Introduction Febrile illnesses in children and its management (especially infectious diseases) continue to result in an enormous increase in morbidity and mortality in developing countries causing a global public health concern. However, most low-middle-income countries have failed to institute systematic outcome assessment measures to ensure quality in the management of these conditions at one breadth. This study therefore aimed at assessing the quality care management of febrile illness in under five (5) in health facilities in the Atwima Kwanwoma district of Ashanti Region, Ghana.Methods The study was quantitative using a cross-sectional study design. Data were collected from 58 healthcare providers and 390 folders of children treated for febrile illnesses. Data were analyzed using STATA version 14. Univariate and multivariate analyses were performed to identify socio-demographic, patient and prescribers’ factors influencing management of febrile illness among children under 5 years. Statistical significance for all testing was set as 0.05.Results The mean age and standard deviation of the prescribers were 30.2 ± 3.4. Majority of the prescribers (65.5%) were aged between 23-30years and the rest (34.5%) between 31-37years. About 67.3% were females and the rest (32.7%) were males, more than half of the prescribers (70.7%) were married and the rest (29.3%) were single. More than half (55.6%) of patients seen were females and 44.4% were males. Most of the patients (43.8%) who presented with febrile illnesses were between 0-11 months, while 29.1% and 27.2% of them were between 1-2 years and 3-5 years respectively. The average age of children was 5.7 ± 2.3 months for those who were less than a year and 2.8±1.4 years for those between 1-5years. Patients who believed in superstition were less likely to receive quality care management of febrile illness as compared with those who did not believe in superstitions (AOR=0.50; 95% CI= 0.03-0.70).The results depict that socio-demographic factors such as age of a child and gender, influenced quality care management of febrile illness as detailed in Table 4. For instance, children below 1 year were less likely to receive quality care management of febrile illness as compared with those above 3 years (AOR=0.05; 95% CI= 0.08-0.28). Also, female children were more likely to receive quality care management of febrile illness as compared with their male counterparts (AOR=1.50; 95% CI=0.03-0.70).Conclusion The study concludes that, prescribers’ factors such as those who believed in superstition and socio-demographic factors of children such as age and gender influenced quality care management of febrile illness.Recommendations Health policy makers should promote health education to reduce the negative effects of supersitition in health care management.