if the condition worsens or on the fourth day if symptoms persist.
Pharmacological Treatment
Drug of choice for treatment of uncomplicated malaria is:
A: Artemether-Lumefantrine (AL), which is a fixed formulation of artemether 20mg and lumefantrine 120mg or dispersible tablets for paediatric use, also with a fixed formulation of artemether 20 mg and lumefantrine 120mg.
Table 5.1: Dosage regimen for AL (artemether 20mg/lumefantrine 120mg)
| Day 1 | Day 2 | Day 3 | |||||
| Kg | Dose | 1st | 2nd | 3rd | 4th | 5th | 6th |
| Hours | 0 (*) | 8 | 24 | 36 | 48 | 60 | |
| Age (years) | tablets | Tablets | tablets | tablets | tablets | Tablets | |
| up to 15 | 0 to 3 | 1 | 1 | 1 | 1 | 1 | 1 |
| 15 up to 25 | 3 up to 8 | 2 | 2 | 2 | 2 | 2 | 2 |
| 25 up to 35 | 8 up to 12 | 3 | 3 | 3 | 3 | 3 | 3 |
| 35 and
above |
12 and
above |
4 | 4 | 4 | 4 | 4 | 4 |
| (*) 0 hours means the time of starting medication | |||||||
An alternative artemisinin-based combination therapy (ACT) for treatment of uncomplicated malaria is:
B: Dihydroartemisinin-Piperaquine (DPQ).
Strength: Standard tablet, fixed formulation containing 40 mg of Dihydroartemisinin (DHA) and 320 mg Piperaquine (PPQ). Paediatric formulation contains a fixed combination of 20 mg of Dihydroartemisinin (DHA) and 160 mg Piperaquine (PPQ)
Table 5.2: Dose schedule for Dihydroartemisinin + Piperaquine
| Body weight (kg) | Dihydroartemisinin + Piperaquine dose (mg) given daily for 3 days |
| 5 to < 8 | 20 + 160 |
| 8 to < 11 | 30+ 240 |
| 11 to < 17 | 40 + 320 |
| 17 to < 25 | 60 + 480 |
| 25 to < 36 | 80 + 640 |
| 36 to < 60 | 120 + 960 |
| 60 < 80 | 160 + 1280 |
| > 80 | 200 + 1600 |
Analgesic Medicines
- Patients with high fever (38.50C and above) should be given an antipyretic medicine like paracetamol or aspirin every 4 to 6 hours (maximum 4 doses in 24 hours) until symptoms resolve, usually after two days.
- Children below 12 years should not be given aspirin because of the risk of developing Reye’s syndrome.
For more details on management of fever and pain, refer to chapter one-syndromic
