Effective management of malaria requires the consumers and the care- givers, seek, obtain, and use drugs appropriately . This is linked to timely decision, accessibility, correct use of the drugs and follow-up after prescription.
Malaria in children under 5 years requires caregiver's early recognition and classification of fever. In the present study, fever and malaria were defined correctly by the majority of caregivers and malaria was identified as a main cause of fever. These findings have been shown to be the key to intervention in rural Ghana . The study results reflected mother's good knowledge about malaria, its transmission and prevention; as in other parts of Africa . Furthermore, they identified that high fever, inability to stand or walk, refusal to feed, loss of consciousness, yellowish sclera, severe diarrhoea and repeated vomiting were the features if malaria episode evolved into a more serious situation (severe malaria) and that requires urgent treatment at health facilities. These findings were consistent with similar studies carried out in Sri Lanka  and in other parts of Africa [9, 18].
Four treatment options were available for a febrile child in the area. Two included the use of drugs (consulting health workers and self treatment). The other two (traditional medicines and herbs) were deeply rooted. Accessing care from a variety of sources is a common practice in malaria endemic areas. A study in Philippine  showed availability of six treatment choices for families ranging from 'not doing any thing for the patient' to 'treatment with drugs based on formal prescription'. Sources of health care identified in Uganda, included public health institutions, private practitioners, traditional healers and self-treatment .
Treatment-seeking behaviour was comparable between villages in the study area. Commonly people start care for a febrile child at home with what available (herbs, remaining drugs, drugs from shops, tepid sponging), when there is no response or if the condition deteriorates then they seek advice from health personnel. Medication at home before moving to health facilities was reported also in Tanzania . A study in Kenya  showed that moving from different options determined by duration of sickness, its intensity and the expected cost. As stated by others, the delay in seeking care at health facilities level was related to existence, accessibility, satisfaction  and cost  of service, as well as satisfaction with traditional medicine and herbs. However, two factors affecting early consultation were actually leading to contradicting results: firstly, severely ill child need urgent consultation and hence short duration and secondly, appearance of illness at night deter the child from health facilities care waiting for the sun to rise and hence prolong the duration. These and other barriers were recognized by other researchers. For instance, Nuwaha F. in Uganda  added long waiting time, health workers abusing patients and being given tablets instead of injections as important barriers. Hill Z. et al in Ghana  considered financial access as a major barrier to care seeking.
Self-treatment and traditional medicine are habitual among the population of the study area. Similar finding had been reported in other parts of Sudan  and in Tanzania . In the present study, seeking health care at health facilities is predominantly decided by mothers, this in contrast to what mentioned by Nsungwa-Sabiiti et al in Uganda  where mothers decide only when treatment is uncharged.
In Sudan, more emphasis for delivery of antimalarials including ACTs is given to health facilities. However, as shown by this study, in situations where coverage with health facilities is low, promoting adequate case management practices at the community level appears necessary. It has been documented [22, 23], through training of mothers and availing adequately packaged drugs, mothers could recognize malaria and as well give appropriate treatment at home and, by doing so, reduce the incidence of severe disease and thus mortality.