BMC Public Health 2009, 9:259 http://www.biomedcentral.com/1471-2458/9/259 Knowledge and practices about malaria prevention Mothers had several opinions about the preventability and ways to prevent malaria. About 94% of them believed that malaria could be prevented, while 5% hold the view that it could not. Few respondents (1.4%) did not know whether malaria could be prevented or not. It was reported by the respondents that they use a variety of methods to protect their family members from malaria. The proportion of mothers who reported their house- holds' current use of different preventive methods against malaria and mosquito biting is summarized in Table 4. Few households reported the use of preventive measures to protect themselves from malaria. Thirty-six percent of mothers reported having their home sprayed with DDT by government employed malaria control staff during the preceding summer (June-July). Most of the respondents in the FGDs believed that malaria could be prevented. The main preventive strategies mentioned by the group discus- sants included eliminating mosquito breeding sites and cleaning the environment around the compound. Of the interviewed mothers, 40.1% (n = 837) said that they had heard of a mosquito net, and 78.4% said that its purpose was to kill mosquitoes, 65.9% replied that it pro- tects against mosquito bite and 38.6% reported that it protects against malaria. About 2% did not know the pur- pose of mosquito net although they had heard about it. Only 14% (n = 117) of households with respondents who heard about a mosquito net owned ITNs. This indicates that only 5.6% of all the surveyed households with women respondents owned any type of mosquito net. Of those households that possessed nets, 93.2% owned one net, while 6.8% possessed two nets. The perceptions and practices of the respondents about mosquito net are illus- trated in the expressions below. "There is a material known as saaphana siree (local name for mosquito net). We were informed by the CHWs and health workers that, if properly used, it can prevent Table 4: Percentage distribution of respondents citing different practices of malaria prevention methods by households, Adami Tulu District, Ethiopia, 2003 Method of malaria prevention (n = 2087) Drainage of mosquito breeding sites Burn cow dung or leaves in the house Blockage of mosquito entry holes Use aerosol sprays Closing doors and windows Mechanical killing of mosquitoes Use of mosquito net Didn't use any protection method a Multiple responses possible. N 931 514 405 298 219 194 117 694 %a 44.6 24.6 19.4 14.3 10.5 9.3 5.6 33.3 malaria. I know that some people in our village are cur- rently using it". (FGD, Gerbi Gilgile village). The FGD participants identified several factors that influ- ence the possession and utilization of ITNs, and those included lack of confidence on mosquito net, high price of the net particularly for large families to acquire two or more nets, lack of understanding about the relationship between mosquitoes and malaria, poor understanding about the role of mosquito net in malaria prevention, lack of cultural use and the generally low awareness of the peo- ple about disease prevention and control. The presence of nets in the household was observed and confirmed by the interviewers. In households where there were ITNs, about 93% of the mothers reported sleeping under the nets the previous night, while 7% did not. However, investigation was not done on the current status of the nets, the re-treat- ment issues and how the nets were used. Mothers' experiences of malaria and treatment seeking behaviour When the mothers were asked about their malaria history, 61.2% reported that they ever suffered from malaria. However, 4.1% of them reported that they had suffered from a febrile illness for which they were not sure about it. Of mothers who had ever suffered from malaria, 74.2% had also suffered from the disease within the preceding one year from the time of survey. However, due to the threat of recall bias, our analysis of the pattern of treat- ment seeking behaviour for malaria among them was lim- ited to the most recent malaria episode self-reported within three months (n = 636) from the time of the sur- vey, representing 30.5% of reported malaria prevalence among the study group over the stated period. With regard to how their recent malaria illness was diag- nosed, 65% recognized the illness themselves by the symptoms of the disease, 22.5% knew the disease by microscopic diagnosis and 8.8% knew the type of the dis- ease from the health worker who examined them based on the signs and symptoms. Nineteen (3%) of them knew about their malaria illness after being diagnosed by CHWs and only 0.8% were told by a family member. Very few respondents (0.3%) were told by a traditional healer that they had malaria. In general, self-diagnosis was the pri- mary diagnostic method for malaria in this rural commu- nity. For the question "How many times/different places did you seek treatment for the recent episode of malaria?": 5.5% (n = 35) did nothing, 72.8% (n = 463) reported one source of treatment, 19.2% (n = 122) stated two places and 2.5% (n = 16) reported three sources of treatment. Table 5 summarizes the patterns of visits to various care providers in three attempts among those who did some- Page 7 of 12 (page number not for citation purposes)