Study clinical response and parasite clearance response to Artemisinins in severe malaria in children


  • Pawan Ghanghoriya Department of Pediatrics, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
  • Purusharth Srivastava Department of Pediatrics, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India
  • Praveen K. Bharti Scientist D, National Institute of Rural and Tribal Health, Jabalpur, Madhya Pradesh, India



Artesunate, Parasite Clearance Time, Severe malaria


Background: The research was conducted to study the clinical response and parasite clearance response to Artesunate therapy, in children admitted with severe malaria at a tertiary care centre in Central India.

Methods: It is a prospective analytical study. 18 microscopy positive children diagnosed with severe malaria were included. Baseline blood samples collected for microscopy and biochemical tests. All patients were administered standard intravenous Artesunate therapy and were watched every 12 hourly for: 1. Resolution of clinical signs and symptoms. Clinical parameters included level of consciousness in form of GCS, vital signs like pulse rate, respiration, signs of bleeding, development of icterus, pallor, urine output and laboratory parameters included blood sugar levels, renal and liver function tests. 2. Time taken for conversion of microscopic Smear positive to Smear negative.

Results: The mean age was 8.34±4.35 years. Males and females were equally affected. 61% of severe malaria patients were infected by P. falciparum and remaining were infected by P. vivax. The most common clinical features were Pallor: 100%, Respiratory distress: 66.7%, Cerebral malaria: 55.6%. After giving Artesunate therapy, Mean GCS in Cerebral malaria patients showed improvement (on admission: 9±1.15, at 72 hours: 12.5±3.7). Effect was marginally better in P. vivax cases. Respiratory distress and tachycardia improved in majority of patients (75% and 80% respectively). The number of patients with icterus progressively increased. Improvement in liver function and renal function was minimal. 100% parasite clearance was achieved. The mean parasite clearance time is 46±9.43 hours. 72.2% were successfully discharged, 22.2% took Leave Against Medical Advice (LAMA) and 5.6% certified dead.

Conclusions: Artesunate is an effective drug in severe malaria patients in terms of rapid improvement of cerebral function, improvement and stabilization of vitals, parasite clearance with favorable long-term outcome. There is no evidence of plasmodium resistance to Artesunate currently as per the present study.


WHO. World Malaria Report 2016: Summary. Geneva: World Health Organization; 2017. Available at

Operational Manual for malaria elimination in India 2016, NVBDCP, DGHS, Ministry Of Health and Family Welfare. Available at:

Guidelines for the Treatment of Malaria. Third edition. World Health Organisation Geneva, 2015. Available at:

Singh N, Chand SK, Mishra AK, Bharti PK, Singh MP, Ahluwalia TP, et al. Epidemiology of malaria transmission in an area of low transmission in central India. Am J Trop Med Hyg. 2006;75:812-6.

Gohiya P, Goel M, Dwevedi R, Renwal S. Clinical profile and prognostic indicators of Plasmodium Falciparum Malaria in children. Int J Med Res Rev. 2014;2(3):215-20.

Ganguly T, Datta AK, Mandal S, Das PK. Clinicoparasitological study of acute severe malaria in children. IOSR J Pharm Biol Sci. 2012;2(6):12-21.

Murmu MC, Behera SR, Satpathy SK. Clinical presentation and survival outcome of severe malaria among hospitalized children: a single centre observational study. J Pediatr Res. 2017;4(05):315-21.

Huda SN, Shahab T, Ali SM, Afzal K, Khan HM. A comparative clinical trial of artemether and quinine in children with severe malaria. Departments of Pediatrics and Microbiology, Jawaharlal Nehru Medical College, AMU, Aligarh, U.P., India. Indian Pediatr. 2003;40:939-45.

Mohanty AK, Rath BK, Mohanty R, Samal AK, Mishra K. Randomized control trial of quinine and Artesunate in complicated malaria. Indian J Pediatr. 2004;71(4):291-5.

Nath KS, Kumar R, Ahmad GS, Prasad D. An observation on the efficacy and outcome of Artesunate versus Quinine therapy in complicated malaria patients: a hospital based study. Int J Recent Sci Res. 2015;6(5):3941-6.

Singh D, Sharma AK. Observation on the efficacy and outcome of Artesunate versus Quinine therapy in complicated malaria. IOSR J Dent Med Sci. 2017;16(5)(VIII):115-9.

Idro R, Marsh K, John CC, Newton CR. Cerebral malaria: mechanisms of brain injury and strategies for improved neurocognitive outcome. Pediatr Res. 2010;68(4):267.

Gehlawat VK, Arya V, Kaushik JS, Gathwala G. Clinical spectrum and treatment outcome of severe malaria caused by Plasmodium vivax in 18 children from northern India. Pathogens and Global Health. 2013;107(4):210-4.

Desai PD, Vasavda H, Vora HD, Mansuri SH, Patel B. Clinical spectrum, complications and treatment outcomes of malaria (in pediatric patients). NJIRM. 2013;4(2):140-3.

Kochar DK, Singh P, Agarwal P, Kochar SK, Pokharna R, Sareen PK. Malaria Hepatitis. J Assoc Physicians India. 2003;51:1069-72.

Joseph BM, Celestin NN, Michel AN, Guy LN, Thomas KS, Pierre TM, Nestor P. Black water fever associated with acute renal failure among congolese children in Kinshasa. Saudi J Kidney Dis Transpl. 2014;25(6):1352-8.

Panwar S, Soni RK, Ahmed N. Study of epidemiological profile, clinico-biochemical spectrum and prognosis of malaria induced renal dysfunction in paediatrics age group. Int J Contemp Pediatr. 2016;3:91-5.

Kumar A, Shrivastava AK, Taksande A, Singh D, Rai R. Severe P. falciparum malaria in children in a tertiary care center of Allahabad region of India. Internet J Pediatr Neonatol. 2009;12(1).






Original Research Articles