Comparative Analysis of Malaria Rapid Diagnostic Test Use Versus Clinical Diagnosis in Community Health Centres in Kano State

Malaria rapid diagnostic tests are recommended globally to improve diagnostic accuracy and guide appropriate antimalarial treatment, yet adherence to test results by health workers in primary care settings remains inconsistent in Nigeria. This study compares the accuracy of malaria rapid diagnostic test use versus clinical diagnosis in community health centres in Kano State, examining diagnostic concordance, health worker compliance with test results, treatment outcomes, and antimalarial prescription patterns. A cross-sectional analytical design is applied across 20 community health centres in eight local government areas selected through stratified random sampling from both urban and rural settings. Consecutive febrile patients aged one year and above presenting over an eight-week data collection period are recruited (n = 1,060). Each patient receives both clinical assessment and malaria rapid diagnostic test, with microscopy serving as the reference standard. Concordance statistics (Cohen's kappa) compare RDT and clinical diagnosis accuracy against microscopy. Treatment prescriptions and 48-hour clinical outcomes are recorded. Chi-square and multivariate logistic regression are applied in SPSS. Available data from Kano State's malaria programme indicate that over-prescription of antimalarials without laboratory confirmation remains widespread, contributing to drug resistance pressure. The Test, Treat, Track strategy of the WHO Roll Back Malaria partnership provides the normative framework. Findings will inform Kano State Malaria Elimination Programme on scaling up RDT compliance and provider training. Keywords: malaria rapid diagnostic test, clinical diagnosis, community health centres, diagnostic accuracy, Kano State.