The health ministry of the Democratic Republic of Congo (DRC) has confirmed that a mysterious illness in the southwestern Kwango province is a severe form of malaria, with 143 deaths reported so far. The outbreak, which began in late October in the Panzi health zone, has affected 592 people, with a case-fatality rate of 6.2%. Initial symptoms of the disease included fever, headache, cough, breathing difficulties, and weakness, prompting local authorities to notify health officials.1
Reports from December 10 confirmed that, of 12 initial samples, 10 tested positive for malaria. However, WHO Director-General Dr. Tedros Adhanom Ghebreyesus suggested that multiple infections may be involved, particularly given the area's high rates of malnutrition and low vaccination coverage, which leave the population vulnerable to diseases such as malaria, pneumonia, and measles.2
Investigators have faced significant challenges in accessing the remote region due to difficult road conditions and the rainy season, which have hampered communication and the transport of medical supplies. Initial samples sent to the National Institute for Biomedical Research (INRB) in Kinshasa were of poor quality, but further tests, including respiratory samples, confirmed malaria as the primary cause of the outbreak. The health ministry has also highlighted malnutrition as a contributing factor, weakening patients and complicating recovery.1
What is Severe Malaria?
According to the Severe Malaria Observatory, Severe malaria is a life-threatening complication of malaria, primarily caused by the Plasmodium falciparum parasite. It results in complications such as multiple organ failure, metabolic abnormalities, and serious issues like anemia, hypoglycemia, respiratory distress, convulsions, and coma. If untreated, severe malaria can progress rapidly and lead to death within hours or days. Malaria is particularly deadly for young children, especially in malaria-endemic regions like sub-Saharan Africa.3 According to the WHO, Africa accounts for 95% of the 608,000 global malaria deaths each year, with 80% of these fatalities involving children under five.4
When diagnosed early and treated promptly, malaria is preventable and treatable, and patients can fully recover without lasting effects. If left untreated the parasites multiply rapidly in the bloodstream, causing potential long-term damage to organs and tissues, particularly in children during critical stages of development.3
Challenges in Treatment
The primary treatment for severe malaria is injectable artesunate, which is recommended by WHO guidelines. Artesunate is administered intravenously or intramuscularly for at least 24 hours, followed by a three-day course of oral artemisinin-based combination therapy (ACT). The issue here is that treating severe malaria is particularly challenging in rural areas where healthcare infrastructure is limited. In these regions, patients often need to be transported to facilities capable of administering injectable artesunate, a process complicated by long distances, poor road conditions, and financial barriers.3
