Abstract
BackgroundEarly diagnosis and treatment of malaria symptoms reduces the risk of severe complication and malaria transmission. However, delay in malaria diagnosis and treatment is a major public health problem in India. The primary aim of the study was to determine cut-off for the delay in seeking treatment of fever, and the secondary aim was to identify the factors associated with delay in malaria-endemic areas of Assam, Northeast India.MethodsThe present study analysed data from two prior cross-sectional surveys (community- and hospital-based) that was conducted to study the health-seeking behaviour of people residing in high malaria-endemic areas of Assam, Northeast India. The hospital-based survey data were used to determine optimal cut-off for the delay in reporting, and further, used to identify the factors associated with delay using community-based data.ResultsMean age of fever cases was similar in both community- and hospital-based surveys (23.1 years vs 24.2 years, p = 0.229). Delay in reporting fever was significantly higher among hospital inpatients compared to community-based fever cases (3.6 ± 2.1 vs 4.0 ± 2.6 days; p = 0.006). Delay of > 2 days showed higher predictive ability (sensitivity: 96.4%, and ROC area: 67.5%) compared to other cut-off values (> 3, > 4, and > 5 days). Multivariable logistic regression analysis revealed that the adjusted odds ratio (aOR) of delay was significantly higher for people living in rural areas (1.52, 95%CI: 1.11–2.09), distance (> 5 km) to health facility (1.93, 95%CI: 1.44–2.61), engaged in agriculture work (2.58, 95%CI: 1.97–3.37), and interaction effect of adult male aged 20–40 years (1.71, 95%CI: 1.06–2.75).ConclusionThe delay (> 2 days) in seeking treatment was likely to be twice among those who live in rural areas and travel > 5 km to assess health care facility. The findings of the study are useful in designing effective intervention programmes for early treatment of febrile illness to control malaria.
Highlights
Diagnosis and treatment of malaria symptoms reduces the risk of severe complication and malaria transmission
Significant differences in the pattern of distribution by age, gender, type of work related to occupation, place of residence and health services used for treatment was observed between two surveys of fever cases
The factors associated with the delay in reporting for the treatment were evaluated in this study
Summary
Diagnosis and treatment of malaria symptoms reduces the risk of severe complication and malaria transmission. Delay in malaria diagnosis and treatment is a major public health problem in India. The World Health Organization (WHO) has accentuated that early diagnosis and prompt treatment for malaria should be occurred within 24–48 h of the onset of malaria symptoms to decrease the risk of severe. Plasmodium falciparum malaria causes a delay in cure, severe disease or death especially in multi-drug resistance areas [4]. High malaria transmission in Northeast India was due to the presence of various malaria parasites and vector species. The consequence of traditional and self-medication could result in misdiagnosis and incorrect choice of drugs, delay in diagnosis of malaria and increasing malaria transmission in the community [2, 3].
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