Malaria in children: Viva

Branch 1: Recognising the time-critical problem

The candidate should immediately recognise that this child has fever with altered consciousness and a travel history to a malaria-endemic area, which places severe malaria at the top of the differential. The combination of drowsiness, pallor, and deep sighing breathing is the clinical signature of severe falciparum disease, and a blood film must be requested within the hour while resuscitation proceeds. ^[1]

The candidate should state that any febrile child with relevant travel in the preceding three months has malaria until the blood film proves otherwise, and that the severity features here mean treatment must begin before the film returns. The first priorities are airway, breathing, and circulation, a fingerprick glucose, and intravenous access so that artesunate can be given the moment severe disease is confirmed clinically. ^[2]