Malaria in children: SAQ

This child has severe falciparum malaria. His travel to Papua New Guinea without prophylaxis, the impaired consciousness with a low Blantyre coma scale, the deep sighing respirations of metabolic acidosis, and the high parasitaemia of six per cent together meet several World Health Organization severity criteria. He needs immediate resuscitation, intravenous artesunate, and cautious supportive care, with paediatric intensive care and retrieval organised early. ^[2]

Question 1 (10 marks)

Outline your immediate assessment and investigation plan for this child, and justify why this is classified as severe malaria. ^[2]

Begin with an airway, breathing, circulation assessment and an overall sick-or-well judgement. This boy is critically unwell, with a reduced conscious level, deep acidotic breathing, and pallor. Check a fingerprick glucose immediately because hypoglycaemia is common and treatable in severe malaria, and measure a full set of vital signs including heart rate, blood pressure, capillary refill, and oxygen saturation. ^[2]

Establish intravenous access and draw a confirmatory blood sample while the team prepares artesunate. Send a full blood count, blood gas, lactate, glucose, urea and electrolytes, bilirubin, and a blood culture, because bacterial co-infection is common in severe malaria. Confirm the species and parasite density on a thin film and run a rapid diagnostic test for falciparum if one is available at the point of care. ^[1]

Classify this as severe malaria because he has several World Health Organization severity features, namely cerebral malaria with a Blantyre coma scale of three, respiratory distress with deep sighing breathing, and a parasitaemia above two per cent in a non-immune child. Any one of these would justify intravenous artesunate, and the combination confirms a high-mortality presentation that needs paediatric intensive care and urgent retrieval. ^[1]