The treatment seeking behaviour and perceptions of cause of malaria amongst caregivers of children under-five living in rural Nigeria,was studied using a cross sectional survey conducted in UgwuogoNike ,a rural community in south-east Nigeria, between November 2001 and April 2002. Quantitative and qualitative research methods were employed using structured questionnaires and focus group discussions. Two hundred and seventy-five out of the 300 care givers were mothers and majority (60.7%) reported malaria to be a common illness. Heat from the sun was the most popularly reported cause of malaria (49.3%). Correct knowledge of mosquitoes causing malaria varied significantly with the level of education.. Most of the interviewed caregivers were familiar with signs and symptoms of malaria and self treatment with inappropriate doses of chloroquine was used by the majority (83.7%) while drug sellers were their most (52.3%) popular source of care. Poor utilization of formal health facilities was noted to be due to cost and absence of health personnel. The most popular treatment for severe malaria by caretakers was herbal remedies. Athough some reasonable knowledge of the symptoms of malaria was found, there is still need for intervention measures directed towards correcting misconceptions about the cause of malaria and improving treatment seeking behavior. It is recommended that appropriate home management with early recognition of symptoms and features of severe illness , correct use of effective anti-malaria drugs and prompt referral of severe cases should be promoted since majority resort to self-treatment. Corresponding author: D. H. U. Okafor Department of Paediatrics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria. E-mail: firstname.lastname@example.org INTRODUCTION Malaria is the most important parasitic disease in the tropics and remains of highest public health importance. About 90% of all malaria deaths in the world today occur in Africa, south of the Sahara. An estimated one million people in Africa die from malaria each year and most of these are children under five years old (WHO, 2002). In Nigeria, malaria transmission is holoendemic and more than 90% of the population lives in areas with stable malaria. It is one of the leading causes of childhood morbidity and mortality with a prevalence rate of 919/ 100,000 and is responsible for 25% and 30% of infant mortality and childhood mortality respectively. Malaria is responsible for over 300,000 deaths in children annually (FMOH, 1983), most of these deaths result from severe and complicated malaria especially in rural areas (Salako, 1994). Fifty percent of outpatient consultations and 15% to 31.3% of hospital admissions occur on account of the disease. It is estimated that 92% of the childhood deaths occur at home (Greenwood et al., 1987), mothers and other caretakers are therefore of foremost importance in recognizing mild or severe malaria disease and seeking treatment for their wards. Most caretakers begin treatment at home with antimalarial drugs and antipyretics purchased over the counter from drug sellers without prescription and usually with inappropriate doses of chloroquine (Derming, 1989; Igun, 1987; Lipowsy, 1992), which often results in poor quality of care and fosters the development of drug resistance(Bermejo, 1993). The ultimate resort after home treatment has failed is the formal health sector. Prompt and effective treatment of all children with malaria is a critical element of malaria control. People who become ill with the disease need prompt and effective treatment to prevent the development of severe manifestations and death (WHO 2003). Early treatment depends upon prompt recognition of symptoms and signs of malaria in the household, mainly by women. Early 216 T.A. OKEKE AND H.U. OKAFOR treatment also requires that appropriate health services and medication are accessible and utilized (Tanner et al.., 1998). The success of this strategy depends on the behavior of patients and caretakers of young children and it has been documented that treatment seeking behavior is related to cultural beliefs about the cause and cure of illness (Bledsoe et al., 1985). In some cases, illnesses are seen as amenable to treatment by modern practitioners, while others are considered best treated by traditional healers (Press, 1980). Illness ideas and behaviors may enhance or interfere with the effectiveness of control measures (Klein et al., 1995). An understanding of communities’ beliefs and behaviors is therefore crucial to the success of a specific control measure. This study aims to ascertain the current perception of cause and treatment seeking practices of caretakers in a rural area in order to identify probable areas of intervention for the control of malaria in the under-fives.