A 32-year-old woman from rural Odisha presents to the primary health centre with fever, chills, and sweating for 3 days. Blood smear microscopy confirms Plasmodium vivax malaria. She is haemodynamically stable, alert, and has no signs of severe malaria. What is the most appropriate next step in management?

Explanation

## Management of Uncomplicated P. vivax Malaria **Key Point:** Uncomplicated malaria in India is managed on an outpatient basis at the primary health centre level with oral antimalarials, provided the patient is stable and compliant. ### Treatment Protocol for P. vivax (NVBDCP Guidelines) For **uncomplicated P. vivax malaria** in a stable, non-pregnant woman: | Component | Regimen | Rationale | |-----------|---------|----------| | **Acute attack** | Chloroquine 600 mg base (Day 1), then 300 mg at 6, 24, 48 hrs | First-line for P. vivax in India (no chloroquine resistance in vivax) | | **Radical cure** | Primaquine 0.5 mg/kg/day × 14 days | Eliminates hypnozoites; prevents relapse | | **Timing** | Start primaquine after completing chloroquine | Reduces GI side effects; allows G6PD screening if needed | **High-Yield:** P. vivax remains chloroquine-sensitive in India; artemisinin derivatives are reserved for severe malaria or P. falciparum. ### Why Outpatient Management Here? - Haemodynamically stable - Alert and oriented (no cerebral involvement) - No signs of severe malaria (no organ dysfunction, no parasitaemia >1%) - Reliable access to PHC follow-up **Clinical Pearl:** Primaquine is **contraindicated in pregnancy** and **must be preceded by G6PD testing** in males from endemic regions to avoid haemolytic crisis. ### Criteria for Hospitalization (Not Met Here) - Severe anaemia (Hb <7 g/dL) - Cerebral malaria - Acute kidney injury - Pulmonary oedema - Severe thrombocytopenia (<50,000/μL) with bleeding - Parasitaemia >1% [cite:Park 26e Ch 13]