Malaria is a serious illness in Uganda that can range from mild to life-threatening. Knowing how it is treated and managed helps patients get the right care and avoid complications. If you or your family are experiencing fever, chills, or weakness, you can get personalised malaria support from licensed doctors through Hope Plus.
Treatment of Uncomplicated Malaria in Uganda
Uncomplicated malaria is the mild or moderate form. Most people recover with oral medicines if treatment is started promptly. Medicines are chosen based on age, weight, pregnancy status, and drug availability.
First-line treatment for most patients, including children over 4 months and pregnant women in the 2nd or 3rd trimester:
- Artemether/Lumefantrine (AL) tablets
Alternative first-line treatment:
- Artesunate/Amodiaquine (AS+AQ) tablets
Second-line medicines (if the first-line is unavailable):
- Dihydroartemisinin/Piperaquine (DHA-PPQ) tablets
- Quinine tablets (if none of the above are available)
For pregnant women in the first trimester, special guidance from a doctor is needed, as some medicines are not recommended.
How to Take Artemether/Lumefantrine (AL)
The dose depends on weight:
| Weight (kg) | Day 1 | Day 2 | Day 3 |
|---|---|---|---|
| <14 | 1 tab at 0 hrs, 1 tab at 8 hrs | 1 tab twice daily | 1 tab twice daily |
| 15–24 | 2 tabs at 0 hrs, 2 tabs at 8 hrs | 2 tabs twice daily | 2 tabs twice daily |
| 25–34 | 3 tabs at 0 hrs, 3 tabs at 8 hrs | 3 tabs twice daily | 3 tabs twice daily |
| ≥35 | 4 tabs at 0 hrs, 4 tabs at 8 hrs | 4 tabs twice daily | 4 tabs twice daily |
Tip for patients: Take the Day 2 and Day 3 doses every 12 hours. Finish all doses even if you feel better.
Artesunate + Amodiaquine (AS+AQ) Dosage
Artesunate (AS) tablets:
| Age | Dose per day | Note |
|---|---|---|
| 0–11 months | 25 mg | Given with Amodiaquine |
| 1–6 years | 50 mg | “ |
| 7–13 years | 100 mg | “ |
| >13 years | 200 mg | “ |
Amodiaquine (AQ) tablets:
| Age | Dose per day | Note |
|---|---|---|
| 0–11 months | 76 mg | Used with Artesunate only |
| 1–6 years | 153 mg | “ |
| 7–13 years | 306 mg | “ |
| >13 years | 612 mg | “ |
Dihydroartemisinin/Piperaquine (DHA/PPQ) Tablets
| Weight (kg) | Day 1 | Day 2 | Day 3 |
|---|---|---|---|
| <5–9.9 | 0.5 tab | 0.5 tab | 0.5 tab |
| 10–20 | 1 tab | 1 tab | 1 tab |
| 20–40 | 2 tabs | 2 tabs | 2 tabs |
| 40–60 | 3 tabs | 3 tabs | 3 tabs |
| 60–80 | 4 tabs | 4 tabs | 4 tabs |
| >80 | 5 tabs | 5 tabs | 5 tabs |
Tip: These medicines are usually taken once daily for three days.
Severe Malaria in Uganda
Severe malaria is a medical emergency. It can cause coma, very low blood sugar, severe anaemia, kidney problems, or difficulty breathing. Immediate treatment at a health facility is required.
First-choice medicine for severe malaria:
- Intravenous (IV) Artesunate
Alternatives:
- IV Quinine
- IM Artemether (injection into the thigh) if IV is not possible
Pre-referral treatment (before reaching a hospital):
- Rectal Artesunate for children 6 years and below
- IM Artesunate, IM Artemether, or Quinine if the facility has injectable medicines
Dosage of Rectal Artesunate
| Weight (kg) | Age | Dose |
|---|---|---|
| 5–14 | 4 months–<3 years | 100 mg (1 suppository) |
| 14–19 | 3–<6 years | 200 mg (2 suppositories) |
Tip for parents: Hold the child’s buttocks together for 10 minutes to ensure the medicine stays in.
IV and IM Artesunate for Severe Malaria
IV Artesunate Loading Dose:
- Children <20 kg: 3 mg/kg
- Adults/Children ≥20 kg: 2.4 mg/kg
Follow-up doses:
- At 12 hours, 24 hours, then once daily until the patient can take oral medicine
- Complete the course with oral Artemisinin Combination Therapy (ACT)
IM Artemether is used if IV is not possible:
- Day 0: 3.2 mg/kg
- Day 1 & 2: 1.6 mg/kg once daily
- Switch to IV Quinine if the patient is not improving after 48 hours
Managing Complications of Severe Malaria
High Fever:
- Paracetamol for adults and children + tepid sponging
Convulsions:
- Diazepam or Phenobarbital (child-appropriate doses)
- Monitor closely; repeat if necessary
Hypoglycaemia (low blood sugar):
- IV Dextrose (adult 25%, child 10%)
- Monitor blood sugar frequently
Acidosis:
- Correct fluids and electrolytes
- Sodium bicarbonate infusion if needed
Severe Anaemia:
- Blood transfusions with packed cells or whole blood
- Repeat haemoglobin checks
Pulmonary Oedema (fluid in lungs):
- Regulate IV fluids carefully
- Oxygen therapy and furosemide as needed
Kidney Problems:
- Monitor urine output
- Refer for dialysis if needed
Shock:
- Fast IV fluids
- Raise patient’s legs, monitor vitals
Bleeding:
- Blood transfusion to replace clotting factors
Coma:
- Check for low blood sugar
- Provide intensive nursing care: IV fluids, feeding tube, catheter for urine monitoring, frequent turning to avoid bedsores
Malaria Testing in Uganda
Even if you feel very sick, all suspected malaria patients must be tested:
- RDT (Rapid Diagnostic Test) detects malaria proteins; can remain positive for 2–3 weeks after treatment
- Blood smear identifies parasites and confirms species
What if the test is negative but you are sick?
- Other causes of fever are investigated: respiratory infections, tonsillitis, ear infections, pneumonia, urinary infections, gastroenteritis, or viral rashes
- Severe malaria may still be treated if symptoms are urgent; tests are repeated within 24 hours
Key Points for Patients
- Always complete your malaria medicine course, even if you feel better.
- Seek urgent medical attention if you experience severe malaria signs: coma, repeated seizures, difficulty breathing, severe vomiting, or dark urine.
- Preventive steps:
- Sleep under insecticide-treated nets
- Use mosquito repellents
- Avoid stagnant water around your home
- For personalised malaria care, including medicine advice, dosing, and follow-up, register with Hope Plus to consult licensed doctors quickly and safely.
