Determinants of Malaria Treatment-Seeking Delay Among Rural Households in Kebbi State, North West Nigeria: A Mixed-Methods Study

Treatment-seeking delay after the onset of malaria symptoms is a principal driver of disease progression to severe malaria and death in rural Nigerian communities, yet the multifactorial determinants of this delay at the household level remain insufficiently characterised. This study investigates determinants of malaria treatment-seeking delay among rural households in Kebbi State, North West Nigeria using a mixed-methods analytical design. A household survey was conducted in 20 rural communities across Argungu, Zuru, and Danko-Wasagu Local Government Areas, enrolling 400 caregivers of children under five who had experienced a malaria episode in the preceding three months. Structured questionnaires collected data on time from symptom onset to health facility attendance, home treatment practices, distance to facility, caregiver malaria knowledge, household wealth, and health insurance status. In-depth interviews and focus group discussions with community members and traditional healers explored underlying behavioural and cultural factors contributing to delay. Logistic regression identified independent predictors of delayed treatment-seeking defined as more than 24 hours from fever onset. Evidence from 2020 to 2024 identifies distance to facility, recourse to traditional healing, financial barriers, and caregiver misattribution of fever as the strongest delay predictors in Kebbi communities. This study generates an explanatory model of delay applicable to health system intervention design. Findings will inform the Kebbi State Ministry of Health and the Primary Healthcare Development Agency. Keywords: malaria treatment-seeking delay, rural households, Kebbi State, mixed methods, determinants.