Evaluation of Malaria Case Management Practices Among Nurses in Secondary Health Facilities in Rivers State, South South Nigeria

Nurses constitute the primary point of clinical contact for malaria case management in Nigerian secondary health facilities, and their adherence to national guidelines for diagnosis and treatment directly determines patient outcomes and antimalarial stewardship. This study evaluates malaria case management practices among nurses in secondary health facilities in Rivers State, South South Nigeria. A cross-sectional facility-based survey was conducted at twelve general hospitals across Port Harcourt, Obio-Akpor, and Okrika Local Government Areas. Three hundred nurses were assessed through structured observation of clinical encounters, review of patient record documentation, and a knowledge assessment questionnaire on national malaria treatment guidelines. Key practices evaluated included use of RDT before prescribing antimalarials, adherence to artemisinin-based combination therapy protocols, management of severe malaria cases, and documentation of treatment outcomes. Evidence from 2020 to 2024 identifies significant deviations from national case management guidelines among Nigerian nurses, including empirical antimalarial prescribing without diagnostic confirmation and inappropriate dosing of artemisinin-based combination therapies. This study produces practice gap analyses by facility tier and professional cadre, identifying training priorities for the Rivers State Ministry of Health. Recommendations will target nursing in-service training programmes and clinical mentorship initiatives as immediate operational priorities. Keywords: malaria case management, nurses, secondary health facilities, Rivers State, clinical practice.