Factors affecting delays in seeking treatment among malaria patients in the post-elimination phase in China

Abstract Background Delays in malaria treatment can not only lead to severe and even life-threatening complications, but can also be a source of malaria re-transmission, putting more people at risk of infection. This study aimed to investigate the influencing factors influencing treatment delays among malaria patients and their health-seeking behavior. Methods The medical records of 494 patients diagnosed with malaria from 6 different malaria-endemic provinces in China were analyzed. A bivariate and multivariable regression model was used to investigate the association between delays in seeking treatment and various factors. A Sankey diagram was used to visualize the trajectories of malaria patients seeking medical care. Total treatment delays were categorized as patient delays and docotor delays. Results The incidence of total delays in seeking malaria treatment was 81.6%, of which 28.4% were delayed by patients alone and 34.8% by doctors. The median time of patient delays was 1 day (IQR, 0-20 days), and the median time of doctor delays was 2 days (IQR, 0-90 days). After being subjected to multiple logistic regression analysis, the factor significantly associated with patient delays was living in central China (OR=0.43, 95% CI: 0.24-0.78). The factors significantly associated with doctor delays were: age between 30 to 49 years old (OR=0.43, 95% CI: 0.23-0.81), being sigle/divorce/separated (OR = 0.48, 95% CI: 0.24-0.95), mixed infections (OR = 2.04, 95% CI: 1.02-4.08), first visiting a county-level health institution (OR = 0.25, 95% CI: 0.14-0.45), first visiting a prefectural health institution (OR = 0.06, 95% CI: 0.03-0.12), first visiting a provincial health institution (OR = 0.05, 95%CI: 0.02-0.12), and having periodic symptoms (OR=1.71, 95% CI: 1.00-2.92). Furthermore, higher financial burden and complications were found to be associated with patient delays. Doctor delays, in addition to incurring these two consequences, were associated with longer hospital stays. Conclusion There was a substantial delay in access to health care for malaria patients before China was certified malaria free. Region, marital status, periodic symptoms and the level of health institutions were factors contributing to delays in treatment-seeking among malaria patients.