Do wealth, education, and urbanicity promote timely healthcare-seeking and diagnostic testing for febrile children? A meta-analysis of 16 national surveys in sub-Saharan Africa

Timely and effective management of suspected paediatric malaria remains critical for reducing mortality in sub-Saharan Africa (SSA). Despite efforts, inequities in access to care and diagnostic services persist. This study re-evaluates the associations of socioeconomic position (SEP), maternal education, and urbanicity with timely healthcare-seeking and malaria testing for febrile children under five in SSA. We analysed nine Demographic and Health Surveys and seven Malaria Indicator Surveys conducted between 2018 and 2023 across 16 SSA countries. Modified Poisson regression estimated associations between SEP, maternal education, urbanicity, and two outcomes: timely healthcare-seeking and malaria diagnostic testing. Prevalence ratios (PRs) were pooled using random-effects meta-analysis, and exploratory mediating pathways between SEP and malaria testing were assessed. Across countries, 58.3% of caregivers sought timely medical care for febrile children, and 38.2% received diagnostic testing. Children from medium (PR = 1.09, 95% CI 1.04–1.14) and higher SEP households (PR = 1.18, 95% CI 1.11–1.25) were more likely to receive timely care than those from lower SEP households. Maternal education beyond primary level was associated with timely healthcare-seeking in high incidence malaria countries (PR = 1.11, 95% CI 1.01–1.23). Higher SEP was associated with increased likelihood of malaria testing (PR = 1.15, 95% CI 1.03–1.28), partly mediated by healthcare-seeking decisions (13/16 surveys) and use of hospital-level facilities (13/15 surveys). No significant urban-rural differences were observed. Socioeconomic disparities continue to be associated with differences in access to timely care and malaria testing for febrile children in SSA. Strengthening diagnostic capacity in primary care and community-driven strategies that address structural barriers are essential to improving malaria outcomes in children.