Conference Abstract | Volume 9 (ConfPro8): Abstract 101 | Published: 13 Oct 2026
Tracy Afia Achaa Asirifi1, &, Harriet Affran Bonful1
1Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
&Corresponding author: Tracy Afia Achaa Asirifi, Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana, Email: tracyasirifi2@gmail.com
Received: 11 Mar 2026, Accepted: 30 Aug 2026, Published: 13 Oct 2026
Domain: Infectious Disease Epidemiology
Keywords: Malaria pre-elimination, malaria-negative febrile cases, antimalarial prescribing, antibiotic stewardship; test, treat and Track (T3)
©Tracy Afia Achaa Asirifi et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Tracy Afia Achaa Asirifi et al., Trends in the management of malaria test-negative febrile cases: A retrospective analysis of outpatient data at Legon Hospital, Ghana. Journal of Interventional Epidemiology and Public Health. 2026;9(ConfPro8):101. https://doi.org/10.37432/JIEPH-CONFPRO8-00101
Appropriate management of malaria test-negative febrile patients remains a major challenge in sub-Saharan Africa despite widespread implementation of the Test, Treat and Track (T3) strategy. Inappropriate antimalarial and antibiotic prescribing among test-negative patients contributes to antimicrobial misuse and weakens malaria control efforts. This study assessed trends in the management of malaria test-negative febrile cases at Legon Hospital, Ghana.
A retrospective cross-sectional analysis was conducted using outpatient malaria test records extracted from the Legon Hospital Hospital Information System (HIS) between January 2023 and December 2025. Prescribing patterns among malaria test-negative patients were analysed, and multivariable logistic regression was used to identify factors associated with inappropriate antimalarial prescription.
A total of 72,344 outpatient malaria test records were analysed, of which 67,038 (92.7%) were malaria-negative. Inappropriate antimalarial prescription among test-negative patients declined from 3.7% in 2023 to 1.5% in 2025, with an overall rate of 2.6% (95% CI: 2.5–2.7%). Analgesics/antipyretics (77.1%), vitamins/supplements (57.2%), and antibiotics (41.3%) were the most frequently prescribed drug classes. Antibiotic prescribing declined from 51.8% in 2023 to 32.9% in 2025. Upper respiratory tract infection was the most frequently recorded diagnosis. Male patients were more likely to receive inappropriate antimalarial prescriptions (AOR 1.39, 95% CI: 1.32–1.46), while prescriptions were less likely among patients tested using RDT compared with blood film microscopy (AOR 0.91, 95% CI: 0.85–0.98).
The declining trend in inappropriate antimalarial prescribing among malaria-negative febrile patients suggests improving adherence to Ghana’s T3 strategy and supports the National Malaria Elimination Programme (NMEP) pre-elimination agenda aimed at reducing unnecessary antimalarial use and improving case management quality. However, persistently high antibiotic prescribing highlights the need for strengthened integrated fever management and antimicrobial stewardship interventions to support sustainable malaria pre-elimination efforts in Ghana.
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