Diagnostic and therapeutic practices for paediatric malaria: Gap between guidelines and clinical reality in south-east Gabon.

Background: Malaria is highly prevalent in Gabon. The objective of this study was to assess adherence to WHO recommendations in the management of paediatric malaria in Franceville, south-east Gabon, and to identify factors influencing clinical decision making. Materials and Methods: This was a prospective observational study conducted from January 2021 to July 2023. Information regarding clinical examination, thick blood smear results, and the prescription of antimalarial drugs of paediatric children were collected anonymously following informed consent from parents or legal guardians. Data were analysed using R software (version 4.0.5), with descriptive statistics, Chi-square tests, and binary logistic regression to estimate crude and adjusted odds ratios with 95% confidence intervals at a significance level of p < 0.05. Results: A total of 3,195 children aged 0-16 years presenting with fever or a history of fever were included. Overall, 41.6% of patients tested positive by thick blood smear, and 21.4% of them had severe malaria. Despite negative thick blood smear results, 86.7% of patients received a presumptive diagnosis and 98.8% of them were treated with antimalarials. Symptoms significantly associated with a presumptive diagnosis were asthenia (aOR = 1.41; 95% CI [1.01-2.00]), headache (aOR = 1.71; 95% CI [1.02-3.03]), and nausea-vomiting (aOR = 1.95, 95% CI [1.20-3.31]). Conclusions: Despite access to parasitological testing, presumptive diagnosis remains common, exposing patients to potential overprescription and increased risk of drug resistance. Strengthening diagnostic capacity and continuous training of healthcare providers are essential to improve case management.