Factors associated with delay in seeking healthcare for imported malaria: a retrospective study in a French hospital

Abstract

Background Delayed treatment is associated with a higher risk of severe malaria. In malaria-endemic areas, the main factors associated with delay in seeking healthcare are low educational level and traditional beliefs. In imported malaria, determinants of delay in seeking healthcare are currently unknown. Methods We studied all patients presenting with malaria from January 1st, 2017, to February 14, 2022, in the hospital of Melun, France. Demographic and medical data were recorded for all patients, and socio-professional data in a subgroup of hospitalized adults. Relative-risks and 95% confidence intervals were determined using univariate analysis by cross-tabulation. Results 234 patients were included, all travelling from Africa. Among them, 218 (93%) were infected with P. falciparum, 77 (33%) had severe malaria, 26 (11%) were younger than 18 years old, and 81 were included during the SARS-CoV-2 pandemic. There were 135 hospitalized adults (58% of all patients). The median time to first medical consultation (TFMC), defined by the period from onset of symptoms to first medical advice, was 3 days [IQR 1–5]. A TFMC ≥3 days tended to be more frequent in travellers visiting friends and relatives (VFR) (RR 1.44, 95% CI [1.0–2.05], p = 0.06), while it was less frequent in children and teenagers (RR 0.58, 95% CI [0.39–0.84], p = 0.01). Gender, African background, unemployment, living alone, and absence of referring physician were not associated with delay in seeking healthcare. Consulting during the SARS-CoV-2 pandemic was not associated with a longer TFMC, nor with a higher rate of severe malaria. Conclusion In contrast to an endemic area, socio-economic factors did not impact on delay in seeking healthcare in imported malaria. Prevention should focus on VFR subjects, who tend to consult later than other travellers.