When to seek health care: A duration analysis for malaria patients in Nepal

We find that the log-normal distribution of care-seeking time - the number of days from the onset of symptoms of malaria to when a patient seeks treatment from a provider - best described the treatment-seeking behavior of malaria patients in rural areas of two districts of Nepal. The care-seeking rate, or the probability of seeking care, was low on the first day of the symptoms; it increased sharply over the first five days and then gradually declined. Since at the time of the research there was a system of malaria workers taking monthly surveillance rounds of each house to detect and treat malaria cases, patients, instead of traveling to a provider for care, generally waited for malaria workers to arrive at home when the wait for malaria workers was short. But, the probability of seeking care on any day rose if the wait was longer. Women generally tended to wait longer for the malaria workers in order to receive treatment at home. Patient's age, household size, education, and the type of malaria species infecting the patient had no significant effect on care-seeking rate. Given an assumption that a wait of 100 days for a malaria worker would effectively represent total absence of surveillance program, the estimated model predicted higher care-seeking rates under no surveillance program than under the monthly surveillance program.Malaria Nepal Hazard model Treatment-seeking behavior Failure model Duration model