Treatment-seeking time and its determinants among patients with confirmed malaria in Thailand: a national surveillance analysis, 2012-2024.
7 affiliations
- 1Division of Vector Borne Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
- 2Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- 3Division of Infectious Diseases and International Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 3720 Spectrum Boulevard, Suite 304, Tampa, FL, USA.
- 4Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- 5Department of Global Health and Biobehavioral Sciences; Department of Epidemiology & Biostatistics; Department of Health, Society, & Behavior, University of California, Irvine, CA, USA.
- 6Center of Excellence for Biomedical and Public Health Informatics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- 7Mahidol Vivax Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. [email protected].
Abstract
Background
Timely treatment of malaria is critical to preventing severe disease and onward transmission. However, treatment-seeking behavior varies across populations and geographic settings. This study examined treatment-seeking time and its determinants among patients with confirmed malaria in Thailand using national surveillance data.Methods
A retrospective analysis was conducted using surveillance data from laboratory-confirmed malaria cases recorded in Thailand's Electronic Malaria Information System (eMIS) from January 2012 to December 2024. The outcome was treatment-seeking time, defined as the number of days between the self-reported date of symptom onset and the date of confirmed malaria diagnosis recorded in the surveillance system. Descriptive statistics summarized treatment-seeking delays, while geographic variation was visualized using choropleth maps. Factors associated with treatment-seeking time were examined using negative binomial regression, with incidence rate ratios (IRRs) and 95% confidence intervals (CIs) reported.Results
A total of 127,242 confirmed malaria cases were analyzed. The majority were male (68.6%) and aged 15 years or older (73.5%), with Plasmodium vivax accounting for 75.0% of infections. The median treatment-seeking time was 2 days (interquartile range [IQR]: 1-3 days). Delays were longer among adults aged 15-34 years (IRR: 1.03; 95% CI 1.01-1.05) and ≥ 35 years (IRR: 1.03; 95% CI 1.01-1.05) compared with children under five years. Longer delays were also observed among long-term migrants (IRR: 1.04; 95% CI 1.03-1.06), short-term migrants (IRR: 1.06; 95% CI 1.04-1.08), and infections due to P. falciparum (IRR: 1.07; 95% CI 1.05-1.08), P. knowlesi (IRR: 1.19; 95% CI 1.12-1.26), and other species (IRR: 1.22; 95% CI 1.16-1.27), relative to P. vivax. Treatment-seeking time was longer in provinces classified as elimination-phase "clear-up" zones (IRR: 1.17-1.20) than in active transmission areas, whereas imported cases had shorter treatment-seeking times than indigenous cases (IRR: 0.96-0.98), likely reflecting differences in surveillance and case detection pathways. Western border provinces with historically high malaria burden showed relatively shorter treatment-seeking times.Conclusions
Most individuals with confirmed malaria in Thailand were diagnosed within a relatively short period following symptom onset, although delays persisted among migrants, individuals with non-P. vivax infections, and residents of elimination-phase settings. Targeted interventions to improve access to care and awareness among mobile populations and low-transmission areas could further reduce treatment-seeking delays and support Thailand's malaria elimination goals.
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BibTeX
@article{srisaard2026treatmentseeking,
title = {{Treatment-seeking time and its determinants among patients with confirmed malaria in Thailand: a national surveillance analysis, 2012-2024.}},
author = {Isara Srisaard and Pyae Linn Aung and Khaing Zin Zin Htwe and Prayuth Sudathip and Suravadee Kitchakarn and Liwang Cui and Saranath Lawpoolsri and Daniel M Parker and Amnat Khamsiriwatchara and Jaranit Kaewkungwal and Jetsumon Sattabongkot},
journal = {Malaria journal},
year = {2026},
month = aug,
doi = {10.1186/s12936-026-06105-6},
url = {https://europepmc.org/article/MED/43009957},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Treatment-seeking time and its determinants among patients with confirmed malaria in Thailand: a national surveillance analysis, 2012-2024.
AU - Isara Srisaard
AU - Pyae Linn Aung
AU - Khaing Zin Zin Htwe
AU - Prayuth Sudathip
AU - Suravadee Kitchakarn
AU - Liwang Cui
AU - Saranath Lawpoolsri
AU - Daniel M Parker
AU - Amnat Khamsiriwatchara
AU - Jaranit Kaewkungwal
AU - Jetsumon Sattabongkot
PY - 2026
DA - 2026/08/14
JO - Malaria journal
DO - 10.1186/s12936-026-06105-6
UR - https://europepmc.org/article/MED/43009957
AB - Background Timely treatment of malaria is critical to preventing severe disease and onward transmission. However, treatment-seeking behavior varies across populations and geographic settings. This study examined treatment-seeking time and its determinants among patients with confirmed malaria in Thailand using national surveillance data.Methods A retrospective analysis was conducted using surveillance data from laboratory-confirmed malaria cases recorded in Thailand's Electronic Malaria Information System (eMIS) from January 2012 to December 2024. The outcome was treatment-seeking time, defined as the number of days between the self-reported date of symptom onset and the date of confirmed malaria diagnosis recorded in the surveillance system. Descriptive statistics summarized treatment-seeking delays, while geographic variation was visualized using choropleth maps. Factors associated with treatment-seeking time were examined using negative binomial regression, with incidence rate ratios (IRRs) and 95% confidence intervals (CIs) reported.Results A total of 127,242 confirmed malaria cases were analyzed. The majority were male (68.6%) and aged 15 years or older (73.5%), with Plasmodium vivax accounting for 75.0% of infections. The median treatment-seeking time was 2 days (interquartile range [IQR]: 1-3 days). Delays were longer among adults aged 15-34 years (IRR: 1.03; 95% CI 1.01-1.05) and ≥ 35 years (IRR: 1.03; 95% CI 1.01-1.05) compared with children under five years. Longer delays were also observed among long-term migrants (IRR: 1.04; 95% CI 1.03-1.06), short-term migrants (IRR: 1.06; 95% CI 1.04-1.08), and infections due to P. falciparum (IRR: 1.07; 95% CI 1.05-1.08), P. knowlesi (IRR: 1.19; 95% CI 1.12-1.26), and other species (IRR: 1.22; 95% CI 1.16-1.27), relative to P. vivax. Treatment-seeking time was longer in provinces classified as elimination-phase "clear-up" zones (IRR: 1.17-1.20) than in active transmission areas, whereas imported cases had shorter treatment-seeking times than indigenous cases (IRR: 0.96-0.98), likely reflecting differences in surveillance and case detection pathways. Western border provinces with historically high malaria burden showed relatively shorter treatment-seeking times.Conclusions Most individuals with confirmed malaria in Thailand were diagnosed within a relatively short period following symptom onset, although delays persisted among migrants, individuals with non-P. vivax infections, and residents of elimination-phase settings. Targeted interventions to improve access to care and awareness among mobile populations and low-transmission areas could further reduce treatment-seeking delays and support Thailand's malaria elimination goals.
SN - 1475-2875
ER -