The authors have studied 68 children admitted with malaria in Sihanoukville Hospital (Cambodia) from December 1992 to April 1993. Sihanoukville is located on coast of the country, in a hypoendemic area with seasonal transmission occurring during this study. The patients lived in urban (1/3) or in rural areas (2/3). Plasmodium (P.) vivax alone was found in 15 cases. Among them, two patients presented with severe malaria, but chloroquine was efficient in all cases. P. falciparum with or without P. vivax, was predominant (53 cases). Most of these cases were severe, according to WHO criteria (n = 43), from which 11 deaths occurred (25%). There were 26 cases of cerebral malaria, with a death rate of 34.6%. A severe course was observed with the following criteria: prostration or coma (p = 0.029), severe anaemia (p = 0.037) and hyperparasitaemia (p = 0.00078). A significant longer delay for treatment and admission was noted among rural patients (p = 0.023 and p = 0.011 respectively). In those children, hyperparasitaemia, poor clinical status on admission and lethality were more frequent. The clinical course was not clearly improved with the addition of erythromycin in the quinine regimen. No quinine resistance was observed in this data.