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Background. This study sought to explore contextual features of an outpatient clinic located in southwest Nigeria that enable and/or discourage effective diagnosis and treatment of child malaria. Methods. We conducted in-depth interviews with mothers of 135 febrile children attending a pediatric outpatient clinic in southwest Nigeria. Also, participant observations and informal discussions with physicians were conducted to examine the potential impact of context on effective child malaria diagnosis and treatment. Results. The findings indicate that availability of drugs and laboratory testing for malaria, affordability of antimalarial drugs, access to the clinic (particularly access to pediatricians), adequacy of the outpatient clinic, and acceptability of services provided at the clinic are key contextual factors that influence effective case management of malaria in children. Conclusion. If the Millennium Development Goal 6 of reversing malaria incidence by 2015 particularly among children is to be achieved, it is necessary to identify the contextual factors that may act as potential barriers to effective diagnosis and treatment practices at clinical settings. Understanding the context in which case management of child malaria occurs can provide insights into the factors that influence mis- and over-diagnosis of malaria in clinical settings.

Contextualizing Child Malaria Diagnosis and Treatment Practices at an Outpatient Clinic in Southwest Nigeria: A Qualitative Study