​What kinds of symptoms do patients experience before receiving treatment?

Early symptoms of uncomplicated malaria include fever and flu-like illness, shaking chills, headaches, muscle aches, and tiredness. Nausea, vomiting, and diarrhea may also occur. Untreated, uncomplicated malaria can quickly progress to complicated malaria. Complicated malaria means that the disease has become life-threatening. By disrupting blood supply to vital organs, it alters important bodily functions. Complicated malaria can lead to death in a few hours or days or have long-term impacts. Symptoms include severe anemia, pulmonary edema, kidney failure, seizures, mental confusion, coma, and death. Neurologic defects may persist following cerebral malaria, especially in children. Such defects include troubles with movement, palsies, speech difficulties, deafness, and blindness. An estimated 90% of the malaria deaths in Africa occur south of the Sahara. Most of these deaths occur in children under 5 years of age.

​What is the impact on patients’ lives of living with these conditions?

Malaria that is not treated promptly can progress to complicated malaria, with potential long-term effects or death. Inadequate treatment of malaria can lead to frequent relapses, resulting in severe anemia, especially in children. There is also some evidence of long-term cognitive impairment in children who have had complicated or cerebral malaria.

What cultural or regional factors affect the treatment of these conditions?

Malaria is endemic to most of sub-Saharan Africa, including Uganda. In rural, southwest Uganda, much of the population is poor and cannot afford insecticide-treated bed nets, one of the best ways to prevent transmission of malaria in children. In addition, their houses may not have doors, windows, or screens to prevent mosquitoes from entering.

What does the treatment process look like?

Treatment for pediatric complicated malaria requires admission to the hospital. A patient is given three doses of intravenous artesunate over 24 hours. In addition, the patient may receive medications to control fever and pain and to support the affected organs. Seizures, if present, need to be stopped with medications. Severe anemia necessitates blood transfusion. Frequently, antibiotics are given to treat concurrent infections. After treatment with artesunate and for any concurrent conditions, the child is sent home with three days of Coartem® to stop the growth of the parasites in the blood.

What is the impact of this treatment on the patient’s life?

If the right treatment is started promptly, then malaria is treatable. A patient’s life can be saved.

What potential side effects or risks come with this treatment?

Artesunate is generally safe and well-tolerated. Coartem may have some side effects, including mild weakness or dizziness, mild headaches, joint or muscle pain, cough, or trouble sleeping.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

Uncomplicated malaria can be treated with oral artemisinin-based combination therapies (ACTs), available from local district health centers. Complicated malaria must be treated in the hospital. Some patients are also referred from lower-level health centers, which are less well-staffed and equipped to manage the complications of malaria.

What are the alternatives to this treatment?

There are no alternatives to intravenous ACT-based medications for complicated malaria. The alternative hospitals are more than a two-hour drive away. Complicated malaria often occurs after patients have tried to self-medicate without consulting a qualified health worker. They use drugs purchased from a local pharmacy or herbal medications from a traditional healer.