BMC Public Health 2009, 9:259 http://www.biomedcentral.com/1471-2458/9/259 cantly higher malaria morbidity and mortality during the peak transmission season from September to December, following a heavy summer rainfall. All age groups are at risk of developing severe illness although children and pregnant women are biologically the most vulnerable. Current malaria control interventions in Ethiopia include early diagnosis and prompt treatment with effective anti- malarial drugs, preventive measures such as the use of insecticide-treated nets (ITNs) and indoor residual spray- ing (IRS), and malaria epidemic prevention and control [2,3]. However, similar to those countries in sub-Saharan Africa (SSA) with seasonal malaria transmission, intermit- tent preventive treatment (IPT) for malaria prevention during pregnancy has not been adopted in the country [4- 7]. The Roll Back Malaria (RBM), Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and other global initi- atives have recently improved the scale-up of anti-malaria interventions particularly for children less than five years of age and pregnant women. The main priority malaria control strategies among this group of population include early diagnosis and prompt treatment with effective anti- malarials, and the use of preventive measures such as ITNs and IPT during pregnancy [8]. However, these interven- tions have not been effectively utilized by the target groups in Ethiopia due to accessibility and knowledge barriers. In Ethiopia, artemether-lumefantrine replaced sulfadox- ine-pyrimethamine (SP) in 2004 due to the increasing resistance of malaria to SP [9,10]. However, there has been a great concern about the availability and affordabil- ity of the newly introduced drug for community-based malaria control interventions carried out by village-based community health workers (CHWs) and home-based management of malaria [11-14]. The coverage and proper utilization of the most promising malaria preventive measure, ITNs, in the country is also limited by lack of sustainable distribution and issues related to replacement of free nets, seasonality of malaria, poor knowledge of the community with regard to the link between mosquitoes and malaria [15]. It is also well recognized that accessibility to anti-malaria interventions alone will not bring about the desired change. Several studies have demonstrated compliance to anti-malaria interventions depends substantially on social, behavioural and cultural factors that affect under- standing of the causes, the relationship between mosqui- toes and the disease, diagnosis, treatment and practices about prevention [16-19]. In addition, factors such as vul- nerability, economic constraints, inadequacy or unavaila- bility of appropriate health services, and other related factors play an important role in explaining health seek- ing behaviour of the people [20]. Studies in the past were mainly carried out in areas of sta- ble malaria transmission due to the overwhelming burden of the disease among young children and pregnant women in those areas. Recently, however, there has been an increased need to understand perceptions and practices of the community about the disease, particularly health and treatment seeking behaviours in areas of seasonal transmission frequently exposed to malaria epidemics in SSA [21-24]. Due to the high burden of malaria among pregnant women and children under the age of five years, targeting women in the reproductive age group to deal with the dis- ease has recently been widely recognized. It has been acknowledged that the success of malaria control in chil- dren and pregnant women depends on the understanding of the local socio-cultural factors affecting women's per- ceptions of causes and modes of transmission of the dis- ease, health seeking behaviour and practices of malaria prevention measures [25-31]. However, research focusing on malaria issues among women in the reproductive age group with children under the age of five years in areas of seasonal transmission has particularly been scarce [21,27]. Therefore, understanding the local perceptions and prac- tices of women is of utmost relevance to enhance commu- nity's potential to deal with village-based malaria interventions. This particular study was carried out in a rural community to examine women's perceptions and practices related to malaria transmission, symptoms/rec- ognition, treatment, prevention, and treatment seeking behaviour in an area of seasonal malaria transmission. The purpose of the study was to generate information that might support malaria control program to design and implement appropriate interventions to control malaria. This study was part of studies that investigated maternal responses to childhood febrile illnesses and the associated socio-economic factors [32,33]. Methods Study setting and population The study was conducted in October–November 2003 in Adami Tulu District in south-central Ethiopia. The district lies at an altitude between 1500 m and 1600 m above sea level and covers an area of about 1403 km2. In 2002, the projected population of the district was 145 000 people with a density of 104/km2. The people are predominantly subsistence farmers belonging to the Oromo ethnic group and are primarily Muslims. The district is administratively Page 2 of 12 (page number not for citation purposes)