背景:延迟治疗与严重疟疾的高风险相关。在疟疾流行地区,与延迟寻求医疗保健相关的主要因素是低教育水平和传统观念。在进口疟疾中,目前尚不清楚延迟寻求医疗保健的决定因素.
方法:我们研究了从1月1日起出现疟疾的所有患者,2017年,至2022年2月14日,在梅伦医院,法国。记录所有患者的人口统计学和医学数据,以及住院成人亚组的社会专业数据。通过交叉制表使用单变量分析确定相对风险和95%置信区间。
结果:纳入234例患者,都是从非洲来的。其中,218(93%)感染恶性疟原虫,77人(33%)患有严重疟疾,26岁(11%)小于18岁,在SARS-CoV-2大流行期间包括81例。有135名住院成年人(占所有患者的58%)。首次医疗咨询的中位时间(TFMC),由从症状发作到第一次医疗建议的时期定义,是3天[IQR1-5]。TFMC≥3天的旅行者往往更频繁地拜访朋友和亲戚(VFR)(RR1.44,95%CI[1.0-2.05],p=0.06),而在儿童和青少年中频率较低(RR0.58,95%CI[0.39-0.84],p=0.01)。性别,非洲背景,失业,独自生活,缺乏转诊医师与延迟寻求医疗保健无关.SARS-CoV-2大流行期间的咨询与更长的TFMC无关,也没有更高的严重疟疾发病率。
结论:与流行区相比,社会经济因素对进口疟疾患者就医延迟没有影响.预防应侧重于VFR受试者,他们往往比其他旅行者更晚咨询。
Delayed treatment is associated with a higher risk of severe malaria. In malaria-endemic areas, the main factors associated with delay in seeking healthcare are low educational level and traditional beliefs. In imported malaria, determinants of delay in seeking healthcare are currently unknown.
We studied all patients presenting with malaria, from 1 January 2017 to 14 February 2022, in the hospital of Melun, France. Demographic and medical data were recorded for all patients, and socio-professional data were recorded for a subgroup of hospitalized adults. Relative-risks and 95% confidence intervals were determined using univariate analysis by cross-tabulation.
There were 234 patients included, all travelling from Africa. Among them, 218 (93%) were infected with P. falciparum, 77 (33%) had severe malaria, 26 (11%) were <18 years old and 81 were included during the SARS-CoV-2 pandemic. There were 135 hospitalized adults (58% of all patients). The median time to hospital admission (THA) , defined by the period from onset of symptoms to arrival at hospital, was 3 days (IQR = 2-5). A THA ≥3 days tended to be more frequent in travellers visiting friends and relatives (
VFR; RR = 1.44, 95% CI = [1.0-2.05], P = 0.06), while it was less frequent in children and teenagers (RR = 0.58, 95% CI = [0.39-0.84], P = 0.01). Gender, African background, unemployment, living alone and absence of referring physician were not associated with delay in seeking healthcare. Consulting during the SARS-CoV-2 pandemic was neither associated with a longer THA nor with a higher rate of severe malaria.
In contrast to an endemic area, socio-economic factors did not impact on delay in seeking healthcare in imported malaria. Prevention should focus on
VFR subjects, who tend to consult later than other travellers.