目的 分析2016—2024年杭州市输入性疟疾病例就诊与诊断延迟情况及其影响因素，为杭州市输入性疟疾病例的管理提供科学依据。 方法 从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2016—2024年杭州市报告的疟疾监测数据和流行病学个案调查表，包括人口学特征、发病及就诊情况、感染来源、既往病史、治疗情况、感染虫种等相关信息。应用SPSS 26.0统计学软件进行统计分析，采用单因素Logistic回归分析输入性疟疾病例就诊及诊断延迟影响因素，多因素Logistic回归分析输入性疟疾病例就诊及诊断延迟与重症疟疾发生的关系。 结果 2016—2024年杭州市累计报告输入性疟疾病例282例，男性占94.0%（265/282）、女性占6.0%（17/282），境外务工人员占80.1%（226/282），非洲输入病例占96.1%（271/282）。发病后初次就诊于区（县）级医疗机构的病例最多，占40.8%（115/282）；初次就诊误诊率为22.7%（64/282）。报告病例中恶性疟占比最高（74.8%，211/282）。发病至初次就诊时间间隔为0~16 d，出现症状当天就诊的病例占30.1%（85/282），初次就诊到确诊时间间隔为0~46 d，就诊当天确诊的病例占38.6%（109/282）。就诊延迟、诊断延迟和总体延迟的病例分别占13.1%（37/282）、28.4%（80/282）和18.4%（52/282）。< 30岁、30~39岁、40~49岁、≥ 50岁的发病至初次就诊延迟率分别占15.5%（9/58）、9.9%（7/71）、6.3%（5/79）、21.6%（16/74），差异有统计学意义（χ² = 8.843，P < 0.05）。不同输入地区、初诊医疗机构级别、初次就诊结果和感染疟原虫虫种的诊断延迟率差异有统计学意义（χ² = 3.860、19.768、113.928、13.030，P < 0.05）。不同年龄组、输入地区、发病距境外旅居史时间间隔、初次就诊结果和感染疟原虫虫种总体延迟差异有统计学意义（χ² = 9.211、5.554、15.354、54.830、31.735，P < 0.05）。单因素Logistic回归分析结果表明，年龄 ≥ 50岁是就诊延迟的危险因素（OR = 1.245，95%CI：1.085~1.708）。发病距境外旅居史间隔6个月以上（OR = 3.057，95%CI：1.041~8.979）、初次就诊为其他疾病（OR = 29.405，95%CI：13.993~61.789）、感染间日疟原虫（OR = 2.717，95%CI：1.016~7.266）以及感染其他疟原虫（OR = 2.810，95%CI：1.498~5.273）的病例更易出现诊断延迟；初次就诊为省级医疗机构的病例是诊断延迟的保护性因素（OR = 0.135，95%CI：0.023~0.800）。282例病例中有11例重症及死亡病例，其中恶性疟10例、卵形疟1例。多因素Logistic回归分析显示，诊断延迟（OR = 6.285，95%CI：1.625~24.302）、总体延迟（OR = 6.046，95%CI：1.491~24.522）与重症疟疾发生风险增加有关。 结论 2016—2024年杭州市输入性疟疾病例就诊和确诊存在一定程度延迟，主要与年龄、境外旅居地、初次就诊医疗机构级别和感染疟原虫虫种有关。

Objective To investigate the delay in healthcare-seeking and diagnosis of imported malaria cases and identify their determinants in Hangzhou City from 2016 to 2024, so as to provide the scientific evidence for improving the management of imported malaria cases in Hangzhou City. Methods Malaria surveillance data and epidemiological case investigation forms reported in Hangzhou City from 2016 to 2024 were collected from Infectious Diseases Report Information Management System and Parasitic Diseases Prevention and Control Information Management System of Chinese Center for Disease Control and Prevention, including demographic characteristics, disease onset and healthcare-seeking, source of acquiring infections, previous medical history, treatment, and parasite species. All statistical analyses were conducted using the software SPSS 26.0. The determinants of delay in healthcare-seeking and diagnosis were identified using a univariate logistic regression model among imported malaria cases, and the association of delay in healthcare-seeking and diagnosis with severe malaria was examined using a multivariate logistic regression model. Results A total of 282 imported malaria cases were reported in Hangzhou City from 2016 to 2024, including 265 men (94.0%) and 17 women (6.0%), and there were 226 overseas labors (80.1%) and 271 African imported cases (96.1%). Most cases (40.8%, 115/282) initially sought healthcare services in district (county)-level medical institutions, and the misdiagnosis rate of initial healthcare-seeking was 22.7% (64/282). Among all reported cases, most acquired Plasmodium falciparum