Study design and duration
From May 20, 2022 to June 25, 2022, a facility-based study was conducted in 322 randomly selected malaria patients (161 cases and 161 controls) at a public health facility in South Gondar District, Ethiopia. An uncontrolled case-control study was conducted. South Gondar region is located in the north-central part of Ethiopia, in the Amhara region, between latitudes 11°8'N, 39°38'E, longitudes 11.133°20'N and 39.633°E. The district spans an altitude range from 2,470 meters to 16,840 meters above sea level and covers a surface area of approximately 16,840 km.2. In terms of geographical proximity, South Gondar region is located 666 km from Addis Ababa, the capital of Ethiopia, and 97 km from Bahir Dar, the capital of Amhara region.
population
All confirmed malaria patients seeking treatment at public health facilities in South Gondar district were recruited as the source population. All confirmed malaria patients who sought treatment at public health facilities in South Gondar district during the data collection period were considered the study population.
Case: Identified as a malaria patient seeking treatment 24 hours after the first symptoms of malaria appeared.twenty two.
Control: Identified as a malaria patient seeking treatment within 24 hours of first malaria symptoms.twenty three.
Inclusion and exclusion criteria
All confirmed malaria cases are malaria parasite Species enrolled in the study with blood film (Bf) or rapid diagnostic test (RDT) were included in the study. On the other hand, patients with severe symptoms were excluded from the study.
Determining sampling method and sample size
Sample size was determined using the case-control study dual population proportion formula in Epi-info 7.0 stat calc. The calculations were calculated using three variables. In most studies, the presence of side effects, knowledge about malaria, and distance to health facilities are significantly associated with treatment delays. The final sample size was calculated using the assumption of “presence of side effects” with an odds ratio of 4.96, a proportion of exposed controls of 2.6%, a proportion of exposed cases of 11.7%, and a 95% confidence interval. The power is: 80%, controlling the 1:1 ratio and adding a 10% non-response rate20. The total number of malaria patients from public health facilities was 17,622. The final sample for this study consisted of 322 participants, evenly divided into 161 cases and 161 controls in a 1:1 ratio. Both cases and controls were selected individually through a systematic random sampling method. Cases were initially selected using a lottery, and then every fourth interval of hers was selected, as shown below. (table 1).
There are 96 public health facilities in South Gondar district, and 9 facilities were randomly selected by lottery for participant selection. This approach ensured equal opportunity for all facilities and maintained a fair and unbiased selection process. Cases were included using a systematic random sampling technique by calculating the case sampling interval based on each health facility's average monthly cash flow, and controls were selected at the time of case enrollment.
The Kth (K = 4) value was determined for both cases and controls. It was done separately by dividing the number of patients by the sample size (the total number of malaria cases in South Gondar district of the EC in June 2013 was 1,288 from the data collected from each facility.The study population was , selected using systematic random sampling techniques), if the patient tests positive for any type of bacteria after a laboratory request is made; malaria parasitethey were eligible and were moved to a private room for interviews until the required total sample size was obtained.
operational definition
Knowledge about malaria
Assessed by 10 knowledge assessment questions, those who score 70% or above are considered to have adequate knowledge, and those who score less than 70% on the knowledge assessment questions are considered to have insufficient knowledge. It was deemed that there was.twenty four.
seek timely treatment
This is a treatment that seeks treatment within 24 hours of the onset of malaria symptoms.23,25.
delay in treatment
This is the treatment required within the recommended 24 hours after the onset of malaria symptoms.23,25.
waiting time
The amount of time patients had to wait at registration, consultation, laboratory, other diagnostic units and pharmacies before receiving services. If a patient's wait time is more than her 120 minutes, it is considered a long wait time, and if the wait time is less than her 120 minutes, it is considered a short wait time.twenty two.
customer satisfaction
a subjective measure of whether a patient's expectations about a health encounter have been mettwenty two.
Trust in medical care
Trust in the health system means an expectation that adequate and appropriate treatment will be provided when needed.twenty three.
Data collection procedures and quality assurance
The questionnaire was initially developed in English after reviewing the available literature. Training was provided to data collectors and supervisors. Data were collected through a structured, pretested questionnaire developed by reviewing a variety of peer-reviewed literature.26,27. This tool consists of questions regarding sociodemographic characteristics, physical accessibility and environmental factors, behavioral factors, and treatment delays. Additionally, the knowledge assessment questions regarding malaria signs/symptoms, transmission, and prevention were partially adapted from previously conducted studies, including his/her Contains 12 closed-ended multiple-choice questions.27,28.
Data processing and analysis
After ensuring completeness and consistency, data were coded, entered into EPI Data v 4.6.0.2, and exported to SPSS 23 statistical software for processing and analysis. Frequency tables and descriptive summaries were used to represent the study variables. Logistic regression analysis assessed the significance of the association between dependent and independent variables. Bivariate and multivariate analyzes were conducted to examine the relationship between delays in treatment seeking in malaria patients and selected independent variables. For bivariate logistic regression, variables with a p value ≤0.25 were included in the multivariate logistic regression analysis.29Then, a p value less than 0.05 was considered a predictor of delayed malaria treatment request, and odds ratios adjusted with 95% CI were considered to confirm the strength and significance of the association. The validity of the final model was checked using the Hosmer and Lemeshow goodness-of-fit test. The pa value was 0.0830.
Ethics approval and consent to participate
Ethical approval was obtained from the Institutional Review Board of the Faculty of Medicine and Health Sciences, University of Wollo, with reference number: CMHS/85/13/2022. Following approval, a formal letter of cooperation was written by the University of Wollo's School of Public Health to the relevant institutions. Permission was also obtained from the South Gondar District Health Department and each health facility where data collection took place. Respondents were informed about the aims and objectives of the study, and verbal informed consent was obtained from each respondent except for the permission of a parent or guardian for participants under 18 years of age and Permission was also obtained for the above participants. Year. Respondents were provided with clear information about the purpose and procedures of the study, the importance of their participation, and their right to withdraw at any time if they wished. Additionally, respondents were informed about the privacy and confidentiality of the information they provided throughout the study by maintaining anonymity and being interviewed in a separate room during the interview. All methods were performed in accordance with relevant guidelines and regulations.
