title: Determinants of delay in malaria care-seeking behaviour for children 15 years and under in Bata district, Equatorial Guinea.
abstract: BACKGROUND
  Malaria remains a major cause of morbidity and mortality in children under 5 years of age in Equatorial Guinea. Early appropriate treatment can reduce progression of the illness to severe stages, thus reducing of mortality, morbidity and onward transmission. The factors that contribute to malaria treatment delay have not been studied previously in Equatorial Guinea. The objective of this study was to assess the determinants of delay in seeking malaria treatment for children in the Bata district, in mainland Equatorial Guinea.
  
  
  METHODS
  A cross-sectional study was conducted in Bata district, in 2013, which involved 428 houses in 18 rural villages and 26 urban neighbourhoods. Household caregivers were identified in each house and asked about their knowledge of malaria and about the management of the last reported malaria episode in a child 15 years and younger under their care. Bivariate and multivariate statistical analyses were conducted to determine the relevance of socio-economic, geographical and behavioural factors on delays in care-seeking behaviour.
  
  
  RESULTS
  Nearly half of the children sought treatment at least 24 h after the onset of the symptoms. The median delay in seeking care was 2.8 days. Children from households with the highest socio-economic status were less likely to be delayed in seeking care than those from households with the lowest socio-economic status (OR 0.37, 95% CI 0.19-0.72). Children that first received treatment at home, mainly paracetamol, were more than twice more likely to be delayed for seeking care, than children who did not first receive treatment at home (OR 2.36, 95% CI 1.45-3.83). Children living in a distance >3 km from the nearest health facility were almost two times more likely to be delayed in seeking care than those living closer to a facility but with non significant association once adjusted for other variables (OR 1.75, 95% CI 0.88-3.47).
  
  
  CONCLUSIONS
  To decrease malaria morbidity and mortality in Bata district, efforts should be addressed to reduce household delays in seeking care. It is necessary to provide free access to effective malaria diagnosis and treatment, to reinforce malaria management at community level through community health workers and drug sellers and to increase awareness on the severity of malaria, the importance of early diagnosis and appropriate treatment.
authors.affiliation: Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain. mromay@isciii.es.|Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain. mromay@isciii.es.
authors.forename: Maria
authors.initials: M
authors.lastname: Romay-Barja
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cano
authors.affiliation: Centro de Referencia de Control de Endemias, Malabo, Equatorial Guinea.
authors.forename: Policarpo
authors.initials: P
authors.lastname: Ncogo
authors.affiliation: Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea.
authors.forename: Gloria
authors.initials: G
authors.lastname: Nseng
authors.affiliation: Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.|Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Tenerife, Spain.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Santana-Morales
authors.affiliation: Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Tenerife, Spain.
authors.forename: Basilio
authors.initials: B
authors.lastname: Valladares
authors.affiliation: Ministerio de Salud y Bienestar Social, Malabo, Equatorial Guinea.
authors.forename: Matilde
authors.initials: M
authors.lastname: Riloha
authors.affiliation: Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain.|Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain.
authors.forename: Agustin
authors.initials: A
authors.lastname: Benito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers; D003430:Cross-Sectional Studies; D016703:Equatorial Guinea; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008288:Malaria / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D055815:Young Adult
keywords: Bata district; Care-seeking behaviour; Delay; Equatorial Guinea; Malaria; Treatment