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BACKGROUND: Delays in seeking appropriate treatment for malaria in children under five remain a major contributor to poor outcomes in sub-Saharan Africa, where multiple socioeconomic, geographic, and health-system factors influence when care is accessed. This review synthesised current evidence on the prevalence and determinants of delayed malaria care-seeking, as well as the associated outcomes among children under five in sub-Saharan Africa. METHODS: This systematic review followed the guidelines by the Joanna Briggs Institute (JBI). This review was reported in accordance with following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULT: The prevalence of delayed malaria care-seeking among children under five ranges from 2% to 95.8%. Factors associated with these delays include financial constraints, long travel distances, reliance on traditional treatments, and the perception of malaria as a mild illness. Additionally, health workers' attitudes and shortages of essential health facility logistics further hinder timely care-seeking by caregivers. These delays are associated with increased mortality, progression to severe malaria, and serious neurological and haematological complications. CONCLUSION: Timely access to effective malaria treatment for young children can be enhanced by interventions that address financial barriers, improve access to care, and strengthen health-system readiness to respond promptly.