The treatment for fever or malaria is not based on classification of malaria risk. Therefore once you have classified for fever, the treatment is the same. The exception is where there is no malaria risk when you do not have to treat the child with an anti malarial drug.

Very severe febrile disease or severe malaria

A child with fever and any general danger sign or stiff neck may have meningitis, severe malaria or sepsis. 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.

The pre-referral Cotrimoxazole oral antibiotics should also be given and prevent low sugar by ensuring the child has food on the journey to health centre or hospital. You should administer Artesunate rectally as indicated in Table 6.3 below.

Rectal artesunate pre-referral treatment for children (0–5 years) and weighing at least 5 kg.

Weight (kg)	Age	Artesunate dose (mg)	Regimen (single dose)
5–8.9	0-12 months	50	One 50 mg suppositry
9–19	13-41 months	100	One 100mg suppository
20–29	42-60 months	200	Two100mg suppositories

Treatment of Malaria

Treat a child over 4 months of age, classified as having P. Falciparum malaria, and treat with Coartem ( if RDT confirms P. vivax malaria, give chloroquine).
You should give Paracetamol if the child has a fever. If the fever has been present every day for more than seven days, you should refer the child for assessment.
Give an Oral Antimalarial.
First-line for Antimalarial for P falciparum and mixed infections ( falciparum + vivax malaria) is ive Artemether-Lumefentrine (COARTUM). Each Coartum pill has 20 mg Artemether and 120 mg Lumefentrine.

COARTUM (20 mg Artemether and 120 mg Lumefentrine)

Weight (kg)	Age	Number of tablets per dose twice daily for 3 days
5-14	3 months—2 years	1
15-24	3-7 years	2
25-34	7—10 years	3
35+	10 + years	4

Chloroquine: 150 mg base syrup 50 mg base in 5ml. A total dose of 25mg base per kg for 3 days (10mg base per kg on day 1and 2 and 5mg base per kg on day 3).

Chloroquine dosage

Weight (kg)	Age in months or Year	Day 1	Day 2	Day 3
5 – 6	<4 months	1/4 5 ml	1/4 5 ml	1/4 2.5 ml
7 – 10	4 - 11 months	1/2 7.5 ml	½ 7.5 ml	1/2 5 ml
11 – 14	1 <3 years	1 12.5 ml	1 12.5 ml	1/2 7.5 ml
15 – 18	3 - <5 years	1 15 ml	1 15 ml	1 15 ml
19 – 24	5 - <8 years	1 1/2 20 ml	1 ½ 20 ml	1 15 ml
25 – 35	8 - <11 years (Tablet)	2 ½	2 ½	1
36 – 50	11 - <14 years (Tablet)	3	3	2
50+	14+ years (Tablet)	4	4	2

Fever (no malaria)

If the child‘s fever is high, give Paracetamol. Advise the mother to return for follow-up visit in two days if the child‘s fever persists. If the fever has been present every day for more than seven days, then you should refer the child for assessment.
You will give paracetamol as a pre-referral treatment for high fever (38.5°C). Treat the fever every 6 hours until the high fever or ear pain is gone (see table below).

Paracetamol dose for High Fever (38.5°C) every 6 hours until high fever or ear pain is gone

PARACETAMOL
Age or Weight	Tablet (100 mg)	Tablet (500 mg)
2 months up to 3 years (4 - 14 kg)	1	¼
3 years up to 5 years (14 - 19 kg)	1 1/2	½

Follow-up:

If the child‘s fever persists after two days, the child should return.
Within 14 days of the initial classification, you should do a full re-assessment of the child. You should consider whether there are other causes of the fever.