Severe Malaria Criteria (WHO, 2015):

• General Danger Signs:
  • Prostration (inability to sit, stand, or walk unassisted)
  • Generalized weakness
  • Altered consciousness
  • Difficulty breathing
  • Inability to feed (in children)
  • Convulsions (in children)
• Specific Severe Manifestations:
  • Cerebral malaria: Unarousable coma (Glasgow Coma Scale <9)
  • Severe anemia: Hemoglobin <7 g/dL or hematocrit <20%
  • Respiratory distress: Acidotic breathing, chest indrawing, nasal flaring
  • Hypoglycemia: Blood glucose <40 mg/dL
  • Acute kidney injury: Serum creatinine >2.5 mg/dL or oliguria (<400 mL/day in adults)
  • Acute hemolytic anemia: Hemoglobin <7 g/dL with parasitemia
  • Shock: Systolic blood pressure <80 mmHg (adults) or lower in children
  • Acute respiratory distress syndrome (ARDS): PaO2/FiO2 <300 mmHg
  • Disseminated intravascular coagulation (DIC): Platelets <50,000/μL + elevated fibrin degradation products
  • Acute liver failure: Jaundice + serum bilirubin >3 mg/dL
  • Hyperparasitemia: Parasitemia >5% (or >10% in non-immune individuals)

• Rationale:
  • The WHO criteria define severe malaria based on clinical and laboratory markers associated with high mortality risk. Hyperparasitemia (>5%) is a key indicator, as it correlates with organ dysfunction and poor outcomes. Cerebral malaria and severe anemia are particularly critical in children, while ARDS and DIC are more common in adults.