BMC Public Health 2009, 9:259 http://www.biomedcentral.com/1471-2458/9/259 636 r epor ted cases of malar ia among women First action n=636 No action, 35(5.5%) Public facility, 225(35.4%) Drug shop/ rural vendor, 39(6.1%) CHW 242(38%) Drug shop/ rural vendor, 7(5.1%) CHW, 5(3.6%) CHW, 1(0.7%) Drug shop/ rural vendor, 2(1.4%) CHW, 3(2.2% Second action n=138 Third action n=16 Public facility, 17(12.3%) Public facility, 1(6.2%) Private clinic, 15(11%) Public facility 1(6.2%) Drug shop/ rural vendor, 2(1.4%) Public facility, 3(2.2%) Public facility, 52(37.7%) Private clinic, 15(11% Private clinic 2(12.5%) Public facility 1 (6.2%) Public facility 2(12.5%) Public facility 3(18.7%) Private clinic 3(18.7%) Drug shop/ rural vendor 2 (12.5%) Private clinic, 87(13.7%) CHW, 1(0.7%) Public facility, 8(5.8%) Traditional medicine, 5(0.8%) Other, 3(0.5%) Public facility, 1(0.7%) Private clinic, 1(0.7%) Private Clinic, 5(3.6%) Private clinic 1(6.2% ) FMiagluarriea t1reatment choices for women who reported recent illness Malaria treatment choices for women who reported recent illness. Public facility includes health center, health sta- tion, health post, and hospital and malaria control laboratory. CHW: Community Health Worker. Adami Tulu District, Ethio- pia, 2003. Despite the high level of general knowledge on malaria, the use of appropriate malaria preventive measures was low in our study setting. Although draining of mosquito breeding sites, cleaning the environment, smoking, block- age of mosquito entry holes and aerosol sprays were reported as common practices of households to prevent malaria, the practice was not observed and might be influ- enced by social desirability bias in which the respondents replied to conform to the expectations of the health work- ers. Very few households in the study area possessed mos- quito nets during the assessment since that measure was a newly adopted control strategy in Ethiopia. The practice of malaria prevention by households is related to perception of the risk, their knowledge of the causes of malaria and its prevention measures [19]. A recent study from an area of seasonal malaria transmission in Eritrea indicates that correct knowledge of malaria transmission through mos- quito bite was found to be a good predictor of ITN posses- sion and use within households [42]. Studies have also demonstrated a link between the demand for ITNs and the knowledge of the benefits of the nets [17,19]. The present study was conducted prior to the massive scale-up of ITNs in malaria endemic areas of Ethiopia. Since 2005, important steps have been under taken partic- ularly to scale-up the implementation of ITNs in the coun- try. A household cluster survey conducted in Oromia and Southern Nations, Nationalities and People's Region (SNNPR) by the Carter Center in January 2007 revealed that 45.4% of the surveyed households in Oromia and 51.2% in SNNPR owned at least one mosquito net of any type and the coverage for at least one long-lasting insecti- cidal nets (LLINs) was 32.5% and 40.1%, respectively [43], indicating a ten-fold increase compared to the Demographic and Health Survey 2005 results of less than 1% in the two regions [44]. The National Malaria Indica- tor Survey carried out from October to December 2007 indicates that in areas below 2000 m, about 65% of the households owned at least one LLIN [45]. Despite the study participant's higher knowledge of malaria, their low educational level implies the need for intensifying the expansion of schools for raising the level of women's education. Evidences show that educational attainment is associated with better malaria knowledge. Page 9 of 12 (page number not for citation purposes)