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

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.

Surveillance and Response to Imported Malaria During the COVID-19 Epidemic—Anhui Province,China,2019–2021

Summary What is already known about this topic?China was certified malaria-free on June 30,2021.However,imported malaria continuously threatens the effort to prevent re-establishment of malaria in China.What is added by this report?Measures such as international travel restrictions,entry quarantine,and screening in fever clinics during the coronavirus disease 2019(COVID-19)period were associated with a significant decrease of imported malaria cases in Anhui Province,a higher proportion of non-Plasmodium falciparum(non-P.falciparum)malaria reported infections,and a higher proportion of cases requiring medical attention at their initial visit.What are the implications for public health practices?It is necessary to be vigilant about imported malaria during the COVID-19 epidemic,especially for non-P.falciparum infections which are more difficult to detect,and to promote research,development,and introduction of more sensitive and specific point-ofcare detection methods for non-P.falciparum species.