6.3.1 Classification of malaria
High malaria risk
There are two possible classifications of fever when the malaria risk is high:
- Very severe febrile disease
- Malaria.
When the risk of malaria is high, the chance is also high that the child's fever is due to malaria.
If the child with fever has any general danger sign or a stiff neck, classify the child as having very severe febrile disease (High Malaria Risk).
If a general danger sign or stiff neck is not present but the child has fever (by history, feels hot, or temperature 37.5°C or above) in a high malaria risk area, you should classify the child as having malaria (High Malaria Risk).
Low malaria risk
If you see children for whom the risk of malaria is low, use the Low Malaria Risk classification table. There are three possible classifications of fever in a child with low malaria risk:
- Very severe febrile disease
- Malaria
- Fever – malaria unlikely.
If the child has any general danger sign or a stiff neck, and the malaria risk is low, classify the child as having very severe febrile disease (Low Malaria Risk).
If the child does not have signs of very severe febrile disease and the risk of malaria is low, a child with fever and no runny nose, no measles and no other cause of fever is classified as having malaria (Low Malaria Risk).
When signs of another infection are not present, and blood film and rapid diagnostic test (RDT) for malaria are not available, you should classify and treat the illness as malaria even though the malaria risk is low.
If the child does not have signs of very severe febrile disease or of malaria and the malaria risk is low and the child has a runny nose, measles or other cause of fever, classify the child as having fever – malaria unlikely.
No malaria risk
There are two possible classifications of fever in a child with no malaria risk:
- Very severe febrile disease
- Fever – no malaria.
If the child has any general danger sign or a stiff neck, and there is no malaria risk, classify the child as having very severe febrile disease (No Malaria Risk).
A child with any general danger sign, stiff neck or bulging fontanelle should be classified as very severe febrile disease and referred urgently.
When there is no malaria risk, a child with fever who has not travelled to a malarious area should be classified as fever — no malaria.
6.3 Classifying fever