Hesperian Health Guides


a mosquito with spotted wings
The malaria mosquito may have spotted wings.

Malaria is caused by a parasite (called Plasmodium) passed to people by mosquitoes (called Anopheles) that bite mostly at night. For most cases of regular malaria (called uncomplicated malaria), the cycles of fever and chills are unpleasant but will go away in a few days with treatment. But untreated, malaria can become dangerous quickly. This is called severe malaria. In regions with malaria, people with unexplained fevers should go to a health center to get a blood test. If the test shows malaria, or if testing is not available but health workers think it is malaria, start treatment with medicines right away.

Different parasites cause falciparum, vivax, and other malaria types. Health authorities know which types are present where you live and which medicines will work best. Without medicines, malaria can come back many times because the parasites stay in the person’s body. Medicines help the person get better by killing the parasites.

Malaria is especially dangerous to babies, children under 5 years old, pregnant women, and people with HIV. When pregnancy or HIV or another illness make it hard for a person’s body to fight off infections, getting malaria or developing severe malaria is more likely.

Uncomplicated malaria

A common sign of malaria is a fever that comes and goes, followed each time by chills. Sometimes the person sweats as the fever goes down. However, many cases of malaria do not follow this pattern. The other signs are common but do not affect everyone and are signs of other illnesses too.

Signs of uncomplicated malaria
  • Fever can be mild but is often high, 39° (102°F) or more
  • Chills and sweats
  • Headaches and body aches
  • Nausea, vomiting, lack of appetite
  • Paleness and weakness from anemia
  • Mild jaundice (yellow in the white part of the eyes or skin of a light-colored person)
  • Enlarged spleen (a health worker feels this by checking the belly)

a health worker taking a drop of blood from the finger of a child who is sitting on his mother's lap
Rapid Diagnostic Tests (RTD) test for malaria using a drop of blood. If the person is already taking malaria medicine, the test may not give a correct result.

A blood test confirms if a person has malaria. Some malaria tests require a microscope but many health workers use rapid test kits that use only a single drop of blood. Because untreated malaria can cause fever and chills several times over a few years, ask if the person has had the same signs in recent months.

Treatment of uncomplicated malaria

Start malaria medicine as soon as possible after a positive blood test or if you have good reason to suspect malaria and a test is not available. In areas with P. falciparum malaria, it is especially important to begin treatment right away. Because mosquitoes pass malaria from person to person, treating a sick person protects others from getting infected.

Find out what medicines for malaria your local health authorities recommend. In many regions, malaria has developed resistance to some older medicines. This means that medicines that once worked to prevent or treat malaria no longer work. Medicines that cure malaria in one region may not cure the malaria found in a different place.

A person with malaria will need to rest and drink clean water, soups, and also rehydration drink if there is fever, vomiting, or diarrhea.

IMPORTANT! Take all of the medicine for all of the days recommended, even if you feel better. If you stop taking the medicine, the malaria may come back and the medicines may no longer work.
a healthy looking woman
The woman who took all of her medicine got better. The woman who did not finish all her medicine is still sick in bed.
a woman in bed with a fever

Severe malaria

Severe malaria can develop when uncomplicated malaria is not treated or not treated soon enough. Severe malaria is more likely when the person’s malaria is caused by the parasite “Plasmodium falciparum” (P. falciparum). The person with severe malaria needs advanced care in a hospital or clinic. Severe malaria can cause death within 1 or 2 days, especially if it spreads to the brain, a condition called “cerebral malaria.”

Danger signs of severe malaria
  • Too weak to sit or stand, cannot stay awake
  • Mental confusion, convulsions, or loss of consciousness
  • Repeated vomiting, cannot drink or breastfeed
  • Rapid breathing or difficulty breathing
  • Low blood pressure or other signs of shock.
  • Dark urine, and less urine as kidneys begin to fail

Health workers will also test blood and urine for:

  • Anemia
  • Hemoglobin in the urine
  • Low blood sugar (glucose)
Treatment of severe malaria

Adults and children with severe malaria need a health worker with advanced training to give artesunate in the vein or injected in the muscle, for 24 hours or more. If the hospital or the person who can give this treatment is not close, a local health worker may have the training and medicines to inject artesunate or quinine to help while you get to a hospital. Artesunate capsules in the rectum are used for children under 6 years old where injected artesunate is not available. Emergency treatment does not cure the malaria; you will also need 3 or more days of additional medicines by mouth.

two children sleeping in a bed with a bednet
Malaria mosquitoes bite at night. To prevent malaria, sleep under an insecticide-treated bednet. Cover a baby’s cradle with netting too.
Prevention of malaria

Medicines that treat malaria are sometimes used to prevent it. In some countries, it is important to take medicine once a month to prevent malaria during the last 6 months of pregnancy (see sulfadoxine + pyrimethamine). In countries where malaria only appears in the rainy season, programs may give malaria prevention medicine to children a few months each year. People traveling to a region with malaria can also prevent it by taking a daily or weekly dose depending on the region and medicine used. Vaccines to prevent malaria are being developed and may become available in the future.

Sleeping under an insecticide-treated bednet is one of the best ways to prevent malaria. These bednets are treated with one or more insecticides, which are relatively safe, especially compared to getting malaria. Learn more about how bednets prevent malaria and other mosquito illness.

Distributing free insecticide-treated bednets and trained workers spraying insecticides indoors can stop malaria when enough homes in the community are involved. You can prevent malaria mosquitoes from breeding or their eggs from hatching. Avoiding mosquito bites will always help prevent the diseases they spread.

a woman talking to a group about the causes of malaria
Rainy season worse each year
Illness brought home by workers who migrated to coast
No medicines in clinic
Hard to find new bednets
...and the pits in the road get filled with water.

Poverty and injustice allow malaria to spread. If people do not have the means to protect themselves from malaria, they get infected and then others get it through the local mosquitoes. For prevention and treatment campaigns to be successful, bednets, malaria tests, medicines, and safe ways to stop mosquitoes from breeding must be available to all.

This page was updated:25 Nov 2019