Delay in malaria care-seeking for children under five in developing economies: A systematic review

Malaria remains one of the most pressing public health challenges in developing economies, particularly affecting children under five years old. Malaria in young children remains a leading cause of morbidity and mortality (Aheto, 2022). In 2023, an estimated 263 million malaria cases and 597,000 malaria-related deaths occurred across 83 countries worldwide (WHO, 2024). Children under five years of age accounted for approximately 76% of all malaria deaths in 2023 (WHO, 2024). In regions like sub-Saharan Africa, where malaria is endemic, malaria-related mortality rates for children under five remain unacceptably high (Mousa et al., 2020). For instance, the World Health Organisation (WHO) in 2021 reported that about 80% of all malaria deaths in Africa are among children under five years (WHO, 2021). These high mortality rates are largely linked to delays in accessing appropriate medical treatment (Mousa et al., 2020). Thus, in developing countries, delays in seeking timely medical care continue to pose a critical challenge. Early care-seeking is essential for reducing the severity of malaria and improving health outcomes in children under five. The WHO strongly recommends that malaria should be treated within 24 hours of symptom onset to prevent the disease from worsening (WHO, 2024). Evidence shows that adults with malaria who sought care more than 24 hours after the onset of symptoms were much more likely to develop severe malaria than those who sought care sooner (Tadesse Abebe et al., 2025). Furthermore, early intervention can prevent the development of severe and cerebral malaria, which are among the most serious complications associated with delayed care (White, 2022). While the prevalence of malaria and the impact of delayed care-seeking are well-documented (Jia et al., 2024; Melese et al., 2024; Tadesse Abebe et al., 2025), there remains a significant gap in understanding the specific factors that contribute to delayed care-seeking among children under five. Existing studies typically provide general information on malaria’s impact (Glendening et al., 2024; Koroma et al., 2022), but few have explored the detailed barriers that caregivers face in different regions, especially in rural or underserved areas. The absence of region-specific data on the outcomes of delayed care-seeking limits the ability of health systems to implement effective, targeted interventions. This knowledge gap prevents the development of strategies tailored to address the unique challenges faced by caregivers, which exacerbates the burden of malaria and impedes progress in reducing child mortality. However, addressing delayed care-seeking requires more than acknowledging its existence. It demands a comprehensive synthesis of evidence on context-specific determinants that shape caregivers’ actions. This review uniquely bridges this gap by consolidating existing studies to provide practical insights for designing timely, locally relevant interventions to reduce malaria-related child deaths. Furthermore, without a deeper understanding of how delays impact the progression of the disease, interventions will remain disjointed and insufficient, preventing meaningful reductions in malaria mortality rates. This systematic review aims to examine the determinants of delayed malaria care-seeking among children under five in developing economies. This review will pay critical attention to socio-economic, cultural, and health system-related factors. It seeks to uncover the underlying causes of these delays and assess how they influence malaria outcomes, including progression to severe disease and mortality. Evidence from this review will provide a robust foundation for formulating policies and interventions that address the real-world barriers preventing caregivers from accessing timely treatment. In doing so, the review will directly contribute to Sustainable Development Goal 3.2, which seeks to end preventable deaths of newborns and children under five years of age by 2030 through equitable access to quality healthcare. Beyond its contribution to global malaria control, the study will generate context-specific insights that strengthen health systems in resource-limited settings and help reduce preventable deaths among children under five.