Evaluation of Rational Drug Use in the Management of Malaria at a Community Health Extension Worker Clinic in Kebbi State, North West Nigeria

Background: Malaria remains a leading cause of morbidity in North West Nigeria, and community health extension workers (CHEWs) serve as frontline providers in many underserved communities. Ensuring rational drug use in CHEW-managed clinics is essential to preserve treatment efficacy and reduce drug resistance. This study evaluated rational drug use in malaria management at a CHEW clinic in Kebbi State. Methods: A retrospective review of 280 malaria-related prescriptions from a CHEW-managed primary healthcare facility was conducted. Prescriptions were evaluated against WHO and national malaria treatment guidelines using standard drug use indicators. Diagnosis confirmation, drug selection, dosing accuracy, and co-prescription practices were assessed. Results: Diagnosis was confirmed by rapid diagnostic testing in only 41 percent of cases. Artemisinin-based combination therapy was correctly prescribed in 67 percent of confirmed malaria cases. Overuse of antimalarials in febrile non-malaria illness was noted in 29 percent of encounters. Antipyretics were co-prescribed appropriately in 75 percent of cases. Conclusion: Rational drug use for malaria in Kebbi CHEW clinics requires reinforcement of diagnosis-before-treatment protocols and continued training on updated guidelines. Keywords: malaria treatment, rational drug use, CHEW, Kebbi State, artemisinin-based combination therapy