Background: Severe falciparum malaria is a major cause of death among children and often the major reason for children hospital admissions in sub-Saharan Africa. Nigerians have partial immunity arising from their residence in a hyperendemic region for malaria transmission but they are still susceptible to severe malaria. It is, also, being reported in clinical practice among adolescent and adult Nigerians.  Severe malaria is a medical emergency that is rapidly associated with complications and death if prompt and appropriate treatment is not given. They present first, not to the few pediatricians and internists in the cities, but to general practitioners (GPs), medical officers, paramedical personnel and community health officers whose grasp of the pathophysiology, complications and treatment of severe malaria is rather woolly; hence, the rationale for this review. 

Objective: The objective of this narrative review is to highlight the pathophysiology of severe malaria and relate that to its clinical manifestations/complications and to highlight the challenges of management of severe malaria in Nigeria and the low income countries of the world.

Methods : Medline, Pubmed, African Journal Online and Google Scholar were searched and using Mesh headings, the terms "severe malaria", "pathophysiology", "clinical presentations", "management", "challenges of management" and "Nigeria" as well as variations thereof were searched for. Studies relevant to my topic were used to document this review. Standard Internal Medicine texts were also used.

Conclusion: With a good understanding of the pathophysiology of severe malaria as it relates to its clinical manifestations/complications, clinicians should achieve a more favorable outcome from the current treatment protocol. Current mortality rates from severe malaria is, unacceptably, too high in view of the available body of knowledge and drugs for managing it  

Keywords: Severe falciparum malaria, Pathophysiology and clinical manifestations of severe malaria, Nigeria, Management challenges of severe malaria.