Time delays in the diagnosis and treatment of malaria in non-endemic countries: A systematic review.

BACKGROUND

Delays in diagnosis and treatment for malaria are associated with an increased risk for severe disease and mortality. Identifying the extent of patient and health system delay can provide a benchmark against which interventions to reduce delays can be measured.

METHODS

We performed an electronic search in PubMed, EMBASE, Web of Science and LILACS for studies reporting time to diagnosis and treatment after return from travel, onset of symptoms and seeking healthcare in non-endemic countries. Additionally, theses, conference proceedings and nationally reported surveillance data were also searched for information on time delays. There were no language restrictions and all the studies were assessed for methodological quality.

RESULTS

Data from 69 papers out of 1719 identified records published between 2005 and 2017 were extracted; our findings show that median diagnosis delays of four or more days are common and patient delays accounted for a large proportion of diagnostic delay. There were limited data available on medical diagnostic delay.

CONCLUSION

Patient delays accounted for a large proportion of the overall diagnostic delay; however the retrospective nature of the studies could have overestimated patient delay since previous healthcare contacts were not included. Additionally, the high frequency of studies reporting a clinically significant delay is a major concern.