OBJECTIVES: To assess malaria diagnosis and treatment practices following introduction of rapid diagnostic test in Adama district health posts, central Ethiopia.                                                                                METHODS: A Cross-sectional study was conducted from January 24 to February 9, 2014 among febrile patients, and caretaking health workers to determine the perceptions and practices related to rapid diagnostic tests (RDTs). Moreover, the treatments prescribed were assessed at the selected Health posts. From the total of 37 health posts in Adama district, 10 health posts were selected by simple random sampling technique. All the patients who visited the health posts during the study period and all health service providers working in the selected health posts were included in the study.                                                                                                   RESULTS:  The survey was undertaken at ten health posts which use RDT for parasitological confirmation. Twenty health workers and 104 patients were interviewed at health posts. Eighty three patients (79.8%) were seen in health posts with available parasite based diagnostic test (i.e. RDT)) and 21(20.2%) in facilities without RDT. The overall malaria positivity rate was 48(57.8%). Anti–malaria drugs were prescribed to all 48(100%) patients with positive RDT and to 19(54.3%) of RDT negative patients. Among non-tested patients, anti-malaria drugs were given to 12(57.1%), with a higher prescription rate in health posts without RDTs results. Among 104 patients presenting with fever or history of fever, 64(61.5%) were prescribed with antibiotics and anti-pain.                                                                                                                                                           CONCLUSIONS: Findings from this study show that over prescription with anti-malarial drugs is common in Adama district health posts. The use of rapid malaria diagnostics was also associated with higher prescription of antibiotics among patients with negative test results. The Adama district health office should provide on job and other capacity building trainings for health workers on RDTs, the diagnosis and management of other causes of fever and the importance of adhering to test results.