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9. Treatment of malaria caused by P. vivax, P. ovale or P. malariae

severe malaria; so broad-spectrum antibiotic treatment should be given initially until a
bacterial infection is excluded.

8.11 treatment of severe malaria in special groups during pregnancy

8.11.1 Treatment during pregnancy
Women in the second and third trimesters of pregnancy are more likely to develop severe
malaria than other adults, and, in low-transmission settings, this is often complicated by
pulmonary oedema and hypoglycaemia. Maternal mortality is approximately 50%, which
is higher than in non-pregnant adults. Fetal death and premature labour are common.

Parenteral antimalarials should be given to pregnant women with severe malaria in full
doses without delay. Parenteral artesunate is preferred over quinine in the second and
third trimesters, because quinine is associated with recurrent hypoglycaemia. In the first
trimester, the risk of hypoglycaemia is lower and the uncertainties over the safety of the
artemisinin derivatives are greater. However, weighing these risks against the evidence
that artesunate reduces the risk of death from severe malaria, both artesunate and quinine
may be considered as options until more evidence becomes available. Treatment must
not be delayed; so if only one of the drugs artesunate, artemether or quinine is available,
then it should be started immediately.
Obstetric advice should be sought at an early stage, the paediatricians alerted, and blood
glucose checked frequently. Hypoglycaemia should be expected, and it is often recurrent
if the patient is receiving quinine. Severe malaria may also present immediately following
delivery. Postpartum bacterial infection is a common complication in these cases.

9. treatment of malaria caused by P. vivax,

P. OvalE or P. malariaE

P. vivax, the second most important species causing human malaria, accounts for about
40% of malaria cases worldwide; it is the dominant malaria species outside Africa. It is
prevalent in endemic areas in the Asia, Central and South America, Middle East and
Oceania. In Africa, it is rare, except in the Horn, and it is almost absent in West Africa.
In most areas where P. vivax is prevalent, malaria transmission rates are low, and the
affected populations, therefore, achieve little immunity to this parasite. Consequently,
people of all ages are at risk. The other two human malaria parasite species P. malariae
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