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Profile and determinants of delayed care-seeking and diagnosis among patients with imported malaria: a retrospective study in China, 2014–2021

查看全文 作　　者：Tao [1]Zhang;Duoquan [2,8]Wang;Yingjun [2]Qian;Wei [3]Ruan;Ying [4]Liu;Jing [5]Xia;Hui [6]Yan;Yuan [7]Sui;Shenning [2]Lu;Xian [1]Xu;Jingjing [1]Jiang;Xiaofeng [1]Lyu;Shuqi [1]Wang;Shizhu [2,8]Li;Weidong [1]Li 高影响力作者 机构地区：[1]Anhui Provincial Center for Disease Control and Prevention,Hefei 230601,China;[2]National Institute of Parasitic Diseases,Chinese Center for Disease Control and Prevention(Chinese Center for Tropical Diseases Research),NHC Key Laboratory of Parasite and Vector Biology,WHO Collaborating Center for Tropical Diseases,National Center for International Research on Tropical Diseases,Shanghai 200025,China;[3]Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou 310051,China;[4]Henan Provincial Center for Disease Control and Prevention,Zhengzhou 450016,China;[5]Hubei Provincial Center for Disease Control and Prevention,Wuhan 430079,China;[6]Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention,Nanning 530028,China;[7]Brown School,Washington University,St.Louis,MO,USA;[8]School of Global Health,Chinese Center for Tropical Diseases Research,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China高影响力机构 出　　处：《Infectious Diseases of Poverty》索引2022年第11卷第6期,共10页高影响力期刊 基　　金：National Natural Science Foundation of China(No. 32161143036). 摘　　要：Background: In areas where malaria has been eliminated, delayed care-seeking and diagnosis of imported malaria are constant threats. This study aimed to describe the profile and determinants of delayed care-seeking and diagnosis among patients with imported malaria in China.Methods: This retrospective study assessed surveillance data obtained from 2014 to 2021 in the Chinese provincial-level administrative divisions (PLADs) of Anhui, Henan, Hubei, and Zhejiang, and Guangxi. Epidemiological characteristics were analyzed using descriptive statistics. Furthermore, factors associated with delayed care-seeking and diagnosis among imported malaria cases were identified using multivariate logistic regression.Results: Overall, 11.81% and 30.08% of imported malaria cases had delays in seeking care and diagnosis, respectively. During the study period, there was a decreasing trend in the proportion of imported malaria cases with delayed care-seeking (χ^(2) = 36.099,P < 0.001) and diagnosis (χ^(2) = 11.395,P = 0.001). In multivariate analysis, independent risk factors associated with delayed care-seeking include PLADs (Guangxi as reference), consultations in high-level facilities for the first medical visit, infections with non-Plasmodium falciparum species, and older age. However, PLADs (Guangxi as reference), the purpose of traveling (labour as reference), and infections with non-P. falciparum species increased the risk of delayed diagnosis. Delayed care-seeking (adjusted odds ratio: 1.79,P = 0.001) and diagnosis (adjusted odds ratio: 1.62,P = 0.004) were risk factors for severe disease development.Conclusions: Based on this study’s findings, we strongly advocate for improved access to quality healthcare to reduce the rate of misdiagnosis at the first visit. Infections caused by non-P. falciparum species should be highlighted, and more sensitive and specific point-of-care detection methods for non-P. falciparum species should be developed and implemented. In addition, education programs should be enhanced to reach target populations at risk of malaria infection. All these factors may reduce delayed care-seeking and diagnosis of imported malaria. 关 键 词：MALARIA Delayed care-seeking Delayed diagnosis Imported malaria Prevention Re-establishment China Plasmodium falciparum
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