Delay in malaria care-seeking for children under five in Africa: a systematic review

Abstract Background Delays in seeking appropriate treatment for malaria in children under five remain a major contributor to poor outcomes in sub-Saharan Africa, where multiple socioeconomic, geographic, and health-system factors influence when care is accessed. This review synthesised current evidence on the prevalence and determinants of delayed malaria care-seeking, as well as the associated outcomes among children under five in sub-Saharan Africa. Methods This systematic review followed the guidelines by the Joanna Briggs Institute (JBI). This review was reported in accordance with following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Result The prevalence of delayed malaria care-seeking among children under five ranges from 2% to 95.8%. Factors associated with these delays include financial constraints, long travel distances, reliance on traditional treatments, and the perception of malaria as a mild illness. Additionally, health workers’ attitudes and shortages of essential health facility logistics further hinder timely care-seeking by caregivers. These delays are associated with increased mortality, progression to severe malaria, and serious neurological and haematological complications. Conclusion Timely access to effective malaria treatment for young children can be enhanced by interventions that address financial barriers, improve access to care, and strengthen health-system readiness to respond promptly.