How do we treat children with severe malaria?

Malaria imposes a profound burden on global public health; over one third of the world’s population (~2 billion people) live in malaria-endemic areas, with ~1 billion people estimated to carry parasites at any one time (Guerin et al., 2002). The greatest burden of malaria falls on sub-Saharan Africa (SSA), where it causes between 200–450 million disease episodes each year and over 1 million deaths. Most of these deaths are in children <5 years. Throughout the world the burden of malaria is increasing, especially in sub-Saharan Africa, mainly attributed to drug and insecticide resistance and social and environmental changes. Couple this to the worldwide increase in international travel, increases in the numbers of legal and illegal economic migrants, as well as in refugees seeking asylum from wars or political unrest, it is not surprising that there is a parallel rise in imported malaria. Nevertheless, in the UK and other European countries malaria is still a rare cause of hospital admission, few paediatricians have ever seen a case of severe malaria. Management of severe malaria should not only focus upon the choice of antimalarial agents, but should include comprehensive management of the child (Maitland et al., 2005a).