Introduction: contrary to World Health Organizations recommendations, health workers (HWs) still prescribe antimalarials to malaria rapid diagnostic test (mRDT)-negative patients, thus increasing overuse and the risk of parasite resistance to the antimalarials. The reasons for this are not clear. We identified factors associated with antimalarial prescription to mRDT-negative patients.

Methods: we conducted a cross-sectional study among 423 HWs. Data on socio-demographic characteristics, training, supervision experience and fever management practices were collected. We tested associations between independent variables and prescription of antimalarials to mRDT-negative patients using Chi square and logistic regression at p < 0.05.

Results: the HWs were mostly community health workers (58.6%), with mean age of 41.0 (±8.8) years and 13.6 (± 9.0) years of professional practice. Females were 322 (76.1%) and 368 (87%) were married. Of the 423 HWs interviewed, 329 (77.8%) received training on mRDT use, 329 (80.6%) received supervision and 129 (30.5%) had good knowledge of causes of fever. Overall, 110 (26.0%) of the HWs prescribed antimalarials to mRDT-negative patients. A higher proportion of non-trained vs trained HWs [Adjusted Odds Ratio (aOR) = 4.9; 95% Confidence Interval (CI) (2.5-8.3)], and HWs having poor knowledge vs HWs having good knowledge of causes of fever [aOR = 1.9; 95% CI (1.0-3.5)], prescribed antimalarials to mRDT-negative patients.

Conclusion: HWs' lack of training on mRDT use and poor knowledge of causes of fever were associated with prescription of antimalarials to mRDT-negative patients. We recommend training on management of fever and mRDT use to reduce such inappropriate antimalarial prescriptions.