{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:12:44Z","timestamp":1781637164254,"version":"3.54.5"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T00:00:00Z","timestamp":1744070400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Delays in seeking healthcare among malaria patients are typically associated with an increased risk of severe disease and mortality. Determining the pooled prevalence and determinants of delays in seeking healthcare may help reduce morbidity and mortality. Therefore, the aim of this systematic review and meta-analysis was to determine the pooled prevalence of delays in seeking healthcare and its determinants among malaria patients in Ethiopia.<\/jats:p>\n<jats:sec id=\"sec001\">\n<jats:title>\nMethods\n<\/jats:title>\n<jats:p>PubMed, Cochrane Library, Scopus, Web of Science, Google Scholar and Google were searched. Cross-sectional and case\u2013control studies about delays in seeking healthcare for more than 24 hours were included. STATA 17 was used to analyze the data. Heterogeneity across studies was assessed via the I<jats:sup>2<\/jats:sup> test. A funnel plot and Egger\u2019s test were used to assess publication bias. Subgroup analyses were performed by region and study setting. Sensitivity analysis was performed to determine the influence of individual studies.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>\nResults\n<\/jats:title>\n<jats:p>A total of 18 articles with 7371 participants were included in this review. The pooled prevalence of delay in seeking healthcare was 67% (95% CI: 51%-84%). Age less than 15 years (OR: 2.27, 95% CI: 1.34-3.85), inability to read and write (OR: 3.36, 95% CI: 1.18-9.69), travel to health institutions on foot (OR: 2.77, 95% CI: 1.71-4.49), and by horse (OR: 2.76, 95% CI: 1.57-4.84), living far from a health institution (OR: 2.65, CI: 1.37-5.13), not having a family history of death (OR: 3.04, 95% CI: 2.14-4.33), and not being a member of community-based health insurance (OR: 7.14, 95% CI: 1.09-46.63) were significant determinants of delays in seeking healthcare.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>\nConclusion\n<\/jats:title>\n<jats:p>The pooled prevalence of delays in seeking healthcare was high, and most of the determinants were modifiable. These findings underscore the need for targeted interventions to address these barriers and improve timely access to healthcare for affected populations.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0320149","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T17:43:30Z","timestamp":1744134210000},"page":"e0320149","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Delays in seeking healthcare and its determinants among malaria patients in Ethiopia: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-1353-9265","authenticated-orcid":true,"given":"Moges","family":"Tadesse Abebe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesfahun Zemene","family":"Tafere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaleab Tesfaye","family":"Tegegne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dessie Alemnew","family":"Shiferaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosef Aragaw","family":"Gonete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadele Kassahun","family":"Wudu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getnet Azanaw","family":"Takele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muluken Chanie","family":"Agimas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,8]]},"reference":[{"key":"pone.0320149.ref001","doi-asserted-by":"crossref","first-page":"3339","DOI":"10.2147\/IDR.S405668","article-title":"Malaria: an overview","volume":"16","author":"M Fikadu","year":"2023","journal-title":"Infect Drug Resist"},{"key":"pone.0320149.ref002","volume-title":"Nelson Textbook of Paediatrics","author":"R Kliegman","year":"2019"},{"key":"pone.0320149.ref003","doi-asserted-by":"crossref","first-page":"17050","DOI":"10.1038\/nrdp.2017.50","article-title":"Malaria","volume":"3","author":"MA Phillips","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"pone.0320149.ref004","article-title":"The 2023 WHO World malaria report","author":"P