Regional heterogeneity of malaria healthcare seeking and diagnosis in China (2017-2022): Implications in preventing re-establishment of malaria transmission

Jian-Hai Yin; Li Zhang; Bo-Yu Yi; Shui-Sen Zhou; Zhi-Gui Xia

doi:10.1016/j.jiph.2024.102601

Regional heterogeneity of malaria healthcare seeking and diagnosis in China (2017-2022): Implications in preventing re-establishment of malaria transmission

J Infect Public Health. 2024 Nov 22;18(1):102601. doi: 10.1016/j.jiph.2024.102601. Online ahead of print.

Authors

Jian-Hai Yin¹, Li Zhang¹, Bo-Yu Yi¹, Shui-Sen Zhou¹, Zhi-Gui Xia²

Affiliations

¹ National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai 200025, China; National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Shanghai 200025, China; NHC Key Laboratory of Parasite and Vector Biology, Shanghai 200025, China; WHO Collaborating Centre for Tropical Diseases, Shanghai 200025, China; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai 200025, China.
² National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai 200025, China; National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Shanghai 200025, China; NHC Key Laboratory of Parasite and Vector Biology, Shanghai 200025, China; WHO Collaborating Centre for Tropical Diseases, Shanghai 200025, China; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai 200025, China. Electronic address: xiazg@nipd.chinacdc.cn.

PMID: 39603059
DOI: 10.1016/j.jiph.2024.102601

Abstract

Background: Enhancing regional collaboration in malaria prevention and control is a pivotal strategy for malaria control and elimination in China. The objective of this study is to examine the regional heterogeneity of malaria healthcare-seeking behaviors and diagnosis across various regions in China from 2017 to 2022.

Methods: Individual case data from national malaria surveillance databases were utilized. An analysis was conducted to discern the regional variations in the healthcare-seeking behaviors and diagnosis among regions.

Results: From 2017 to 2022, a total of 10,943 malaria cases were reported in China, predominantly imported cases (10,929), with significant variations in the distribution of different Plasmodium species among regions (P < 0.001) and annually (P < 0.001). There was a notable lack of timeliness in healthcare seeking (56.1 %) and case confirmation (67.3 %) with substantial regional disparities (P < 0.001). These delays predominantly occurred in county and prefectural-level medical institutions (P < 0.001), where misidentification of Plasmodium species was also prevalent (P < 0.001). Furthermore, an initial diagnosis of malaria was observed in 76.6 % of cases (P < 0.001), yet 87.8 % of malaria cases were ultimately confirmed correctly (P < 0.001). Notably, P. ovale (21.0 %) and P. malariae (10.8 %) were easily misidentified as P. vivax (P < 0.001).

Conclusion: The development of regional-specific interventions is essential to raise public awareness regarding malaria-related knowledge and to enhance the vigilance of health workers and their capacity of malaria testing. This will strengthen the nation's malaria surveillance and response system. Concurrently, fostering technological innovations for the rapid and precise identification of Plasmodium species, along with effective coordination of cross-regional mechanisms, is imperative to prevent re-establishment of malaria transmission in China.

Keywords: Case diagnosis; Healthcare seeking; Malaria; Re-establishment; Regional cooperation.