BMC Public Health 2009, 9:259 http://www.biomedcentral.com/1471-2458/9/259 organized into 62 rural and four urban kebeles (the lowest administrative units in the country). behaviour were assessed. Three supervisors who were experienced in field activities supervised the field work. Malaria transmission in the district is seasonal and epi- demic type, peaking from September to December. Severe malaria epidemics occurred in the area in 1991, 1998 and 2003 [2,34,35]. Two species of human Plasmodia are present in the area; Plasmodium falciparum (about 70%) and P. vivax (about 30%). The district is characterized by widespread occurrence of drug resistance to chloroquine and SP. At the time of the study, therapeutic study of SP conducted between October and December 2003 at the district's malaria control laboratory (MCL) revealed 53.4% total treatment failure against P. falciparum [9]. The main malaria vector in the area was Anopheles arabiensis [36]. The health service coverage of the district was low; there were two health centers, three health stations, three health posts, one MCL, 34 community health workers (CHWs) and a number of private health care providers. At the time of the study, the first-line treatment for uncomplicated malaria at peripheral health facilities and community- based outlets such as CHWs was SP [37], and the imple- mentation of ITNs for malaria prevention was at an early stage. Sample size estimation and sampling methods The detail of the sample size calculation and sampling techniques was described else where [32,33]. In short, the sample was estimated at 2270 households with 30% expected prevalence of perceived malaria illness and 3.5% margin of error at 95% confidence level. Briefly, 18 of the 62 rural kebeles in the district were randomly selected, and all mothers/caretakers of children under five years of age were interviewed by house-to-house visits. Finally, the data for mothers with at least one child less than five years of age were separately analyzed and used for the prepara- tion of this paper. For the qualitative research, the partici- pants of the focus group discussions (FGDs) and in-depth interviews were purposively selected through discussions with community leaders and village coordinators. Data collection Eighteen 10th or 12th grade graduate trained local inter- viewers administered structured questionnaires in the local language (i.e., Afan Oromo). The questionnaire was designed in English, translated into the local language and pre-tested before the actual use to validate its reliability. Information was collected on the socio-demographic characteristics of the mothers and their knowledge, per- ceptions and practices related to malaria transmission, symptoms, treatment and preventive methods. In addi- tion, history of malaria morbidity during the previous three months and related practices of treatment seeking Three FGDs with an average of eight participants in each group and five in-depth interviews were held with moth- ers of children under the age of five years in three kebeles to further explore the modes of malaria transmission, signs and symptoms, health seeking behaviour and pre- vention about the disease. The qualitative data were used to supplement, cross check and further explore the quan- titative findings. Open-ended FGD and interview guides originally prepared in English and translated into the local language were used for data collection by the first author with the assistance of two health workers from the District Health Office and village coordinators. In addi- tion to field notes, each session was tape-recorded. Data analysis All data collection forms were checked by field supervisors for completeness and reliability. The quantitative data were entered and cleaned using Epi Info software version 6.04d (CDC, Atlanta, GA, USA) and transferred to SPSS version 11 statistical software package (SPSS, Chicago, IL, USA) for analysis. Descriptive statistics such as frequen- cies and proportions were used for the analysis of the quantitative data. The FGDs and in-depth interviews from the different groups were transcribed and analyzed manu- ally along the major themes of the study. Verbatim tran- scriptions in Afan Oromo were made for all tape-recorded FGDs and in-depth interviews, and finally translated into English. The findings from the individual interviews and FGDs were presented in an integrated manner. Where appropriate, quotes that best explained the perceptions and practices of the mothers about malaria were identi- fied and used in parallel with the quantitative findings to elaborate more on the insights of the perceptions and practices of the community. Ethical considerations This study was reviewed and approved by the Ethical Clearance Committee of the Faculty of Medicine at Addis Ababa University (AAU). Verbal informed consent was obtained from all respondents who participated in the study after explaining the purpose and objectives of the study in the local language. Participation in the study was voluntary and confidentiality of the information was assured both during and after data collection. The respondents were informed about their right either not to participate, not to answer any question or all of the ques- tions. Any patient with symptoms suggestive of clinical malaria was treated with SP according to the national guidelines at the time of the study [37]. Patients with other illnesses were advised to seek medical care from appropriate service providers. Page 3 of 12 (page number not for citation purposes)