Background: Accurate malaria diagnosis remains a cornerstone in the control of malaria infection in endemic regions. Despite increased availability of malaria rapid diagnostic tests (mRDTs), microscopy remains the gold standard for confirming malaria cases.

Aim/Objective: This study examined the level of diagnostic agreement between mRDT and blood film microscopy in diagnosis of malaria in febrile patients attending the General Outpatient Clinic of Benue State University Teaching Hospital (BSUTH), Makurdi, Nigeria.

Methods: This was a hospital-based cross-sectional analytical study involving 120 consecutive febrile patients aged ≥5 years who gave consent/assent, over a period of six months at the GOPC of BSUTH Makurdi, Benue state. Data on socio-demographics, clinical and laboratory information were collected using a pre-tested semi-structured interviewer administered questionnaire. Blood samples were examined using mRDT and microscopy for malaria diagnosis. Data were analyzed with SPSS version 25. Descriptive statistics summarized the data and Cohen’s kappa statistic was used to assess agreement between mRDT and microscopy.

Results: 120 participants were recruited, majority of whom were less than 40 years of age with higher number of females 72 (60.0%) than males. The prevalence of malaria was 48.3% by mRDT and 47.5% by microscopy. Plasmodium falciparum was the predominant species (45.8%), followed by P. malariae (1.7%). There was an excellent agreement between mRDT and microscopy (κ = 0.983, p < 0.001).