School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China.
National Health Commission Key Laboratory of Parasitic Disease Control and Prevention, Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology, Jiangsu Institute of Parasitic Diseases, Wuxi, China.
Trop Med Int Health. 2022 Jan;27(1):28-37. doi: 10.1111/tmi.13698. Epub 2021 Nov 16.
To identify barriers to seeking health care among returning travellers with malaria with the aim of developing targeted interventions that improve early health care-seeking behaviour, diagnosis and treatment.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of published medical literature, selecting studies that investigated and reported barriers to seeking health care among returning travellers and migrants with malaria. In total, 633 articles were screened, of which four studies met the inclusion criteria after a full-text review.
The four studies reported barriers to seeking healthcare among returning travellers in China, the United States, Thailand and the Dominican Republic. Three studies had an observational design. The identified barriers were summarised based on the appraisal delay, illness delay and utilisation delay stages. During appraisal delays, low awareness of malaria was the most significant factor. Once the patient assessed that he or she was ill, belonging to a specific minority ethnicity, being infected with P. vivax and receiving a low level of social support were predictors of delayed health care-seeking. Finally, the most significant factor associated with utilisation delays was the monetary cost.
The health care-seeking behaviour of returning travellers with malaria should be further investigated and improved. Addressing the identified barriers and gaps in health care-seeking behaviour among returning travellers with malaria, particularly among groups at high risk of travel-associated infections, is important to prevent severe disease and deaths as well as secondary transmission and epidemics.
确定疟疾归国旅行者寻求医疗保健的障碍，旨在制定有针对性的干预措施，以改善早期医疗保健寻求行为、诊断和治疗。
我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对已发表的医学文献进行了系统综述，选择了调查和报告疟疾归国旅行者和移民寻求医疗保健障碍的研究。共筛选出 633 篇文章，其中 4 篇经过全文审查后符合纳入标准。
四项研究报告了中国、美国、泰国和多米尼加共和国归国旅行者寻求医疗保健的障碍。三项研究具有观察性设计。根据评估延迟、疾病延迟和利用延迟阶段总结了确定的障碍。在评估延迟期间，对疟疾的低认识是最重要的因素。一旦患者评估自己患病，属于特定的少数族裔、感染间日疟原虫和获得低水平的社会支持是延迟寻求医疗保健的预测因素。最后，与利用延迟最相关的因素是货币成本。
应进一步调查和改善疟疾归国旅行者的医疗保健寻求行为。解决疟疾归国旅行者医疗保健寻求行为中存在的障碍和差距，特别是在高旅行相关感染风险群体中，对于预防严重疾病和死亡以及二次传播和流行至关重要。