Venkatesan","year":"2024","journal-title":"Lancet Microbe"},{"key":"pone.0320149.ref005","first-page":"1429","volume-title":"Ending Malaria: Where Are We?","author":"J Tavares","year":"2024"},{"issue":"1","key":"pone.0320149.ref006","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1186\/s12936-024-04965-4","article-title":"Prevalence of malaria and associated risk factors among household members in South Ethiopia: a multi-site cross-sectional study","volume":"23","author":"G Yutura","year":"2024","journal-title":"Malar J"},{"issue":"7","key":"pone.0320149.ref007","doi-asserted-by":"crossref","first-page":"e0271771","DOI":"10.1371\/journal.pone.0271771","article-title":"Malaria prevalence and risk factors among patients visiting Mizan Tepi University Teaching Hospital, Southwest Ethiopia","volume":"17","author":"T Duguma","year":"2022","journal-title":"PLoS One"},{"issue":"5","key":"pone.0320149.ref008","doi-asserted-by":"crossref","first-page":"e2156","DOI":"10.1002\/hsr2.2156","article-title":"Trends of malaria cases (plasmodium species) in Gute Health Center, Wayu Tuka District, East Wollega Zone, (2013\u20132022): a cross-sectional study","volume":"7","author":"T Tafesse","year":"2024","journal-title":"Health Sci Rep"},{"issue":"365","key":"pone.0320149.ref009","first-page":"1165","article-title":"Prevalence of malaria and associated factors among febrile patients visiting Kalala Health Center in Haro Limmu Woreda, East Wollega Zone, Western Ethiopia, 2016","volume":"9","author":"K Bidu","year":"2019","journal-title":"Epidemiology (Sunnyvale)"},{"key":"pone.0320149.ref010","first-page":"1784012","article-title":"Prevalence and associated factors of malaria infection among outpatients visiting Shewa Robit Health Center, Northcentral Ethiopia","author":"A Tesfaye","year":"2022","journal-title":"J Trop Med"},{"issue":"1","key":"pone.0320149.ref011","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1186\/s12936-023-04697-x","article-title":"Magnitude of malaria and associated factors among febrile adults in Siraro District Public Health facilities, West Arsi Zone, Oromia, Ethiopia 2022: a facility-based cross-sectional study","volume":"22","author":"YY Lakew","year":"2023","journal-title":"Malar J"},{"issue":"1","key":"pone.0320149.ref012","article-title":"Prevalence of, and risk factors for, malaria infection among patients visiting Goljota Health Center, Heben Arsi District, West Arsi Zone, Oromia Regional State, Ethiopia: a retrospective and an institution-based cross-sectional study","volume":"35","author":"B Dobo","year":"2021","journal-title":"Ethiopian J Health Develop"},{"issue":"2","key":"pone.0320149.ref013","doi-asserted-by":"crossref","first-page":"e0263178","DOI":"10.1371\/journal.pone.0263178","article-title":"Malaria treatment-seeking behaviour and its associated factors: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia","volume":"17","author":"RD Guntur","year":"2022","journal-title":"PLoS One"},{"issue":"6","key":"pone.0320149.ref014","doi-asserted-by":"crossref","first-page":"e001856","DOI":"10.1136\/bmjgh-2019-001856","article-title":"How delayed and non-adherent treatment contribute to onward transmission of malaria: a modelling study","volume":"4","author":"JD Challenger","year":"2019","journal-title":"BMJ Glob Health"},{"key":"pone.0320149.ref015","unstructured":"Ababa A. National malaria guidelines. 2018:1\u201350."},{"key":"pone.0320149.ref016","volume-title":"WHO Guidelines for Malaria, 14 March 2023","author":"World Health Organization","year":"2023"},{"issue":"1","key":"pone.0320149.ref017","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s12936-022-04301-8","article-title":"Severe malaria","volume":"21","author":"NJ White","year":"2022","journal-title":"Malar J"},{"issue":"1","key":"pone.0320149.ref018","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40794-021-00146-2","article-title":"Malaria prevalence, knowledge, attitude, and practice among febrile patients attending Chagni health center, Northwest Ethiopia: a cross-sectional study","volume":"7","author":"B Belay","year":"2021","journal-title":"Trop Dis Travel Med