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The purpose of the KAP Study was to determine the community perceptions in terms of malaria cause, prevention and treatment, and also to find out the extent of bed net use and the factors associated with the net use. The study was carried out in two malaria hyper-endemic districts of Sarpang and Samdrup Jongkhar covering four rural areas and two urban areas with 250 households and 1415 members. 92% of the household members sleep under a mosquito net. 87% of the nets are treated with insecticides. And 35.6% of the respondent had encountered some problem in using the treated nets, primarily as skin irritation. A total of 81 persons (5.7%) were diagnosed and treated for malaria in 2001. On an average 19.6% of the households had at least one member who had malaria in the past 12 months. The gewogs of Chuzagang and Bangtar had one third of their households with at least one member contracting malaria. Farmers and household with more than 6 members had more than two times the risk of having a household with malaria compared with other variables. Also households where they know malaria can be dangerous, if they are sure neighbour had malaria and using preventive measure other than nets then the risk of getting malaria is comparatively high. Probably this indicates that people must be living in high incidence areas except from usage other than nets. The results are also significant when tested in a multivariate statistical model. 35.6% of the respondents had encountered some problem in using the treated nets, primarily as skin irritation. This survey points that it should be possible to reduce side effects substantially in Bhutan too. This may be very critical to the program if it means that people will stop using nets because of the side effects. It is suggested that awareness and prevention should be more differentiated on how to protect, and when to protect at all places. It should be considered whether delay plays an important role for malaria morbidity and mortality in Bhutan, and if more efficient measures could be implemented to prevent mortality and severe morbidity especially in localities where falciparium incidences are increasing. [ABSTRACT FROM AUTHOR]