 The World Health Organization, WHO, recommends a three-step approach to treating severe malaria in children under five years old. The first step involves providing rectal artesanate, RAS, as a pre-referral treatment. The second step consists of administering an injectable anti-malarial drug and oral artemisinin-based combination therapy, ACT, after referral to a health facility. Lastly, the third step involves providing ACT at home. However, this study found that only 2.7% of children received the correct treatment steps in Nigeria, 44.5% in Uganda, and 50.3% in the Democratic Republic of the Congo, DRC. Additionally, while in DRC, inpatient ACT administration was common, ACTs were often prescribed at discharge in Nigeria and Uganda. These results suggest that there is a need for improved compliance with the WHO's severe malaria treatment guidelines. This article was authored by Aida Signorel, Phyllis R., Jean Okatawichu, and others.