Malaria Case Management and Laboratory Utilisation Practices Among Health Workers at Primary Health Centres in Niger State, North Central Nigeria

Effective malaria case management depends on parasitological confirmation before treatment, yet health worker compliance with test-and-treat guidelines remains inconsistent in many primary health care settings. This study assessed malaria case management practices and laboratory utilisation patterns among health workers at primary health centres in Niger State, North Central Nigeria. A descriptive cross-sectional survey was conducted among 180 health workers including nurses, community health extension workers, and clinical officers across 30 PHCs in three local government areas. Structured questionnaires assessed knowledge of malaria diagnosis guidelines, practice of confirmatory testing, and barriers to laboratory use. Patient registers for the preceding six months were also reviewed. Only 52.2% of health workers correctly identified parasitological confirmation as a requirement before antimalarial treatment. Laboratory testing prior to treatment was documented in only 44.3% of patient records. Malaria RDT was the predominant diagnostic method used in 87.6% of tested cases. Microscopy was largely unavailable or non-functional in rural PHCs. Barriers to testing included non-availability of RDTs, high patient load, and pressure from patients for immediate treatment. The study reveals persistent gaps in adherence to test-and-treat malaria guidelines at primary care level in North Central Nigeria and recommends continuous in-service training, reliable RDT supply chain strengthening, supportive supervision, and performance monitoring of malaria case management practices at PHC level. Keywords: malaria case management, laboratory utilisation, rapid diagnostic test, primary health care, Niger State