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Clinical Review

Management of severe malaria in children: proposed guidelines for the United Kingdom

BMJ 2005; 331 doi: (Published 04 August 2005) Cite this as: BMJ 2005;331:337
  1. Kathryn Maitland, lecturer in tropical paediatrics (,
  2. Simon Nadel, consultant in paediatric intensive care2,
  3. Andrew J Pollard, consultant in paediatric infectious diseases3,
  4. Thomas N Williams1, Wellcome Trust senior research fellow,
  5. Charles R J C Newton1, Wellcome Trust senior research fellow,
  6. Michael Levin, professor in experimental medicine4
  1. 1 Kenya Medical Research Institute/Wellcome Trust Programme, Centre for Geographic Medicine Research-Coast, PO Box 230, Kilifi, Kenya
  2. 2 Department of Paediatrics, St Mary's Hospital, London W2 1NY
  3. 3 Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU
  4. 4 Brighton and Sussex Medical School, Medical Research Building, University of Sussex, Falmer, Brighton BN1 9PS
  1. Correspondence to: K Maitland


    Malaria is the most important vector borne disease worldwide. Globally it results in an estimated 400 million infections and more than 1 million deaths each year.1 Although malaria is a rare cause of hospital admission in the United Kingdom, it constitutes a substantial health threat for people travelling in endemic areas. The incidence of imported malaria is rising throughout much of the developed world, largely because of a global increase in long distance travel, immigration, and the resurgence of malaria in many tropical countries.24 Moreover, although Plasmodium vivax was once the most common form of imported malaria, it has since been superseded by P falciparum5—the only form of malaria that can be lethal—which now accounts for some 80% of reported cases. Around 15% of episodes of malaria occur in children aged 15 years or younger. Most of those affected are UK residents of African ethnicity who have recently visited family in endemic areas but have not taken preventive measures.5 Nevertheless, even strict compliance with preventive measures is never 100% effective, as resistance to available chemoprophylactic agents is increasing in many parts of the world.

    Although most cases of P falciparum malaria in patients presenting to health services in the UK are uncomplicated, up to 10% become severe and life threatening malaria, principally because of delays in diagnosis and inadequate treatment.5 6 In uncomplicated disease, the clinical features of malaria are similar in children and adults, but in severe disease, the clinical spectrum, complications, and management differ and merit the development of separate guidelines for children. We therefore propose the following guidelines for the assessment and emergency management of children with imported malaria.


    Few data are available on the clinical spectrum of severe malaria in children living in non-endemic areas. As a result, …

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