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Peer-reviewedCC BY-NC-ND 4.0BMC Public Health

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

  • Solomon T. Wafula1,2,3
  • Eva Lorenz1,4
  • David Musoke2
  • Jürgen May1,4,5
  • Dewi Ismajani Puradiredja6
  • Maike M. Lamshöft1,4,5
6 affiliations
  1. 1Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
  2. 2Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
  3. 3Department of Community Health, Kabale University, Kabale, Uganda
  4. 4German Centre for Infection Research, Partner Site, Hamburg-Borstel- Lubeck-Riems, Hamburg, Germany
  5. 5Department of Tropical Medicine, University Medical Centre Hamburg- Eppendorf, Hamburg, Germany
  6. 6Interdisciplinary Academy of Competence and Education for Global Health (iACE Global Health), Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28987-6.

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Cite

BibTeXRIS
BibTeX
@article{wafula2026wealth,
  title = {{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}},
  author = {Solomon T. Wafula and Eva Lorenz and David Musoke and Jürgen May and Dewi Ismajani Puradiredja and Maike M. Lamshöft},
  journal = {BMC Public Health},
  year = {2026},
  month = aug,
  doi = {10.1186/s12889-026-28987-6},
  url = {https://doi.org/10.1186/s12889-026-28987-6},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - 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
AU  - Solomon T. Wafula
AU  - Eva Lorenz
AU  - David Musoke
AU  - Jürgen May
AU  - Dewi Ismajani Puradiredja
AU  - Maike M. Lamshöft
PY  - 2026
DA  - 2026/08/12
JO  - BMC Public Health
DO  - 10.1186/s12889-026-28987-6
UR  - https://doi.org/10.1186/s12889-026-28987-6
AB  - Background: 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.  Methods: 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.  Results: 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.  Conclusions: 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.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28987-6.
SN  - 1471-2458
ER  -