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

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.