Analysis of Care-seeking Pathway and Factors Influencing Early and Appropriate Care-seeking for Malaria Patients in the Republic of Guinea, 2022-2023

Abstract

Aim: This this study was conducted to analyze the diagnostic pathway and the factors associated with early and appropriate care-seeking for malaria patients in the Republic of Guinea. Methods: A cross-sectional study was carried out between November 2022 - March 2023 among 3300 patients diagnosed of malaria in health facilities in nine health districts. Axel Kroeger’s conceptual framework was used for the design of the questionnaire. Conventional recourse was defined as the use of a healthcare facility or community services, early and appropriate care-seeking was defined as within 24 hours of symptom onset in a conventional recourse, and care pathway the sequence of recourses followed by each patient. Sankey alluvial plots were used to represent patients' diagnostic pathways, and logistic regression to identify factors associated with early and appropriate care-seeking. Results: 1632 (49.45%) were female and 1132 (34.30%) were under 5 years old, with a mean age of 27.46 months (SD = 16.03). At time of interview, 1337 (40.52%), 1423 (43.12%), 437 (13.85%) of patients were respectively in their first, second and third recourse. A total of 2002 (60.67%) patients had gone to a conventional recourse as a first line. Of all patients, 1757 (53.25%) had sought care within 24 hours and 28.55% had sought early and appropriate care. Individually and as a first intention, self-medication was the main modality with 1214 (37.30%). The health districts of Boffa (Lower Guinea, coastal region) OR = 0.48 95% CI 0.33 – 0.70, Dabola (Upper Guinea, savanna region) OR = 0.43 95% CI 0.30 – 0.63 and Labe (Middle Guinea, mountain region) OR = 0.63 CI 95% 0.43 – 0.91 (p<0.05) were at risk of delaying appropriate care seeking, regarding reference district (Dixinn, Conakry). However, the under 5 years old group OR = 1.55 95% CI 1.30 – 1.85 (p<0.001) and the availability of a stable monthly household income (p<0.001) were positively associated with early and appropriate care seeking. Conclusion: A low rate of early and appropriate care-seeking was observed. Patients sought care through multiple means, often resulting in a delay adequate management. The results, shows the need to deploy strategies adapted to the needs of communities.