Factors associated with delayed health-seeking behaviour and disease severity on admission among patients diagnosed with acute encephalitis syndrome: an observational study from North India.

Introduction: Acute encephalitis syndrome (AES) poses a significant health challenge to children across India. Late arrival at tertiary care hospitals is a primary contributor to disease severity and poor outcomes. This study identifies the determinants of delayed health seeking and disease severity in AES cases. Methods: We interviewed the parents/guardians/caregivers of 242 patients with AES admitted at a tertiary care centre. Multivariable analyses identified factors for delayed health seeking, defined as >3 days spent at home after symptom onset; and disease severity on admission, defined as need for oxygen support. 131 patients were evaluated for long-term outcomes after 3 years using the Liverpool Outcome Score. Results: 90 (37.2%) patients had delayed health seeking and 202 (83.5%) had severe disease on admission. Lack of awareness about AES was a significant risk factor (OR 2.4, 95% CI 1.2 to 5.0, p=0.01) for delayed health seeking. Disease severity was associated with seeking treatment from uncertified medical practitioners (UMPs) (OR 7.3, 95% CI 2.7 to 19.8, p<0.01) and ≥2 days of time spent between the first healthcare provider and tertiary care admission (OR 3.0, 95% CI 1.3 to 7.3, p=0.01). At follow-up, disability was observed in 18.3% (n=24) of the patients. Conclusion: Delayed health seeking, treatment from UMPs and multiple healthcare consultations contributed to disease severity in patients with AES on admission at tertiary care health facilities.