Table 5 Illustrative quotes for the determinants of anti-malarial drug prescription practices by primary healthcare workers

“After doing test and drugs are not there, it will affect [my prescription]. If you charge high or costly [for ACTs] it will affect [patients affordability].” (Female)

“……..AL [artemethher-lumefantrine] particularly more effective and less side effects than AA [artesunate-amodiaquine] [so, I mostly prescribe AL].” (Female)

“We use that AL (artemether-lumefantrine) mostly as side effect is less than that of AA (artesunate-amodiaquine). That AA weakens some people.” (Female)

“… to me, I don’t think it [RDT] is 100% because it is not all malaria that shows in the RDT.” (Female)

“… if somebody presents with these symptoms, it [RDT] may read negative and if you treat with like [say] antibiotics, the sickness will not go and you now decide to treat with anti-malarial…, even with the negative result, the sickness will go.” (Female)

“One of the reason that make health workers give [anti-malarial drug for negative RDT results] is to please some clients, in order to retain them, meet up their demand.” (Female)

“[Prescribing] Malaria drug when [RDT is] negative: (1) Patient pressure (2) Get money from patient, something like that, but it is a wrong practice.” (Female)

“To some of the health workers, the villagers have known that the anti-malarial drug [ACT] is free, if you give them only ACT [for positive RDT], they won’t pay. If you add antibiotics, they can now pay. Ideally it is not good.” (Female)