Estimating rates of treatment delay for malaria fevers among children in Sub-Saharan Africa 2006-2022.

Late diagnosis and treatment of malaria increase the odds of severe disease by nearly 2.8 times, enhance transmission rates, compromise drug effectiveness, and trigger malaria outbreaks. No continent-wide estimates for malaria treatment delay exist. We estimate delay rates among African children treated for malaria between 2006 and 2022, using 177 nationally representative surveys. We found that 60% [95% UI 45.7-72.8] of treated children experienced >24 h of delay, while 29% [95% UI 18.9-41.2] faced delays exceeding 48 h, affecting 33 million and 16 million children, respectively. Spatiotemporal variability exists across Africa. Somalia has the highest (76% [95% UI 39.7-97.9]) and Tanzania has the lowest (35.3% [95% UI 11.5-53.8]) delay rates. Overall, initial improvements in treatment delay stagnated post-2015, but East Africa showed the most progress, while Central and West Africa experienced increases. Socioeconomic factors and residence influenced delays, with poorer and rural populations facing higher rates. These findings are vital for policymakers to enhance malaria case management, access to effective treatment, and reduce malaria mortality among children.