Health-Seeking Behavior for Malaria in Mesoamerica and the Dominican Republic: A Multi-Country Cross-Sectional Survey

Health-Seeking Behavior for Malaria in Mesoamerica and the Dominican Republic: A Multi-Country Cross-Sectional Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health-Seeking Behavior for Malaria in Mesoamerica and the Dominican Republic: A Multi-Country Cross-Sectional Survey Santiago Esteban, Daiki Hattori, Jiayi Wu, Diego Rios-Zertuche This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8604310/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 4 You are reading this latest preprint version Abstract Background: Timely diagnosis and treatment of malaria are essential for breaking transmission cycles and preventing mortality, yet many cases fail to seek care promptly. This study aims to examine the health-seeking behaviors (HSB) of individuals aged 15 years and older who experienced fever in the preceding two weeks, specifically within malaria-endemic and high-risk areas across Belize, Colombia, Costa Rica, the Dominican Republic, Guatemala, Honduras, Nicaragua, Panama, and El Salvador. Methods: Data was collected between September 2019 and March 2020 through household surveys (n = 964) and linked health facility surveys. Mixed-effects logistic regression models were used to explore associations between sociodemographic, behavioral, and community-level factors and care-seeking. Results: Care-seeking for fever varied widely, ranging from 42.8% in Honduras and 43.1% in the Dominican Republic to 74.8% in Panama. Across settings, most individuals sought care at formal facilities; however, malaria testing coverage remained low, with Panama reporting the highest testing rate (29.4%) and Costa Rica (0.4%) and El Salvador (0.7%) the lowest. Self-treatment was a leading reason for not seeking care, reported by up to 71% in Colombia, while perception of mild illness was most common in Panama (53%). Economic barriers were rare (< 10% in most countries), though geographic access remained a constraint in Guatemala, where 96% of respondents lived more than 1 km from a facility. Higher educational attainment (OR = 1.78, 95% CI: 1.02–3.10), greater wealth (OR = 1.70, 95% CI: 1.05–2.76), and malaria knowledge (OR = 2.56, 95% CI: 1.71–3.83) were significantly associated with greater odds of care-seeking, as was the presence of voluntary collaborators in communities (OR = 2.16, 95% CI: 1.32–3.55). Conclusion: Our findings underscore the need for integrated efforts to address socioeconomic, behavioral, and health system factors to enhance early diagnosis and treatment for malaria and support ongoing elimination initiatives in the region. health-seeking behavior malaria South and Central America Mesoamerica Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Reviewers invited by journal 30 Jan, 2026 Editor assigned by journal 18 Jan, 2026 Submission checks completed at journal 16 Jan, 2026 First submitted to journal 14 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8604310","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":583087915,"identity":"1c4ecb7d-f63d-4fb2-abe8-606042b41c67","order_by":0,"name":"Santiago Esteban","email":"data:image/png;base64,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","orcid":"","institution":"Inter-American Development Bank","correspondingAuthor":true,"prefix":"","firstName":"Santiago","middleName":"","lastName":"Esteban","suffix":""},{"id":583087916,"identity":"f18f28cd-53bc-40bc-afe4-045991940a70","order_by":1,"name":"Daiki Hattori","email":"","orcid":"","institution":"Cornell University","correspondingAuthor":false,"prefix":"","firstName":"Daiki","middleName":"","lastName":"Hattori","suffix":""},{"id":583087917,"identity":"46e97174-5c2a-4ebe-a6f2-508996fc05e5","order_by":2,"name":"Jiayi Wu","email":"","orcid":"","institution":"Cornell University","correspondingAuthor":false,"prefix":"","firstName":"Jiayi","middleName":"","lastName":"Wu","suffix":""},{"id":583087918,"identity":"923fb87e-ac5d-4f00-b338-5373ce193dbf","order_by":3,"name":"Diego Rios-Zertuche","email":"","orcid":"","institution":"Inter-American Development Bank","correspondingAuthor":false,"prefix":"","firstName":"Diego","middleName":"","lastName":"Rios-Zertuche","suffix":""}],"badges":[],"createdAt":"2026-01-14 18:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8604310/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8604310/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101753292,"identity":"4b9db24a-cc9b-483d-84bb-56e4435b2b2b","added_by":"auto","created_at":"2026-02-03 10:39:37","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1026276,"visible":true,"origin":"","legend":"","description":"","filename":"HealthSeekingBehaviorsMalaria.ene.14.26.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8604310/v1_covered_92832dcb-5ea0-4eda-a81e-3f05525bd828.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health-Seeking Behavior for Malaria in Mesoamerica and the Dominican Republic: A Multi-Country Cross-Sectional Survey","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"health-seeking behavior, malaria, South and Central America, Mesoamerica","lastPublishedDoi":"10.21203/rs.3.rs-8604310/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8604310/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eTimely diagnosis and treatment of malaria are essential for breaking transmission cycles and preventing mortality, yet many cases fail to seek care promptly. This study aims to examine the health-seeking behaviors (HSB) of individuals aged 15 years and older who experienced fever in the preceding two weeks, specifically within malaria-endemic and high-risk areas across Belize, Colombia, Costa Rica, the Dominican Republic, Guatemala, Honduras, Nicaragua, Panama, and El Salvador.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eData was collected between September 2019 and March 2020 through household surveys (n\u0026thinsp;=\u0026thinsp;964) and linked health facility surveys. Mixed-effects logistic regression models were used to explore associations between sociodemographic, behavioral, and community-level factors and care-seeking.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eCare-seeking for fever varied widely, ranging from 42.8% in Honduras and 43.1% in the Dominican Republic to 74.8% in Panama. Across settings, most individuals sought care at formal facilities; however, malaria testing coverage remained low, with Panama reporting the highest testing rate (29.4%) and Costa Rica (0.4%) and El Salvador (0.7%) the lowest. Self-treatment was a leading reason for not seeking care, reported by up to 71% in Colombia, while perception of mild illness was most common in Panama (53%). Economic barriers were rare (\u0026lt;\u0026thinsp;10% in most countries), though geographic access remained a constraint in Guatemala, where 96% of respondents lived more than 1 km from a facility. Higher educational attainment (OR\u0026thinsp;=\u0026thinsp;1.78, 95% CI: 1.02\u0026ndash;3.10), greater wealth (OR\u0026thinsp;=\u0026thinsp;1.70, 95% CI: 1.05\u0026ndash;2.76), and malaria knowledge (OR\u0026thinsp;=\u0026thinsp;2.56, 95% CI: 1.71\u0026ndash;3.83) were significantly associated with greater odds of care-seeking, as was the presence of voluntary collaborators in communities (OR\u0026thinsp;=\u0026thinsp;2.16, 95% CI: 1.32\u0026ndash;3.55).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eOur findings underscore the need for integrated efforts to address socioeconomic, behavioral, and health system factors to enhance early diagnosis and treatment for malaria and support ongoing elimination initiatives in the region.\u003c/p\u003e","manuscriptTitle":"Health-Seeking Behavior for Malaria in Mesoamerica and the Dominican Republic: A Multi-Country Cross-Sectional Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-02 17:26:29","doi":"10.21203/rs.3.rs-8604310/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-01-30T14:05:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-19T00:10:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-16T12:39:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2026-01-14T17:51:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"77747032-c72a-437f-bec4-159663fddb02","owner":[],"postedDate":"February 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-09T11:41:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-02 17:26:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8604310","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8604310","identity":"rs-8604310","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}