Vaccines"},{"issue":"8","key":"pone.0320149.ref019","doi-asserted-by":"crossref","first-page":"e0160234","DOI":"10.1371\/journal.pone.0160234","article-title":"Malaria related perceptions, care seeking after onset of fever and anti-malarial drug use in malaria endemic settings of southwest Ethiopia","volume":"11","author":"Z Birhanu","year":"2016","journal-title":"PLoS One"},{"key":"pone.0320149.ref020","doi-asserted-by":"crossref","first-page":"3741413","DOI":"10.1155\/2021\/3741413","article-title":"Prevalence of malaria and associated knowledge, attitude, and practice among suspected patients in Bahir Dar Zuria District, northwest Ethiopia","author":"Z Dejazmach","year":"2021","journal-title":"Biomed Res Int"},{"key":"pone.0320149.ref021","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/1475-2875-6-49","article-title":"Treatment-seeking behaviour for febrile illness in an area of seasonal malaria transmission in rural Ethiopia","volume":"6","author":"W Deressa","year":"2007","journal-title":"Malar J"},{"issue":"2","key":"pone.0320149.ref022","first-page":"99","article-title":"Knowledge, attitude and practice about malaria, the mosquito and antimalarial drugs in a rural community","volume":"17","author":"W Deressa","year":"2003","journal-title":"Ethiopian J Health Develop"},{"issue":"1","key":"pone.0320149.ref023","doi-asserted-by":"crossref","DOI":"10.4314\/ejhd.v17i1.9777","article-title":"Treatment seeking of malaria patients in East Shewa Zone of Oromia, Ethiopia","volume":"17","author":"W Deressa","year":"2003","journal-title":"Ethiopian J Health Develop"},{"issue":"1","key":"pone.0320149.ref024","first-page":"5","article-title":"Treatment-seeking behavior and associated factors among malaria suspected patients in Bale Zone, Southeast Ethiopia: institution-based cross-sectional study","volume":"2","author":"N Dida","year":"2015","journal-title":"J Fam Med"},{"issue":"1","key":"pone.0320149.ref025","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s12936-017-1798-8","article-title":"Caregivers\u2019 perception of malaria and treatment-seeking behaviour for under five children in Mandura District, West Ethiopia: a cross-sectional study","volume":"16","author":"I Mitiku","year":"2017","journal-title":"Malar J"},{"issue":"3","key":"pone.0320149.ref026","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s10389-017-0863-7","article-title":"Delay in malaria diagnosis and treatment and its determinants among rural communities of the Oromia special zone, Ethiopia: facility-based cross-sectional study","volume":"26","author":"H Regassa","year":"2017","journal-title":"J Public Health"},{"issue":"1","key":"pone.0320149.ref027","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1186\/s12936-018-2556-2","article-title":"Early treatment-seeking behaviour for malaria in febrile patients in northwest Ethiopia","volume":"17","author":"B Workineh","year":"2018","journal-title":"Malar J"},{"issue":"9","key":"pone.0320149.ref028","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.trstmh.2007.04.018","article-title":"Household and socioeconomic factors associated with childhood febrile illnesses and treatment seeking behaviour in an area of epidemic malaria in rural Ethiopia","volume":"101","author":"W Deressa","year":"2007","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pone.0320149.ref029","doi-asserted-by":"crossref","unstructured":"Birhanu Z, Yihdego Y, Yewhalaw D. Caretakers\u2019 understanding of malaria, use of insecticide treated net and care seeking-behavior for febrile illness of their children in Ethiopia. 2017.","DOI":"10.1186\/s12879-017-2731-z"},{"key":"pone.0320149.ref030","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1186\/1475-2875-9-320","article-title":"Determinants of delay in malaria treatment-seeking behaviour for under-five children in south-west Ethiopia: a case control study","volume":"9","author":"A Getahun","year":"2010","journal-title":"Malar J"},{"issue":"1","key":"pone.0320149.ref031","first-page":"6","article-title":"Determinants of delay in treatment seeking among malaria patients in public health facilities of Dambi Dollo and Sayyo district, Western Ethiopia: a facility based case control