Infectious Disease Travel Medicine Emergency Medicine A

WHO Severe Malaria Criteria

WHO 2015 criteria for severe P. falciparum malaria requiring parenteral artesunate and ITU-level care.

Impaired consciousness (GCS < 11 in adults, Blantyre coma score < 3 in children)*

Prostration (unable to sit/stand)*

Multiple convulsions (>2 in 24 hours)*

Acidosis (base deficit > 8 mEq/L, bicarbonate < 15 mmol/L or lactate > 5 mmol/L)*

Pulmonary oedema (radiological, or SpO₂ < 92% on air with respiratory rate > 30/min)*

Significant bleeding (recurrent or prolonged nose, gum or venepuncture bleeding; haematemesis or melaena)*

Jaundice (bilirubin > 50 µmol/L) with parasite count > 100,000/µL*

Severe anaemia (Hb < 5 g/dL or haematocrit < 15% in children < 12 years; Hb < 7 g/dL or < 20% in adults) with parasite count > 10,000/µL*

Hypoglycaemia (glucose <2.2 mmol/L)*

Acute kidney injury (creatinine > 265 µmol/L or urea > 20 mmol/L)*

Shock (SBP < 80 mmHg in adults or < 70 mmHg in children with impaired perfusion; or capillary refill ≥ 3 s)*

Hyperparasitaemia (P. falciparum > 10% of red cells)*

Score interpretation

Uncomplicated Malaria 0

No WHO severe criterion: uncomplicated malaria. UK guideline: P. falciparum with > 2% parasitised red cells is treated as complicated (IV artesunate).

→ Oral artemisinin-based combination therapy (ACT); outpatient if reliable follow-up; recheck in 48h

Severe Malaria 1–12

≥1 WHO severe criteria: Severe malaria

→ IV artesunate (first-line); ICU admission; check blood glucose; urgent specialist review

Interpretation bands for the Severe Malaria. Apply clinical judgement and local guidance.

References

WHO. Severe malaria. Trop Med Int Health. 2014;19 Suppl 1:7-131.
WHO. Guidelines for the treatment of malaria. 3rd edition. Geneva: World Health Organization; 2015.
Lalloo DG, Shingadia D, Bell DJ, et al. UK malaria treatment guidelines 2016. J Infect. 2016;72(6):635–649.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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