Factors influencing health workers' adherence to malaria treatment guidelines in under-five children in Nigeria: A scoping review.

Background: Malaria is a leading cause of mortality in children aged 5 years and below in Nigeria. Treatment guidelines stipulate among other recommendations, testing by microscopy or a rapid diagnostic test (RDT) before treatment. Non-adherence to these guidelines portends a challenge, especially among vulnerable under-five children. This study explored the factors influencing Nigerian public health workers' (HWs) adherence to these guidelines in under-five children. Methods: A review of literature published between 2011- 2023 was conducted on Web of Science, Ovid Embase, Medline, Global Health, CAB Abstracts, Scopus, and Global Index Medicus. Data was extracted and analyzed under 4 themes: diagnosis, compliance with test results, use of recommended treatment, post-treatment counselling and severe malaria management. Results: Nineteen (19) studies were included for review. Training and supervision, RDT and antimalarial availability, good knowledge of, and positive perception of RDTs promoted adherence to mRDT use. A lack of confidence in RDTs and age (≥ 40 years) fuelled presumptive treatment, especially among clinicians. mRDT and artemisinin-based combination therapy (ACT) stockouts dissuaded HWs from adhering to case management guidelines. Caregiver pressure for treatment was identified as a barrier to compliance with test results. Conclusions: It is important to design context-specific strategies to improve adherence to guidelines for malaria case management, especially in under-five children. Training on the guidelines should be tailored, needs-based, and continuous, and HWs should be supportively supervised in implementing case management. Maintaining an adequate supply of quality-assured mRDTs and antimalarials can facilitate adherence to the guidelines.