Background <p>Malaria is ranked among the major causes of morbidity and mortality in children under 5 years of age in Uganda. Prompt and early appropriate malaria treatment can prevent progression of illness to severe stages, thereby mitigating mortality and morbidity. Therefore, this study aimed at determining the factors associated with timeliness to malaria treatment in children under five years in Uganda.</p> Method <p>This study used 2016 Uganda Demographic and Health Survey data and a total of 4,063 children under age of five years who had fever as a proxy for malaria two weeks prior to the survey were included. The median time to malaria treatment using Kaplan Meier curve were computed. A multivariable Cox regression model were fitted to establish factors associated with time to malaria treatment. Proportional hazard assumption was checked graphically and using Schoenfeld residual statistical test.</p> Results <p>Forty one percent of the children delayed to receive prompt malaria treatment beyond the recommended 24 hours. The median time to malaria treatment was 24 hours after onset of malaria symptoms. Children whose mothers made decisions jointly as a wife and a spouse on treatment were associated with faster time to malaria treatment (HR=1.11, 95%CI: 1.02-1.21) compared to when the mother made decisions alone. Children whose mothers sought treatment from community health workers were associated with faster time to malaria treatment (HR=1.17, 95%CI: 1.02-1.34) compared to those who did not. Children whose mothers/caregivers were from Western region (HR=0.84, 95%CI: 0.73-0.96) of the country were associated with delayed time to malaria treatment compared to other regions of the country. Similarly, children whose mothers frequently listened to radio were significantly associated with faster time (HR=1.11, 95%CI: 1.02-1.21) to treatment of malaria compared to those who did not listen to radio.</p> Conclusion <p>Faster time to malaria treatment was significantly associated with joint spousal health decision making, utilization of community health workers, not being in Western region of Uganda and frequency of listening to radio. Thus, the government and non-government organizations should organize community dialogues that involve both men and women to discuss malaria prevention, treatment, and the importance of joint decision-making, ensure Community Health Workers receive regular, in-depth training on malaria diagnosis (using Rapid Diagnostic Tests or RDTs), treatment, and prevention strategies, provide CHWs with adequate transportation to facilitate their visits to households and communities, develop engage radio programs that feature community leaders, CHWs and health experts to promote malaria prevention messages, ensure all communication materials and messages are in local languages to ensure maximum understanding and engagement.</p>