• Paracheck ONLY if fever (>38°C oral) or history of fever in the last 48 hours. Do a Paracheck test every time you think the patient may have malaria.
  
  
• If Paracheck negative treat as PV or send to a health center for Optimal test or microscopy. Remember to tell the patient: “if you still have fever on the third day of treatment please come back”.
  
  
• If Paracheck positive treat as PF but treat only uncomplicated cases. If the patient has any sign of severe malaria refer to health center or hospital. (signs of severe malaria in Appendix 1).
  • Give MAS3: if the patient has NOT received Mefloquine 25mg/kg in the last 2 months or give COARTEMETHER
  • Give AS7 (D7) if the patient has received Mefloquine 25 mg/kg in the last 2 months. Remember: NO Doxycycline or CoArtemether to children under 8 years old or to pregnant women)
  
  
• IMPORTANT: If you are SURE that the patient has received a COMPLETE treatment for malaria in the last month for examples MAS3, Q7T7 or 6 doses of CoArtemether, you need to check the malaria smear by microscope because the patient may be cured and have a Paracheck test still positive.
  If the malaria smear is negative: No treatment is needed.
  
  
• If the patient cannot take oral treatment (vomiting) refer to health center.
  
  
• Remember: If you have a patient with a positive Paracheck and the fever continues after the third day of treatment then maybe the patient has not got malaria. Tell the patient to go to health center.
  
  
• If the Paracheck result is not clear, repeat the Paracheck test.

Appendix 1

1. Cerebral malaria - coma
2. Severe anaemia - pale sclera, pale palate, pale nails
3. Renal failure - no (or low) urine output
4. Pulmonary oedema - water in the lungs (fast breathing)
5. Hypoglycaemia - low blood sugar (patient is fainting)
6. Circulatory collapse, shock - very low blood pressure, weak pulse
7. Spontaneous bleeding/disseminated intravascular coagulation - bleeding gums, nose, skin petechiae or bruised
8. Repeated generalized convulsions - fitting
9. Acidaemia/acidosis - fast deep breathing
10. Malarial haemoglobinuria - red or black urine

1. Impaired consciousness but rousable, cannot eat and drink him/herself
2. Prostration, extreme weakness - lying down and cannot get up unaided
3. Jaundice - yellow sclera
4. Hyperpyrexia - very high fever (> 40°C): cool down with water and give paracetamol.