Malaria is a fever caused by Plasmodium parasites that spread through the bite of an infected female Anopheles mosquito. It is fully curable when it is confirmed early with a blood test and treated with the right medicines, but it can turn serious within a day or two, especially in children and pregnant women. This guide explains the symptoms, which tests confirm it, how it is treated in India, and when a fever needs urgent care.
Quick answer: Any fever in or after a stay in a malaria area should be tested the same day with a rapid diagnostic test (RDT) or a blood smear under the microscope. Symptoms usually start 7 to 30 days after the bite and include fever with chills, sweating, headache and body ache. Treatment depends on the species: P. vivax needs a medicine to clear the blood plus a 14-day course to prevent relapse, and P. falciparum needs an artemisinin-based combination. Confusion, fits, breathlessness, dark urine or repeated vomiting mean hospital care now.
Key takeaways
- ✅ Never treat a fever as malaria without a test. Test first, then treat.
- ✅ Both the RDT and the smear are cheap and are free at government health facilities in India.
- ✅ Finish the whole course, including the 14 days of primaquine for vivax, even if you feel better.
- ✅ Mosquito nets, repellents and removing standing water are still the best protection.
What causes malaria?
Five Plasmodium species infect people. In India almost all cases are caused by two of them:
| Species |
What makes it different |
| P. falciparum | Causes most severe malaria and deaths. Can damage the brain, kidneys and lungs within hours if untreated. |
| P. vivax | Usually milder, but it hides in the liver and can come back (relapse) weeks or months later unless the liver stage is treated. |
| P. malariae, P. ovale, P. knowlesi | Uncommon in India. Found through the same blood tests. |
After the bite, parasites multiply in the liver and then burst into the bloodstream, infecting red blood cells. The cycle of red cells bursting is what causes the waves of fever and chills. Malaria can also pass through blood transfusion and from mother to baby, but it does not spread from person to person like a cold.
Symptoms of malaria
Symptoms usually begin 7 to 30 days after an infected bite. Vivax can first appear months later. Early malaria looks like many other fevers, which is why testing matters.
- Fever with chills and shivering, followed by heavy sweating as the fever breaks
- Headache, body ache and joint pain
- Tiredness and weakness
- Nausea, vomiting, loss of appetite or loose stools
- In children: irritability, poor feeding, drowsiness or fast breathing
The classic "fever every second or third day" pattern is often missing, especially early on, so do not wait for it before getting tested.
Danger signs of severe malaria
Go to hospital immediately if there is:
- Confusion, unusual sleepiness or unconsciousness
- Fits (convulsions)
- Difficulty breathing
- Repeated vomiting, or being unable to eat, drink or take tablets
- Very little urine, or dark, cola-coloured urine
- Yellow eyes (jaundice), bleeding, or severe weakness and inability to sit or stand
Young children, pregnant women, older adults and people who have never lived in a malaria area are at highest risk of severe disease.
Blood tests for malaria
India's national programme asks that every suspected malaria fever is confirmed by a blood test before treatment. There are two main tests.
| Test |
How it works |
Good to know |
| Rapid diagnostic test (RDT) | A finger-prick drop of blood on a test card detects parasite proteins. Result in about 15 to 20 minutes. | Tells falciparum apart from other types. Used by ASHAs and at primary health centres. Some falciparum tests can stay positive for weeks after a cure. |
| Thick blood smear | A thick drop of blood is stained and checked under the microscope. | The most sensitive way to find parasites, even when there are few of them. |
| Thin blood smear | A thin film of blood, stained with Giemsa or Leishman stain. | Shows the species and the percentage of infected red cells, which helps judge severity and response to treatment. |
| PCR (molecular test) | Detects parasite DNA. | Mainly used in research and reference labs, not for routine care. |
If the first test is negative but the fever continues, repeat it after 12 to 24 hours. Parasite levels rise and fall, so one negative smear does not always rule malaria out. In severe illness, doctors also check a complete blood count, blood sugar, kidney and liver function.
How malaria is treated in India
Treatment follows India's National Drug Policy on Malaria and is free in the public health system. The exact medicines and doses depend on the species, age, weight, pregnancy and where you live, so they should always be decided by a doctor or health worker after a positive test.
- P. vivax: chloroquine for three days to clear the blood, plus primaquine for 14 days to kill the hidden liver stage and prevent relapse. Primaquine is not given to pregnant women, infants or people with G6PD deficiency, because it can break down red blood cells in them.
- P. falciparum (uncomplicated): an artemisinin-based combination therapy (ACT) for three days, plus a single low dose of primaquine to stop onward spread. The combination used differs between the north-eastern states and the rest of India.
- Severe malaria: hospital admission and injectable artesunate, followed by a full oral ACT course once the patient can swallow.
- Pregnancy: treatment is chosen by trimester and should be managed by a doctor. Malaria in pregnancy is dangerous for both mother and baby, so do not delay testing.
Fever usually settles within two to three days. If it does not, or if symptoms return within a few weeks, go back for a repeat blood test.
Malaria in children and in pregnancy
Children under five can become seriously ill very quickly. Watch for drowsiness, refusal to feed, fast breathing, fits or pale palms. Doses are worked out by weight, so never share an adult's tablets with a child.
Pregnant women are more likely to develop severe malaria and anemia, and the infection raises the risk of miscarriage, low birth weight and premature birth. Every fever in pregnancy in a malaria area should be tested.
How to prevent malaria
- Sleep under an insecticide-treated bed net, especially children and pregnant women
- Use mosquito repellent and wear long sleeves and full-length clothes after dusk
- Fit mesh screens on windows and doors
- Empty or cover water in coolers, tyres, pots and tanks every week so mosquitoes cannot breed
- Allow indoor residual spraying when the health department visits
- If you travel to a high-risk area, ask a doctor whether preventive medicine is advised for you
India's national framework aims to eliminate malaria by 2030. Early testing and complete treatment protect not only you but your neighbours too, because each treated case removes a source of infection for local mosquitoes.
Frequently asked questions
Can malaria come back after treatment?
Vivax malaria can relapse from the liver weeks or months later if the 14-day primaquine course is not completed. A new mosquito bite can also cause a fresh infection.
Is a negative RDT enough to rule out malaria?
Usually, but not always. If fever continues and there is no other clear cause, a repeat test or a thick smear is advised.
Can I take malaria tablets without a test?
No. Guessing wastes time if the fever is something else, such as dengue or typhoid, and needless use of malaria medicines encourages drug resistance.
How long does recovery take?
Most people feel better within a few days of starting treatment. Tiredness and mild anemia can last a few weeks, so eat well and follow up if weakness persists.
Related reading: Top iron-rich foods for recovering from anemia after malaria, and our guide to anemia.
Last updated: September 2026. General health information only, not a diagnosis or a treatment plan. Always get a fever tested and follow the treatment advised by a qualified doctor or health worker.
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