study","volume":"1","author":"C Goshu","year":"2023","journal-title":"Open Access J Disease Global Health"},{"key":"pone.0320149.ref032","first-page":"2016","article-title":"Determinants of delay in malaria treatment seeking for under-five children with malaria attending health centers of Bench-Maji Zone, South-Western Ethiopia case-control study","volume":"1","author":"D Shiferaw","year":"1930","journal-title":"Methods"},{"issue":"1","key":"pone.0320149.ref033","doi-asserted-by":"crossref","first-page":"6648","DOI":"10.1038\/s41598-024-56413-7","article-title":"Factors influencing delay in malaria treatment seeking at selected public health facilities in South Gonder, Ethiopia","volume":"14","author":"A Alga","year":"2024","journal-title":"Sci Rep"},{"key":"pone.0320149.ref034","first-page":"2310971","article-title":"Determinants of delay in seeking malaria treatment for under-five children at Gambella Town, Southwest Ethiopia: a case\u2013control study","author":"AT Shumerga","year":"2020","journal-title":"J Trop Med"},{"issue":"1","key":"pone.0320149.ref035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12936-019-2992-7","article-title":"Determinants of malaria treatment delay in northwestern zone of Tigray region, Northern Ethiopia, 2018","volume":"18","author":"A Tesfahunegn","year":"2019","journal-title":"Malaria J"},{"issue":"3","key":"pone.0320149.ref036","doi-asserted-by":"crossref","first-page":"552","DOI":"10.4314\/ahs.v18i3.12","article-title":"Determinants of delay in seeking treatment among malaria patients in Dera district, NorthWest Ethiopia: a case control study","volume":"18","author":"M Tiruneh","year":"2018","journal-title":"Afr Health Sci"},{"key":"pone.0320149.ref037","article-title":"Determinants of delay in malaria prompt diagnosis and timely treatment among under-five children in Shashogo Woreda, Hadiya Zone, Southern Ethiopia: a case control study","author":"E Turuse","year":"2014","journal-title":"Health"},{"key":"pone.0320149.ref038","doi-asserted-by":"crossref","unstructured":"Tiruneh M, Gebregergs G, Birhanu D. Determinants of delay in seeking treatment among malaria patients in Dera district, NorthWest Ethiopia: a case control study. 2018.","DOI":"10.4314\/ahs.v18i3.12"},{"key":"pone.0320149.ref039","doi-asserted-by":"crossref","first-page":"105906","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"88","author":"MJ Page","year":"2021","journal-title":"Int J Surg"},{"issue":"3","key":"pone.0320149.ref040","doi-asserted-by":"crossref","first-page":"478","DOI":"10.11124\/JBIES-22-00125","article-title":"Revising the JBI quantitative critical appraisal tools to improve their applicability: an overview of methods and the development process","volume":"21","author":"TH Barker","year":"2023","journal-title":"JBI Evid Synth"},{"key":"pone.0320149.ref041","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1186\/1475-2875-11-417","article-title":"Malaria treatment-seeking behaviour and related factors of Wa ethnic minority in Myanmar: a cross-sectional study","volume":"11","author":"J-W Xu","year":"2012","journal-title":"Malar J"},{"key":"pone.0320149.ref042","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1186\/1475-2875-13-348","article-title":"Determinants of delay in care seeking among children under five with fever in Dodoma region, central Tanzania: a cross-sectional study","volume":"13","author":"T Kassile","year":"2014","journal-title":"Malar J"},{"issue":"1","key":"pone.0320149.ref043","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12936-024-04892-4","article-title":"Factors affecting delays in seeking treatment among malaria patients during the pre-certification phase in China","volume":"23","author":"L Jia","year":"2024","journal-title":"Malar J"},{"issue":"1","key":"pone.0320149.ref044","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/s12936-022-04180-z","article-title":"Attitudes, practices, and determinants of community care-seeking behaviours for fever\/malaria episodes in the context of the implementation of multiple first-line therapies for uncomplicated malaria in the health district of Kaya, Burkina Faso","volume":"21","author":"JMT Kabor\u00e9","year":"2022","journal-title":"Malar