Symptomatic malaria is predominantly a disease of childhood in areas of higher transmission (i.e. much of sub-Saharan Africa). Most cases of severe malaria occur in children less than 5 years of age. In these regions both malaria and sepsis are major causes of childhood death, yet the clinical distinction between the two is difficult, particularly if there is no obvious focus of infection. Furthermore, severe malaria predisposes to bacterial infections, particularly with Salmonella sp, so a very sick child may have both.