Sudanese migrants' pathways to malaria care in Egypt: An in-depth qualitative study

Abstract

Egypt has recently been certified as malaria-free. To sustain this status, the Egyptian Ministry of Health has implemented a policy of centralised malaria treatment at specialised hospitals, provided free of charge to all populations regardless of migrant status. This study examines migrants' malaria care-seeking experiences, the factors influencing their choices, and strategies to improve access. A qualitative study was conducted in Cairo using semi-structured interviews, inviting adult migrants from malaria-endemic countries and with prior malaria experience. Participants were recruited through purposive and convenience sampling. Data were collected in Arabic, transcribed, translated, and analysed thematically. We recruited 21 individuals, all Sudanese; 90.5% were female. Five participants (24%) developed malaria symptoms immediately upon arrival in Egypt; others developed symptoms within six months. Three themes emerged from the analysis: “Malaria-specific healthcare practices,” “Determinants of healthcare-seeking behaviour,” and “Recommendations.” Although participants recognised the severity of malaria and the need for treatment, 19 (90.5%) initially relied on traditional remedies or self-medication without malaria testing. Factors influencing healthcare-seeking behaviour included, at the patient level, a lack of trust in healthcare professionals, reluctance to disclose a malaria diagnosis due to stigma, fears of quarantine, concerns about adverse drug effects, and exposure to negative rumours and misconceptions about treatment. Factors within the healthcare system encompassed malaria services' affordability, accessibility, and perceived quality. Sudanese migrants’ malaria care-seeking behaviours are influenced by multiple personal and systemic factors. Improving access requires targeted health education to address misconceptions, raise awareness, and build trust in the healthcare system. • Egypt has achieved malaria elimination; however, the ongoing conflict in Sudan now poses a serious threat to the sustainability of this achievement. • Both individual and systemic barriers shape Sudanese migrants’ healthcare-seeking behaviour for malaria in Egypt. • A lack of trust in the local healthcare system emerged as the main factor influencing malaria care-seeking behaviour among Sudanese migrants. • Enhancing Sudanese migrants’ capacity and awareness, and building trust in the health system, are key to improving their access to and navigation of malaria healthcare services.