Background <p>Malaria continues to rank among the most concerning vector-borne infectious diseases affecting sub-Saharan Africa, including Ethiopia. Effective malaria case management largely depends on the timing of treatment seeking. Patients who sought care more than 24&#xa0;h after symptoms began were more likely to develop severe malaria. Concrete evidence can be generated by systematic reviews and meta-analyses, which may assist programme managers and policymakers in designing effective interventions. Therefore, the goal of this study was to assess the pooled prevalence and determinants of delay in treatment-seeking among malaria patients attending health facilities in Ethiopia.</p> Methods <p>Literature searches were conducted in Medline (PubMed), EMBASE, HINARI, Google Scholar, Science Direct, CINAHL, the Cochrane Library, and African Journals Online (AJOL) to find the pertinent studies. A standardized data extraction format created in Microsoft Excel was used to extract data from a chosen set of studies. The studies included in the analysis were evaluated for heterogeneity using inverse variance (I²) testing. A random-effects meta-analysis estimated the pooled prevalence of delay in treatment-seeking due to significant heterogeneity among studies. Determinants of delay in treatment-seeking among malaria patients were also examined.</p> Results <p>This systematic review considered a total of twelve studies, which included 4511 study subjects. The pooled prevalence of delay in treatment-seeking among malaria patients in Ethiopia was 62.00% (95% CI 46.00, 77.00). Lack of malaria knowledge, living far from a health facility, expensive health care costs, lack of transportation access, being a farmer, the practice of self-medication, not having a previous history of malaria infection, low family income, not being a member of community-based health insurance, large family size, having no formal education, fear of side effects of malaria treatment drugs, and no history of death from malaria among their family members were determinants of delay in treatment-seeking among malaria patients.</p> Conclusions <p>The pooled prevalence of delay in treatment-seeking among malaria patients was high. Health literacy, behavioural factors, accessibility, infrastructure, clinical factors, financial barriers, and socio-demographic factors were significantly associated with delay in treatment-seeking. To reduce delay in treatment-seeking, it is recommended to strengthen malaria education campaigns, target fear of drug side effects, expand community health outreach services, reduce out-of-pocket health care expenses, integrate community-level data, and engage with affected communities and families.</p>