Severe Malaria facts

Malawi is among the top 20 countries with the highest malaria prevalence and mortality rates.1 About 7.4% of all malaria cases in Eastern and Southern Africa occur in Malawi. Between 2015 and 2018, the case burden for malaria stagnated at between 214 to 217 per 1000 of the population at risk while deaths fell by about 13% from 0.41 to 0.36 per 1000 of the population at risk.1

Prevalence and transmission

Malaria is endemic in over 95 % of Malawi and was responsible for 36 % of all outpatient visits, 46% of all in-patient cases, and 24% of all in-patient deaths in 2016.  Malaria transmission is at its peak in high temperature areas as well as locations that have more rainfall and humidity. For Malawi, this is mainly along the low-lying lakeshore areas.2

Transmission is recurrent in most areas of the country and is highest after the beginning of the annual rains in November and continue through to April. Plasmodium falciparum accounts for 98% of the infections and all severe disease and deaths.  

Malawi’s healthcare system

The country’s health care system is organized within structures established at national, zonal, district and community levels. Public services provides 60% of health services and is free of charge; Christian Health Association Malawi (CHAM) provides 36% of services with malaria treatment services being at no charge. Private sectors facilities cater for 4% of services.3 All of these systems offer malaria control services.3 Tertiary health care centres, which consist of highly specialized services, manage severe malaria patients.3

Uptake of interventions

Utilization of healthcare services:

Although the 2017 Malaria Indicator Survey revealed high levels of knowledge on malaria symptoms (71%) and prevention (87%) among the general population, the proportion of those who sought treatment within 24 hours of the onset of symptoms is still low at 31%.3

Intermittent Preventative Treatment in Pregnancy (IPTp): IPTp uptake has increased and 76 % of women received two or more doses of sulfadoxine-pyrimethamine (SP) versus 63 % in 2014.31 41 % of pregnant women received three or more doses of SP in comparison to 13 % in 2014.2

Insecticide Treated Nets (ITNs):

The percentage of households that own at least one ITN increased from 70 % in the 2014 Malaria Indicator Survey (MIS) to 82 % in 2017.31 However, the proportion of households that slept under an ITN the night before increased from 41 % to 55 %.2

Worryingly, ITN use fell from 87 % in 2014 to 79 % for children under five years of age, and from 85 % to 73 % during that same period for pregnant women in households that own at least one ITN.3

Barriers to the uptake of interventions

Several cultural and social barriers, such as lack of equal access to resources by women, high female illiteracy and household decision-making by males regarding the seeking of healthcare services, continue to restrict access to interventions by women and children.3


Inpatient cases and deaths caused by severe malaria

Distribution of malaria cases

Severe malaria policy and practice

National treatment guidelines
Recommendation Treatment
Strong IV artesunate
Alternative IM artesunate
Alternative IV quinine
Recommendation Pre-Referral
Community level Rectal artesunate
Health facility  IM artesunate
Health facility alternative Rectal artesunate
Health facility alternative IM quinine
First trimester pregnancy
Recommendation Treatment
Strong IV quinine
Alternative IM quinine