Malaria care-seeking among febrile patients in Myanmar and Thailand: an accelerated failure time analysis

Authors:
  • KHKhaing Zin Zin Htwe
    Khaing Zin Zin Htwe
  • PAPyae Linn Aung
    Pyae Linn Aung
  • PSPiyarat Sripoorote
    Piyarat Sripoorote
  • MSMyat Thu Soe
    Myat Thu Soe
  • PPPattamaporn Petchvijit
    Pattamaporn Petchvijit
  • PAPoh Poh Aung
    Poh Poh Aung
  • AKAmnat Khamsiriwatchara
    Amnat Khamsiriwatchara
  • SLSaranath Lawpoolsri
    Saranath Lawpoolsri
  • LCLiwang Cui
    Liwang Cui
  • DPDaniel M Parker
    Daniel M Parker
  • MKMyat Phone Kyaw
    Myat Phone Kyaw
  • JSJetsumon Sattabongkot
    Jetsumon Sattabongkot
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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 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 log-logistic Accelerated Failure Time (AFT) models were used to estimate Time Ratios (TRs). In Myanmar (n = 2,960), the 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 P. 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 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 behaviors, should be considered in the design of targeted interventions to promote timely care-seeking in malaria-endemic settings.

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