Early and prompt treatment-seeking for malaria is necessary to reduce the progression of the disease to its severe forms and the associated mortality. Various studies have indicated that treatments sought for malaria were not always within the recommended timeframe. Therefore, this study aims to assess factors influencing delay in malaria treatment seeking at public health facilities in South Gonder, Ethiopia. An unmatched case-control study was conducted among 322 individuals, comprising 161 cases and 161 controls, who were randomly selected malaria patients visiting public health facilities in South Gonder District, Ethiopia, from May 20/2022 to June 25/2022. An interviewer-administered questionnaire was used to collect data, which were subsequently cleaned and entered into Epi data. Descriptive statistics were performed, and variables with a p-value of ≤ 0.25 from the bivariate analysis were included in a multivariable logistic regression model. Significant variables with a p-value of < 0.05 were retained in the multivariable model. Patients who were unable to read and write [AOR = 3.47 (1.01-11.9)], fear of side effects of malaria treatment drugs [AOR = 1.89 (1.04-3.42)], lack of access to health education malaria disease and its treatment [AOR = 1.93 (1.02-3.65)], lack of transportation access [AOR = 4.70 (1.73-12.7)], not membership of community-based health insurance [AOR = 2.5 (1.3-4.82)] and lack of confidence on malaria care health facility providing [AOR = 2.14 (1.06-4.29)], were found to be determinants of treatment-seeking delay among malaria patients. In Summary, this study revealed significant associations between delays in seeking malaria treatment and factors such as educational status (those who were unable to read and write), malaria drug side effects, health education on malaria, transportation access, CBHI membership, and confidence in health malaria care. it is recommended that targeted interventions and awareness campaigns be implemented to address these determinants, promoting prompt and effective malaria treatment-seeking behavior in the studied population.