Evaluation of Malaria Case Management Quality at Public Health Facilities in Zamfara State

Malaria case management quality at public health facilities determines treatment outcome, antimicrobial stewardship, and patient trust in the health system, and its systematic evaluation in high-burden North West Nigerian states is essential for programme improvement. This study evaluated malaria case management quality at public health facilities in Zamfara State, North West Nigeria. A health facility assessment design was adopted, covering 18 public facilities (six hospitals, six PHC level 2 centres, and six PHC level 1 facilities) across Gusau, Bungudu, and Maradun LGAs. Data collection tools included structured observation of 270 malaria case management encounters (15 per facility) using adapted National Malaria Elimination Programme observation checklists, exit interviews with 270 patients, and facility assessment questionnaires. Key domains assessed were malaria diagnostic testing rates, appropriate artemisinin-based combination therapy prescription, dosing accuracy, caregiver counselling quality, and severe malaria referral practices. Results showed that rapid diagnostic test use prior to treatment occurred in 62.2 percent of encounters. ACT prescribing was appropriate in 68.9 percent of confirmed cases. Correct weight-based dosing was achieved in 57.8 percent of paediatric prescriptions. Caregiver counselling on drug administration and danger signs was adequate in 43.3 percent. Severe malaria referral was completed correctly in 66.7 percent of cases. NMEP-trained providers showed significantly higher quality scores (p < 0.001). Recommendations include refresher provider training, diagnostic equipment maintenance, and structured malaria case management supervision in Zamfara State. Keywords: malaria case management, health facility assessment, Zamfara State, ACT prescribing, North West Nigeria