WHO severe malaria criteria | Description as published in national guidelines | Availability at BRH | Treatment available |
---|---|---|---|
Prostration | Inability to sit upright without support or to drink | Yes | Supportive only |
Impaired consciousness | Modified Glasgow score ≤ 9 in adult and children >5 years old or Blantyre coma score ≤ 2/5 in children who have not learned to speak | Yes | Supportive only |
Respiratory distress | Sustained nasal flaring, intercostals recession and deep or fast breathing (RR >25/min in adults and >40/min in children) | Yes | Limited - no ventilators, low flow oxygen only |
Multiple convulsions | > 1/24 h | Yes | Parenteral or NG diazepam |
Circulatory collapse | BP <50 mmHg before 5 years old or BP <80 mmHg above 5 years old, cool peripheries, weak pulses | Yes | Peripherally administered IV pressors, fluids |
Pulmonary oedema | Radiological features | Yes | Limited - diuretics, oxygen, morphine |
Abnormal bleeding | (No definition provided) | Yes | Blood transfusion (limited) |
Jaundice | (No definition provided) | Yes | Supportive |
Haemoglobinuria | (No definition provided) | Yes | Blood transfusion (limited) |
Frequent vomiting | Vomiting everything with inability to retain food or medicines | Yes | Antiemetic drugs, parenteral route of drug administration |
Laboratory finding | |||
Severe anaemia (or pallor) | Hb <5g/dl or Ht <15% | Yes | Blood transfusion (limited) |
Hypoglycaemia | Glycaemia <2.2 mmol/l or 0.4 g/l | Yes | IV dextrose |
Metabolic acidosis | Plasma bicarbonate <15 mmol/l | No | IV fluids |
Hyperlactataemia | Plasma lactate >5 mmol/l | No | IV fluids |
Hyperparasitaemia | P. falciparum “++++” or >200 000 parasites/μ l | Often | Intramuscular artemether |
Renal failure (or oliguria) | Urine output <400 ml/24 h or plasma creatinine>265 μ mol/l in adult or urine output <12 ml/kg/24 h or plasma creatinine above the age-related normal range, persisting after rehydration in children | Clinical only - rare lab tests | Peritoneal dialysis occasionally available; supportive care |