Adherence to Paediatric Malaria Treatment Guidelines Among Healthcare Providers in Primary Care Facilities in Nassarawa State, North Central Nigeria

Adherence to evidence-based malaria treatment guidelines is critical for reducing childhood morbidity and preventing the emergence of drug-resistant Plasmodium falciparum strains. Despite the adoption of artemisinin-based combination therapy (ACT) in Nigeria's national malaria treatment policy, prescribing practices at primary care level remain inconsistent. This cross-sectional observational study assesses adherence to paediatric malaria treatment guidelines among healthcare providers at primary healthcare facilities in Nasarawa State, North Central Nigeria. Structured observation of 680 paediatric consultations for febrile illness across 24 primary healthcare centres was conducted over a three-month period. Appropriate diagnostic testing before ACT prescription, correct ACT choice, dosing accuracy, and prescription of adjunct treatments were assessed against Federal Ministry of Health guidelines. RDT or microscopy was performed before treatment in only 38.7% of consultations. ACT was prescribed empirically based on clinical suspicion alone in 61.3% of cases. Among tested and confirmed malaria cases, correct ACT (artemether-lumefantrine) was prescribed in 74.2% of instances, but dosing was accurate for weight in only 51.9%. Quinine was inappropriately prescribed for uncomplicated malaria in 12.4% of cases. Paracetamol co-prescription for fever management occurred in 87.3% of cases. Provider knowledge of guidelines was moderate, with 61.4% scoring above 60% on a knowledge test. Recommendations include regular guideline training, provision of RDTs, and implementation of clinical mentorship at primary care level. Keywords: malaria treatment guidelines, adherence, ACT, Nasarawa State, North Central Nigeria.