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The current national malaria treatment policy is to use artemisinin-based combination therapy (ACT) as first-line treatment, and recommends parasitological confirmation of malaria before therapy. Adherence to this policy, however, remains suboptimal, with the self-initiated home-based therapy being common\u2014posing undue exposures to, and pressure on the current artemisinin-based combinations, with the danger of emergence of drug resistance. The study evaluated the anti-malarial use and its appropriateness among febrile children under five presenting to a tertiary health facility in northern Uganda in light of the current malaria treatment policy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross-sectional study in a tertiary health facility in northern Uganda between March and September 2021. Children aged 6\u201359\u00a0months with fever were selected using systematic random sampling. A pretested interviewer-administered questionnaire was used to collect clinical data from the caregivers. Data were analysed using SPSS version 23. Descriptive statistics and multiple logistic regression models were applied. P-value\u2009&lt;\u20090.05 was considered for statistical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy-two (34.3%) of the 210 children with fever in this study used anti-malarials prior to the hospital visit, 29.2% (21\/72) of which were on a self-medication basis, 22.2% (16\/72) were empiric prescriptions\u2014all of which inappropriate, and only 48.6% (35\/72) were prescribed based on a parasitological diagnosis of malaria. The most commonly used anti-malarials were artemether-lumefantrine 60\/72 (88.3%), while a lesser proportion of quinine 7\/72 (9.7%), artesunate 3\/72 (4.2%) and dihydroartemisinin-piperaquine 2\/72 (2.8%) were used. The factors independently associated with anti-malarial use among the children with febrile illnesses were duration of fever (p\u2009=\u20090.001); level of the nearest facility (p\u2009=\u20090.027), distance from the nearest health facility (p\u2009=\u20090.025), and caregivers\u2019 age (p\u2009=\u20090.038).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Inappropriate use of anti-malarials for childhood febrile illnesses is prevalent in the study setting, facilitated by the ease of over-the-counter access, empiric prescription and use of leftover anti-malarials. This calls for a need to address communities\u2019 health-seeking behaviour and the health providers\u2019 practice alike.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-023-04534-1","type":"journal-article","created":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T17:06:05Z","timestamp":1679850365000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Anti-malarial drug use, appropriateness and associated factors among children under-five with febrile illnesses presenting to a tertiary health facility: a cross sectional study"],"prefix":"10.1186","volume":"22","author":[{"given":"Richard","family":"Nyeko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Otim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn Miriam","family":"Obiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Abala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,3,21]]},"reference":[{"key":"4534_CR1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0004040","volume":"9","author":"JA Crump","year":"2015","unstructured":"Crump JA, Kirk MD. 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The study was approved by Lacor Hospital Institutional Research and Ethics Committee (LHIREC No: 0192\/10\/2020) and registered with the Uganda National Council of Science and Technology (UNCST HS1091ES). Voluntary informed consent was obtained from the parents\/caretakers of the children before participating in the study after an explanation of the nature and purpose of the study, the potential benefits and risks if any.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"103"}}