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Background <p>Imported malaria poses a growing challenge to elimination efforts in non-endemic countries, with migrant workers constituting a high-risk population. Understanding care-seeking behaviours and diagnostic delays is crucial for preventing secondary transmission. This study investigated the systemic determinants of diagnostic delays among returning migrant workers.</p> Methods <p>Using data from the national surveillance system, we retrospectively analyzed a cohort of 2098 imported malaria cases involving migrant workers reported in Jiangsu Province, China, between January 2012 and December 2019. Delayed care-seeking was defined as &gt; 3&#xa0;days from symptom onset, and diagnostic delay as &gt; 2&#xa0;days post-consultation. Multivariate regression analyses were used to assess the relationships between demographic characteristics, clinical presentation, healthcare utilization patterns, socioeconomic factors (including destination city GDP), and time-to-diagnosis outcomes.</p> Results <p>Sub-Saharan Africa accounted for the largest share of infection origins (78.65%, 1650/2098), with Plasmodium falciparum being the leading species (78.41%, 1645/2098). Factors significantly associated with a decreased risk of diagnostic delay included delayed care-seeking &gt; 3&#xa0;days (OR = 0.62, 95% CI 0.44–0.88), non-severe malaria (OR = 0.57, 95% CI 0.38–0.86), symptom onset &gt; 1&#xa0;month after-entry (OR = 0.46, 95% CI 0.31–0.69), and initial consultation at municipal (OR = 0.20, 95% CI 0.11–0.37) or provincial (OR = 0.27, 95% CI 0.16–0.52) institutions. Conversely, higher destination city GDP (Second-level: OR = 2.74, 95% CI 1.88–400) were associated with increased diagnostic delays.</p> Conclusions <p>Our findings highlight the need to increase clinician awareness regarding malaria diagnosis, particularly for patients presenting early with mild symptoms. Enhancing primary healthcare diagnostic capacity and educating migrant workers about promptly seeking medical advice are critical for preventing the re-establishment of malaria.</p>

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Healthcare utilization patterns and diagnostic delays among international migrant workers with imported malaria in China: a retrospective cohort analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月3日

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  • Taining Sha,
  • Yuanyuan Cao,
  • Kaixuan Liu,
  • Zeyin Chong,
  • Enyu Xu,
  • Yin Wang,
  • Olaf Müller,
  • Jun Cao,
  • Guoding Zhu,
  • Guangyu Lu

摘要

Background

Imported malaria poses a growing challenge to elimination efforts in non-endemic countries, with migrant workers constituting a high-risk population. Understanding care-seeking behaviours and diagnostic delays is crucial for preventing secondary transmission. This study investigated the systemic determinants of diagnostic delays among returning migrant workers.

Methods

Using data from the national surveillance system, we retrospectively analyzed a cohort of 2098 imported malaria cases involving migrant workers reported in Jiangsu Province, China, between January 2012 and December 2019. Delayed care-seeking was defined as > 3 days from symptom onset, and diagnostic delay as > 2 days post-consultation. Multivariate regression analyses were used to assess the relationships between demographic characteristics, clinical presentation, healthcare utilization patterns, socioeconomic factors (including destination city GDP), and time-to-diagnosis outcomes.

Results

Sub-Saharan Africa accounted for the largest share of infection origins (78.65%, 1650/2098), with Plasmodium falciparum being the leading species (78.41%, 1645/2098). Factors significantly associated with a decreased risk of diagnostic delay included delayed care-seeking > 3 days (OR = 0.62, 95% CI 0.44–0.88), non-severe malaria (OR = 0.57, 95% CI 0.38–0.86), symptom onset > 1 month after-entry (OR = 0.46, 95% CI 0.31–0.69), and initial consultation at municipal (OR = 0.20, 95% CI 0.11–0.37) or provincial (OR = 0.27, 95% CI 0.16–0.52) institutions. Conversely, higher destination city GDP (Second-level: OR = 2.74, 95% CI 1.88–400) were associated with increased diagnostic delays.

Conclusions

Our findings highlight the need to increase clinician awareness regarding malaria diagnosis, particularly for patients presenting early with mild symptoms. Enhancing primary healthcare diagnostic capacity and educating migrant workers about promptly seeking medical advice are critical for preventing the re-establishment of malaria.