Drivers of delay in reported malaria care-seeking in Myanmar and Thailand

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Abstract
Timely malaria care-seeking and treatment is crucial to prevent severe illness and reduce onward transmission. This study assessed the reported time to care-seeking and identified its associated factors among febrile patients attending community-based malaria facilities in Myanmar and Thailand. Longitudinal data were collected from febrile patients suspected of malaria who sought care through Village Health Volunteers in Myanmar (December 2017-June 2021) and at malaria clinics and posts in Thailand (January 2018-June 2024). Standardized case record forms in local languages were used at diagnosis. Descriptive statistics and multivariable log-logistic Accelerated Failure Time (AFT) models were used to estimate Time Ratios (TRs). In Myanmar (n = 2,960), the reported mean fever duration at diagnosis was 1.8 days (SD: 1.3). Longer time to care-seeking was associated with Shan ethnicity (TR: 1.48; 95% CI 1.41-1.55), other ethnicities (TR: 1.24; 95% CI 1.08-1.41), farmers (TR: 1.12; 95% CI 1.0-1.25), uncertain malaria history (TR: 1.26; 95% CI 1.09-1.47), and diagnosis with Plasmodium falciparum (TR: 1.10; 95% CI 1.02-1.19) or Plasmodium vivax (TR: 1.23; 95% CI 1.13-1.34). Shorter delays were associated with daily bed net use and diagnosis during the third or fourth quarters of the year. In Thailand (n = 15,576), the reported mean fever duration was 2.9 days (SD: 1.8). Longer delays were linked to farmers (TR: 1.07; 95% CI 1.02-1.11), pre- or primary education (TR: 1.02; 95% CI 1.00-1.04), uncertain malaria history (TR: 1.10; 95% CI 1.06-1.14), diagnosis with P. falciparum (TR: 1.27; 95% CI 1.09-1.46), P. vivax (TR: 1.20; 95% CI 1.17-1.23), or other malaria species (TR: 1.32; 95% CI 1.12-1.56), and diagnosis during the third (TR: 1.03; 95% CI 1.00-1.05) or fourth quarters of the year (TR: 1.06; 95% CI 1.04-1.09). Shorter care-seeking times were observed among non-agricultural occupations such as merchants and monks, individuals with prior malaria episodes, and occasional or daily bed net users. Delays in malaria care-seeking remain common in both Myanmar and Thailand. The identified risk factors, including ethnicity, occupation, malaria history, and preventive behaviours, should be considered in the design of targeted interventions to promote timely care-seeking in malaria-endemic settings.
Funding Information
  • National Institute of Allergy and Infectious Diseases (U19AI089672, U19AI181583, and D43 TW011509, U19AI089672, U19AI181583)
  • Mahidol University

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