The most important element in the clinical diagnosis of malaria is for you to be alert and to suspect malaria in all patients with fever, whether your catchment area is located in a malarious area or not. Because the distribution of malaria in Ethiopia is patchy, it is also very important for you to find out the geographical and travel history of a patient who shows signs and symptoms of malaria, most importantly fever.

In non-malarious areas, you should suspect malaria in a patient who has high fever, or has had fever in the last 48 hours, if the person has travelled to a malarious area or country in the previous two weeks. In malarious areas, fever, or a history of fever in the last 48 hours, should be enough for you to suspect malaria in a patient. You should pay particular attention to children under the age of five years and pregnant mothers, as these groups are at a higher risk than others.

Why do you think children are at higher risk of getting severely ill or dying of malaria than adults?

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Children have a much weaker immunity against malaria. Immunity develops after repeated exposures to the malaria parasite and this takes time.

You can recognise malaria by asking the right questions and looking for the important signs (see Box 7.2):

Box 7.2 How to approach a clinical diagnosis of malaria

Ask: Ask questions and listen to what the patient has to say (if the patient is a young child, listen to the parent or guardian). If the patient (or parent) does not mention fever, ask whether there has been a fever at any time during the past 2–3 days. Patients who have had fever during the last 2–3 days may have malaria.
Look: Examine the patient for symptoms of malaria. Measure the temperature with a thermometer. If the temperature is more than 37°C, the patient has a fever. (If you do not have a thermometer with you, feel the forehead with the back of your hand. If the forehead feels hot, the patient probably has a fever).
Check: In addition to fever, malaria patients can show the following signs and symptoms: loss of appetite, refusal to breastfeed (child), weakness, nausea, vomiting, headache, joint pains, muscle aches. If you see any of these features you should think about malaria and act immediately. If there is no fever and no history of fever during the past 2–3 days, the patient does not have malaria.