Assessment of Diagnostic Accuracy of Clinical Features for Malaria in Under-Five Children at Primary Healthcare Centres in Anambra State

Background: Accurate malaria diagnosis in young children is critical to appropriate treatment and prevention of antimicrobial resistance. Over-reliance on clinical diagnosis without laboratory confirmation remains prevalent at primary healthcare centres in the South East geopolitical zone. This study assesses the diagnostic accuracy of clinical features for malaria in under-five children at primary healthcare centres in Anambra State. Methods: A cross-sectional diagnostic accuracy study enrolled 300 children under five years presenting with febrile illness. Clinical diagnosis by healthcare workers was compared to malaria rapid diagnostic test results as the reference standard. Sensitivity, specificity, positive predictive value, and negative predictive value were computed. Results: Clinical diagnosis demonstrated high sensitivity but poor specificity, resulting in substantial overdiagnosis. Fever with rigors, pallor, and splenomegaly had the highest positive likelihood ratios. The positive predictive value of clinical diagnosis was significantly lower during low transmission seasons. Conclusion: Clinical diagnosis alone is insufficient for accurate malaria detection in under-five children in Anambra State. Family medicine programmes should ensure universal access to rapid diagnostic tests at primary care level and train practitioners in evidence-based diagnostic decision-making. Keywords: malaria diagnosis, clinical features, diagnostic accuracy, under-five children, Anambra State