How can you tell whether malaria is uncomplicated or severe?

In uncomplicated malaria the patient:

  • Has mild symptoms
  • Is fully alert and able to stand and walk
  • Is passing urine
  • Is not vomiting repeatedly, and is able to take oral medication
  • Has no signs of organ failure

In uncomplicated malaria the parasite count on a thin blood smear is less than 5%, i.e. less than 5% of red cells containing malaria parasites.

In severe malaria the patient may have any of the following:

  • Signs of cerebral malaria
  • Breathing difficulty
  • Hypoglycaemia, jaundice or severe anaemia (Hb less than 5 g/dl)
  • Repeated vomiting, apparent dehydration or little urine passed
  • A shocked appearance

In severe malaria the parasite count is well over 5% (hyperparasitaemia). The higher the count, the more severe the malaria. Metabolic acidosis may occur.

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