From March to December 2000, we carried out a prospective study in the emergency and the internal medicine wards of Bobo-Dioulasso central hospital (Burkina Faso). Among 280 adults with clinical diagnosis of severe malaria, only 60 were confirmed to have severe forms of malaria after the laboratory investigations. Most of these patients (49 cases) were living in the city. The average age was 29.2 years +/- 13.1. At hospital admission, the average temperature was 39.1 degrees C +/- 1 and signs of severe malaria were dominated by impaired consciousness (43 cases), multiple convulsions (6 cases) and severe anaemia (6 cases). Two of these signs were associated in the third of patients. The average parasite density at admission was 11,660 parasites per microliter. 85% of patients hospitalized recovered, 8% died and 7% escaped. The control thick smear at day 3 showed that 23% of patients were still positive. At day 7 none of them was positive. Malaria in adults in urban area is a phenomenon which needs to be assessed and followed in African big towns.