INTRODUCTION: Malaria elimination remains a global public health priority, particularly in low- and middle-income countries. India has set a target of eliminating malaria by 2030, making it essential to understand gaps in healthcare access, utilization, and preventive practices in endemic areas to guide focused interventions to achieve national and global malaria elimination targets. METHODS: A subnational, cross-sectional study surveying 37,849 households in ten malaria-endemic states in India, which covered 177,644 individuals, was carried out to estimate the health service and long-lasting insecticidal net (LLIN) utilization for febrile illness and malaria. RESULTS: The study found that the accessibility of a government healthcare facility was within 2.5 km (interquartile range IQR 1-5 km), with 57.4% of febrile individuals visiting a government healthcare center or approaching a government-designated healthcare provider for fever within 24-48 h. Adequate knowledge and behavior regarding prevention were observed in 89.2% households, while 73.6% households reported using LLINs regularly. CONCLUSIONS: Lack of formal education and belonging to the tribal population were found to be high risk factors for malaria. Healthcare-seeking behavior played a crucial role in malaria burden. This study highlights the gap between accessibility of health facility and its utilization, as well as LLIN ownership and its regular utilization.
Chalageri et al. (2026) studied this question.