{
  "abstract": "Objective To identify psychosocial and structural barriers to prompt malaria care-seeking in Malawi by applying the Three Delays Model (delay 1: deciding to seek care; delay 2: reaching a facility; delay 3: receiving quality care).Design cross-sectional study.Setting Nationally representative data collected from Malawi communities between 25 May 2021 and 1 July 2021.Participants 913 female caregivers who reported a child with fever in the past 2 weeks.Primary outcome measures Prompt care-seeking for fever (same or next day) from a qualified health provider.Results Prompt care-seeking was primarily associated with delay 1 (adjusted OR (aOR) 0.58, 95% CI 0.43 to 0.78) and psychosocial (aOR 0.59; 95% CI 0.44 to 0.79) factors. Significant factors included incorrect knowledge of malaria symptoms, cause and diagnosis (aOR 0.71: 95% CI 0.53 to 0.97), negative attitudes towards care-seeking (aOR 0.58; 95% CI 0.41 to 0.82), incorrect knowledge of when and where to seek care (aOR 0.19: 95% CI 0.07 to 0.50) and far distance from a health facility (aOR 0.67, 95% CI 0.49 to 0.93).Conclusion Despite the availability of free malaria services, significant bottlenecks remain in the initial decision-making phase. To reduce malaria mortality, national programmes should prioritise social and behaviour change interventions that move beyond general awareness to target specific care-seeking attitudes and intra-household decision-making dynamics.",
  "authors": [
    {
      "affiliations": [
        "Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA"
      ],
      "name": "Bolanle Olapeju"
    },
    {
      "affiliations": [
        "Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"
      ],
      "name": "Michael Bride"
    },
    {
      "affiliations": [
        "U.S. President’s Malaria Initiative, US Centers for Disease Control and Prevention Research Centers, Lilongwe, Malawi"
      ],
      "name": "Tyson Volkmann"
    },
    {
      "affiliations": [
        "U.S. President’s Malaria Initiative, Malaria Branch, US Centers for Disease Control and Prevention Research Centers, Atlanta, Georgia, USA"
      ],
      "name": "Shelby Cash"
    },
    {
      "affiliations": [
        "U.S. President’s Malaria Initiative, USAID, Lilongwe, Malawi"
      ],
      "name": "Edson Dembo"
    },
    {
      "affiliations": [
        "National Malaria Control Program, Government of Malawi Ministry of Health, Lilongwe, Central Region, Malawi"
      ],
      "name": "Michael Kayange"
    },
    {
      "affiliations": [
        "National Malaria Control Program, Government of Malawi Ministry of Health, Lilongwe, Central Region, Malawi"
      ],
      "name": "Austin Gumbo"
    },
    {
      "affiliations": [
        "National Malaria Control Program, Government of Malawi Ministry of Health, Lilongwe, Central Region, Malawi"
      ],
      "name": "Taonga Mafuleka"
    },
    {
      "affiliations": [
        "Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"
      ],
      "name": "Jennifer Boyle"
    },
    {
      "affiliations": [
        "Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"
      ],
      "name": "Alfred Mang’ando"
    },
    {
      "affiliations": [
        "Evidence Informed Decision Making Centre, Department of Epidemiology and Biostatistics, Kamuzu University of Health Sciences School Global and Public Health, Blantyre, Southern Region, Malawi"
      ],
      "name": "Nyanyiwe Masingi Mbeye"
    },
    {
      "affiliations": [
        "Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"
      ],
      "name": "Chime Mukwakwa"
    }
  ],
  "title": "Three delays of malaria care-seeking in Malawi: a cross-sectional study",
  "uid": "bdcdaeb9-44b1-5aca-96a5-b9795c53f3d2"
}