Abstract: Objective　To investigate the health⁃seeking behaviors of imported malaria cases after returning to China, and to investigate the factors affecting the time to initial diagnosis, so as to provide the scientific evidence for early identification of imported malaria cases and prevention of severe cases development and secondary transmission. Methods　The individual demographic features, and the disease onset and the time to initial diagnosis of imported malaria cases in Jiangsu Province in 2019 were captured from the National Notifiable Disease Report System and the Information Management System for Parasitic Disease Control in China. The characteristics of health⁃seeking behaviors and epidemiological features of imported malaria cases were descriptively analyzed, and the factors affecting the time to initial diagnosis of imported malaria cases after returning to China were identified using multivariate logistic regression analysis. Results　A total of 244 imported malaria cases were reported in Jiangsu Province in 2019, and the time to initial diagnosis of the cases were 1-12 days, with mean time of (1.53 ± 1.65) days, with median time of one day. The highest number of malaria cases seeking healthcare services were found on the day of developing primary symptoms (76 cases, 31.1%), followed by on the second day (68 cases, 27.9%), on the third day (46 cases, 18.9%), and 54 cases (22.1%) received initial diagnosis 3 days following presence of primary symptoms, including 3 cases with initial diagnosis at more than one week. High proportions of imported malaria cases with a delay in the time to initial diagnosis were seen in migrant workers who returned to China in January (14 cases, 5.7%) and December (13 cases, 5.3%) and those aged between 41 and 50 years (32 cases, 13.1%). Multivariate logistic regression analysis showed relative short time to initial diagnosis among imported malaria cases returning to China on March [odds ratio (OR) = 0.16, P = 0.03, 95% confidence interval (CI): (0.03, 0.85)] and those with a history of overseas malaria parasite infections [OR = 0.36, P = 0.001, 95% CI: (0.19, 0.67)]. Conclusions　Timely health⁃seeking behaviors should be improved among imported malaria cases in Jiangsu Province, patients with a history of overseas malaria infections require faster health⁃seeking activities.

Key words: Import malaria, Initial diagnosis, Health?seeking behavior, Influencing factor, Jiangsu Province

摘要： 目的　了解江苏省输入性疟疾病例回国后就医行为特征，分析病例初诊时间影响因素，为输入性疟疾病例早期发现、防止重症病例发生及继发传播提供科学依据。方法　在中国疾病预防控制中心传染病报告信息管理系统和寄生虫病防治信息管理系统中，收集2019年江苏省报告的输入性疟疾病例个案信息以及发病及初诊时间信息。对输入性疟疾病例回国后就医行为及流行病学特征进行描述性分析，采用多因素logistic回归分析探索病例回国后初诊时间影响因素。结果　2019年江苏省累计报告输入性疟疾病例244例，病例初诊时间在1～12 d，平均初诊时间（1.53 ± 1.65） d、中位初诊时间1 d。出现首发症状当天就医的病例数最多（76例，31.1%），68例（27.9%）第2天就医、46例（18.9%）第3天就医、54例（22.1%）3 d后就医，其中3例初诊时间在1周以上。归国时间在1月（14例，5.7%）和12月（13例，5.3%）、年龄在41～50岁（32例，13.1%）的外出务工人员中初诊时间延误者比例较高。多因素logistic回归分析发现，归国时间在3月[比值比（OR）= 0.16, P = 0.03, 95%可信区间（CI）：（0.03，0.85）]及有境外疟原虫感染史者[OR = 0.36, P = 0.001, 95% CI :（0.19, 0.67）]的病例初诊时间相对较短。结论　江苏省输入性疟疾患者主动就医及时性有待提高，有疟原虫感染史者就医更及时。

关键词: 输入性疟疾, 初诊, 就医行为, 影响因素, 江苏省