Determination of cut-off and correlates of delay in treatment-seeking of febrile illness: a retrospective analysis

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 (23.1years vs 24.2years, p =0.229). Delay in reporting fever was significantly higher among hospital inpatients compared to community-based fever cases (3.62.1 vs 4.0 +/- 2.6days; p =0.006). Delay of >2days showed higher predictive ability (sensitivity: 96.4%, and ROC area: 67.5%) compared to other cut-off values (>3, >4, and>5days). 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 (>5km) 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 20-40years (1.71, 95%CI: 1.06-2.75).Conclusion p id=Par The delay (>2days) in seeking treatment was likely to be twice among those who live in rural areas and travel >5km 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.