BMC Public Health 2009, 9:259 http://www.biomedcentral.com/1471-2458/9/259 For example, in Nigeria, higher levels of education were associated with improved knowledge and practice about the appropriate malaria prevention and control interven- tions [46]. Knowledge of malaria was found to be posi- tively associated with level of education in Zambia; however, this knowledge did not translate into increased mosquito net use [47]. In Uganda, malaria knowledge was found to be related to net ownership [48]. In Nigeria, a study found a statistically significant higher knowledge of malaria among mothers who were educated, skilled or professionals than among the uneducated or unskilled category [49]. Education also increases the probability that households would purchase ITNs [46]. This suggests that higher level of education may be required to impact upon the intake of malaria prevention and control inter- ventions. We found that people with malaria get treatment from a variety of sources, as elsewhere in SSA [50]. In this sea- sonal transmission area, the first response to febrile ill- nesses suspected to be malaria was seeking care from outside the home mainly from CHWs, public and private health facilities. Nearly 50% of the mothers first sought treatment for malaria from a health facility, suggesting that about half of the people with malaria do not seek care from the public health sector. The most common reasons for utilizing CHWs were greater proximity and free treat- ment. Home treatment and the use of herbal/traditional reme- dies were found to be very low in this study. In a study of treatment seeking behaviour among women in Uganda, the use of local herbs and self-treatment were found to be the first resort for malaria treatment, followed by seeking treatment from formal care [26]. Most studies across Africa in areas of stable malaria transmission indicate that the first response to malaria illness is home treatment [26,40,50-52]. The use of health care facilities as the first response for malaria treatment was reported in limited studies. In Uganda, more than 60% of those who had experienced an episode of malaria during an epidemic first sought treatment from a health facility [53]. In addi- tion, in one study in an area of seasonal malaria transmis- sion in Kenya, health facilities were initially used by 26% of persons with fever, with the majority first visiting the informal retail sector [23]. The main factors influencing initial treatment seeking from health facilities include severity of the illness, cost of treatment, poor access to health facilities, long waiting time, dissatisfaction with the performance and behaviour of health workers, and una- vailability of appropriate drugs [50]. The findings of this study show that SP is well accepted as a treatment for perceived malaria. However, people seem to be concerned with its efficacy. The dissatisfaction of the community about the efficacy of SP is inline with the nationwide failure of SP for the treatment of falciparum malaria in Ethiopia in 2003 [9]. In 2004, Ethiopia adopted a new antimalarial drug policy and abandoned SP as the first-line treatment for confirmed uncomplicated falciparum malaria in favour of ACT (artemether-lume- fantrine) [10,54]. The decision created the need to find ways of availing and effectively administering the new drug. The consequences of the lack of effective and afford- able antimalarial drugs are clear. SP-resistant malaria has spread virtually throughout SSA and many countries have changed their first-line drug to ACTs [13]. At present, there are several caveats with regard to the treatment of malaria at community level. In the recent past, using SP at community level through home manage- ment of malaria strategy raised hope to reduce the burden of malaria morbidity and mortality particularly among <5 children. Ethiopia adopted home management of malaria strategy using trained mother coordinators and CHWs [2] based on the promising findings from the randomized clinical trial study conducted in the northern part of the country using trained mother coordinators to provide early treatment of malaria for children using chloroquine [55]. However, the implementation of this strategy has recently been compromised due to lack of an effective and cheap drug that can be easily administered at community level [3,10]. It is hoped that the current deployment of health extension workers in the country would result in improved anti-malaria interventions such as ITNs and ACTs at the grassroots level. Like all questionnaire-based cross-sectional studies, this study is limited by the self-reported data, which are sus- ceptible to recall and information biases. We attempted to minimize those biases through piloting the questionnaire and training of data collectors and field supervisors. The other limitation of the study is that malaria was assessed by the local term "busaa" where symptoms such as fever, headache, and vomiting might as well have been due to other illnesses, resulting in misclassification problems. However, most malaria cases in Ethiopia are treated based on the signs and symptoms of the disease. Therefore, the significance of our study might be substantial as the study was conducted during peak malaria transmission season. Conclusion The findings of this study indicate the importance of understanding women's perspective in community-based malaria prevention and control. The envisaged reduction in malaria morbidity and mortality will depend on the successful implementation of malaria control strategies by involving the local community. A more concerted effort is needed for scaling-up the distribution of ITNs, improving the knowledge of the community about the link between Page 10 of 12 (page number not for citation purposes)