J"},{"issue":"12","key":"pone.0320149.ref045","doi-asserted-by":"crossref","first-page":"e0295772","DOI":"10.1371\/journal.pone.0295772","article-title":"Delays in seeking treatment for fever in children under five years of age in Nigeria: Evidence from the National Demographic Health Survey","volume":"18","author":"AE Anyasodor","year":"2023","journal-title":"PLoS One"},{"issue":"6","key":"pone.0320149.ref046","doi-asserted-by":"crossref","first-page":"e0269844","DOI":"10.1371\/journal.pone.0269844","article-title":"Factors associated with delay in treatment-seeking behaviour for fever cases among caregivers of under-five children in India: evidence from the National Family Health Survey-4, 2015\u201316","volume":"17","author":"D Debsarma","year":"2022","journal-title":"PloS ONE"},{"issue":"6","key":"pone.0320149.ref047","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s10900-014-9872-4","article-title":"Determinants of delay in seeking malaria treatment for children under-five years in parts of South Eastern Nigeria","volume":"39","author":"UM Chukwuocha","year":"2014","journal-title":"J Community Health"},{"issue":"1","key":"pone.0320149.ref048","doi-asserted-by":"crossref","first-page":"78","DOI":"10.2174\/1874944501912010078","article-title":"The determinants of delayed diagnosis and treatment among malaria patients in Myanmar: a cross-sectional study","volume":"12","author":"MM Than","year":"2019","journal-title":"TOPHJ"},{"key":"pone.0320149.ref049","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1186\/1475-2875-7-245","article-title":"Malaria treatment-seeking behaviour and recovery from malaria in a highland area of Kenya","volume":"7","author":"PO Sumba","year":"2008","journal-title":"Malar J"},{"issue":"5","key":"pone.0320149.ref050","doi-asserted-by":"crossref","first-page":"e0250981","DOI":"10.1371\/journal.pone.0250981","article-title":"Malaria prevention practices and associated factors among households of Hawassa City Administration, Southern Ethiopia, 2020","volume":"16","author":"A Fikrie","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pone.0320149.ref051","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s12936-021-03586-5","article-title":"Improving malaria preventive practices and pregnancy outcomes through a health education intervention: a randomized controlled trial","volume":"20","author":"AD Balami","year":"2021","journal-title":"Malar J"},{"issue":"4","key":"pone.0320149.ref052","doi-asserted-by":"crossref","first-page":"taab156","DOI":"10.1093\/jtm\/taab156","article-title":"Care-seeking delay of imported malaria to China: implications for improving post-travel healthcare for migrant workers","volume":"29","author":"G Lu","year":"2022","journal-title":"J Travel Med"},{"key":"pone.0320149.ref053","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s12936-016-1239-0","article-title":"Determinants of delay in malaria care-seeking behaviour for children 15 years and under in Bata district, Equatorial Guinea","volume":"15","author":"M Romay-Barja","year":"2016","journal-title":"Malar J"},{"issue":"1","key":"pone.0320149.ref054","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/tmi.13698","article-title":"Barriers to seeking health care among returning travellers with malaria: a systematic review","volume":"27","author":"G Lu","year":"2022","journal-title":"Trop Med Int Health"},{"issue":"3","key":"pone.0320149.ref055","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1080\/14635240.2020.1730703","article-title":"Choices and determinants of malaria treatment seeking behaviour by rural households in Enugu state, South-East Nigeria","volume":"59","author":"CE Urama","year":"2020","journal-title":"Int J Health Promotion Educ"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T17:44:15Z","timestamp":1744134255000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320149"}},"subtitle":[],"editor":[{"given":"Bedilu Linger","family":"Endalifer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,8]]},"references-count":55,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0320149","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,8]]}}}