Determinants of Delayed Malaria Treatment-Seeking Among Under-Five Children in a Post-Conflict District of Northern Ethiopia: A Facility-Based Unmatched Case-Control Study.

BACKGROUND: Delayed treatment seeking for malaria among under-five children remains a major public health problem in low-resource and post-conflict settings. However, there is limited evidence on its determinants in a post-conflict district. This study aimed to identify determinants of delayed malaria treatment seeking among under-five children in a post-conflict district of Northern Ethiopia, 2024. METHODS: A facility-based unmatched case-control study was conducted in Samre District, Tigray, from March 18 to May 18, 2024. The study included 364 under-five children (182 cases and 182 controls) selected through systematic random sampling. Delayed malaria treatment-seeking was defined as seeking care more than 24 h after the onset of fever or malaria symptoms, whereas timely treatment-seeking was defined as seeking care within 24 h. Data were coded and entered into EpiData and analyzed using the Statistical Package for the Social Sciences version 27. Bivariable logistic regression was first used to select candidate variables at P < 0.2 for further analysis. In the multivariable analysis, variables with P < 0.05 were considered statistically significant. The Hosmer-Lemeshow test was used to assess model fit (P > 0.05). RESULTS: Among the participants, delayed treatment-seeking was independently associated with caregiver's lack of formal education (AOR = 2.7; 95% CI: 1.19-6.12), poor perception of malaria (AOR = 3.5; 95% CI: 1.71-7.37), self-medication (AOR = 8.3; 95% CI: 3.78-18.27), no previous history of malaria (AOR = 4.6; 95% CI: 2.34-8.94), and residence more than 5 km from a health facility (AOR = 7.8; 95% CI: 3.70-16.32). CONCLUSION: Delayed malaria treatment-seeking was associated with caregiver educational level, malaria perception, self-medication, previous malaria experience, and geographic access to health facilities. In this post-conflict setting, strengthening caregiver education, reducing self-medication, and improving access to primary malaria services in remote communities should be prioritized.