# 6. Management of Sick Children with Fever Study Session Management of Sick Children with Fever 4

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## 6.3  Classifying fever

The next step after assessing for fever and measles is to classify the illness. If the child has fever and no signs of measles, classify the child for fever only. If the child has signs of both fever and measles, classify the child for both.

#### Activity 6.1  Assess and classify fever (1)

This activity will help you to check your understanding of what you have learned so far. Make notes in your Study Diary in answer to the following questions:

1. How would you classify a child with fever who lives in a low risk malaria area, and who does not have measles or a runny nose?

2. If a child brought to your health post with fever has recently travelled to another area, but neither his mother nor you know the malaria risk for that area, how would you classify the child?

3. What is the classification in all cases when a child has a fever and a stiff neck, bulging fontanelle or any general danger sign?

### Discussion

As you may recall, the Assess and Classify chart has three tables for fever classification. One is for classifying fever when the risk of malaria is high; the second is for when the risk of malaria is low and the third is for classifying fever when there is no malaria risk.

Therefore, to classify fever, you must know if the malaria risk is high, low or none and then select the appropriate table.

For the child in question (a) above, you would use the ‘low risk’ table and classify for ‘malaria low risk’.

All children with fever and a stiff neck, bulging fontanelle or any general danger sign must be referred urgently.

The child in question (b) will need to be classified according to the high risk malaria table. You read that if you do not know the risk of malaria in an area a child has visited, you should assume ‘high risk’. Therefore this child should be classified as ‘malaria high risk’.

(c) In all cases where a child with fever also has a stiff neck, bulging fontanelle or any general danger sign, they must be classified as very severe febrile disease. In such cases you must refer the child urgently.

You will now look in more detail at how to classify malaria.

End of discussion

### High malaria risk

There are two possible classifications of fever when the malaria risk is high:

• Very severe febrile disease

• Malaria.

When the risk of malaria is high, the chance is also high that the child's fever is due to malaria.

If the child with fever has any general danger sign or a stiff neck, classify the child as having very severe febrile disease (High Malaria Risk).

If a general danger sign or stiff neck is not present but the child has fever (by history, feels hot, or temperature 37.5°C or above) in a high malaria risk area, you should classify the child as having malaria (High Malaria Risk).

### Low malaria risk

If you see children for whom the risk of malaria is low, use the Low Malaria Risk classification table. There are three possible classifications of fever in a child with low malaria risk:

• Very severe febrile disease

• Malaria

• Fever – malaria unlikely.

If the child has any general danger sign or a stiff neck, and the malaria risk is low, classify the child as having very severe febrile disease (Low Malaria Risk).

If the child does not have signs of very severe febrile disease and the risk of malaria is low, a child with fever and no runny nose, no measles and no other cause of fever is classified as having malaria (Low Malaria Risk).

When signs of another infection are not present, and blood film and rapid diagnostic test (RDT) for malaria are not available, you should classify and treat the illness as malaria even though the malaria risk is low.

If the child does not have signs of very severe febrile disease or of malaria and the malaria risk is low and the child has a runny nose, measles or other cause of fever, classify the child as having fever – malaria unlikely.

### No malaria risk

There are two possible classifications of fever in a child with no malaria risk:

• Very severe febrile disease

• Fever – no malaria.

If the child has any general danger sign or a stiff neck, and there is no malaria risk, classify the child as having very severe febrile disease (No Malaria Risk).

A child with any general danger sign, stiff neck or bulging fontanelle should be classified as very severe febrile disease and referred urgently.

When there is no malaria risk, a child with fever who has not travelled to a malarious area should be classified as fever — no malaria.

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