6.4.1  Very severe febrile disease or severe malaria

A child with fever and any general danger sign or stiff neck may have meningitis, severe malaria (including cerebral malaria) or sepsis. It is not possible to distinguish between these severe diseases without laboratory tests.

A child classified as having very severe febrile disease needs urgent treatment and referral. Before referring urgently, you should give a dose of paracetamol if the child’s temperature is 38.5°C or above, and prevent low sugar by ensuring the child has food on the journey to hospital. You should administer artesunate rectally as indicated in Table 6.1 below.

Table 6.1  Rectal artesunate treatment for children (aged 0–5 years) and weighing at least 5 kg.
Weight (kg)AgeArtesunate dose (mg)Regimen (single dose)
5–8.90–12 months50One 50 mg suppository
9–1913–41 months100One 100 mg suppository
20–2942–60 months200Two 100 mg suppositories

6.4  Treatment for fever and malaria

6.4.2  Malaria