infections (74.8%, 211/282). The interval between disease onset and initial healthcare-seeking was 0 to 16 days, with 30.1% (85/282) of cases seeking healthcare on the day of disease onset. The interval between initial healthcare-seeking and definitive diagnosis was 0 to 46 days, with 38.6% (109/282) of the cases receiving definitive diagnosis on the day of healthcare-seeking. The proportions of cases with delays from disease onset to initial healthcare-seeking, from initial healthcare-seeking to definitive diagnosis, and from disease onset to definitive diagnosis were 13.1% (37/282), 28.4% (80/282), and 18.4% (52/282), respectively, and the percentages of cases with delay from disease onset to initial healthcare-seeking were 15.5% (9/58), 9.9% (7/71), 6.3% (5/79), and 21.6% (16/74) among cases under 30 years of age, at ages of 30 to 39 years, 40 to 49 years and 50 years and older (χ² = 8.843, P < 0.05). There were significant differences in the proportions of cases with delays from initial healthcare-seeking to definitive diagnosis in terms of sources of acquiring infections (χ² = 3.860, P < 0.05), levels of medical institutions for initial healthcare seeking (χ² = 19.768, P < 0.05), initial diagnosis results (χ² = 113.928, P < 0.05), and infected Plasmodium species (χ² = 13.030, P < 0.05), and there were significant differences in the proportions of cases with delays from disease onset to definitive diagnosis in terms of age groups (χ² = 9.211, P < 0.05), sources of acquiring infections (χ² = 5.554, P < 0.05), interval from disease onset to overseas travel history (χ² = 15.354, P < 0.05), initial diagnosis results (χ² = 54.830, P < 0.05), and infected Plasmodium species (χ² = 31.735, P < 0.05). Univariate logistic regression analysis identified age of 50 years and older as a risk factor for delay in healthcare-seeking (OR = 1.245, 95%CI: 1.085-1.708). Cases with an overseas travel history of more than 6 months prior to disease onset (OR = 3.057, 95%CI: 1.041-8.979), initial diagnosis as other diseases (OR = 29.405, 95%CI: 13.993-61.789), P. vivax infection (OR = 2.717, 95%CI: 1.016-7.266), and infection with other malaria parasite species (OR = 2.810, 95%CI: 1.498-5.273) were more likely to experience delay in diagnosis, and initial healthcare-seeking at province-level medical institutions was a protective factor for delay in diagnosis (OR = 0.135, 95%CI: 0.023-0.800). Of 282 imported malaria cases, there were 11 severe cases and deaths, including 10 P. falciparum malaria cases, and one P. ovale malaria case. Multivariate logistic regression analysis revealed that delay in diagnosis (OR = 6.285, 95%CI: 1.625-24.302) and overall delay (OR = 6.046, 95%CI: 1.491-24.522) were significantly associated with an increased risk of severe malaria. Conclusion There was a delay in healthcare-seeking and definitive diagnosis among imported malaria cases in Hangzhou City from 2016 to 2024, which was mainly attributed to age, place of overseas travel, level of medical institutions for initial healthcare-seeking, and Plasmodium species.