Background <p>The surge in malaria-related mortality among children under-five in African countries, mainly owing to late treatment, poses a major concern. The failure to effectually treat malaria early has mired efforts to reduce the disease burden in the region, as early treatment failure is linked to the endemic nature of the disease. The study examined the prevalence as well as determinants of treatment delays for childhood malaria in Mali, Niger, Nigeria, and Senegal.</p> Methods <p>The cross-sectional study analysed secondary data (Malaria Indicator Survey data) from Mali. Niger, Nigeria, and Senegal using Stata package for the analyses. The descriptive statistics, chi-square test and binary logistic regression were employed to identify factors influencing treatment responsiveness.</p> Results <p>The prevalence of the treatment delay was highest in Mali. Children’s sex (AOR = 0.41&#xa0;L; CI (0.25–0.66), mothers’ wealth index (AOR = 0.037; CI (0.3–0.96)) and place of residence (AOR = 1.82^; CI(1.04–3.16)) were the factors influencing treatment delay in Senegal. Mothers’ wealth index (AOR = 0.54; CI (0.3–0.96 and education attained (AOR = 0.49; CI (0.29–0.83)) were the factors that influenced late treatment of malaria in Nigeria. Mothers’ place of residence (AOR = 1.24; CI (0.54–2.87)) was the only factor that influenced late treatment in Niger, while the age of mothers (AOR = 0.6^; CI (0.38–0.95) was the only factor that caused delayed treatment in Mali.</p> Conclusion <p>Intervention targeting these populations would play a significant role in curbing the menace of malaria in these countries.</p>