The study was undertaken in a group of 42 villages and hamlets near Farafenni. The villages ranged in size from 46 to 1250 inhabitants. The total population of the rural FDSS catchment area was about 17 000 and that of children under 5 years of age was about 3000. The area has one general hospital, three health centres and two private healthcare clinics. There are 18 rural primary health care (PHC) villages in the study area. PHC villages, each with a population over 400, have mainly been selected plus, occasionally, others located in relatively isolated areas. In all villages, village health workers (VHWs) and traditional birth attendants (TBAs) are selected by the Village Development Committee (VDC) and given 6 to 8 weeks of training with a standardised curriculum on how to treat common conditions such as uncomplicated malaria, ARI, diarrhoeal diseases and minor injuries. Thus, VHWs function as primary health care providers for minor illnesses and injuries for all ages. In addition, the VHW are expected to work as a community-based health educator. TBAs functioned as birth attendants, family planning distributors and health educators. Both TBAs and VHWs were expected to refer serious cases to the local health facility for management. VHWs and TBAs are supervised by Community Health Nurses who oversee circuits of 4 to 10 PHC villages. All rural settlements also have a Medical Research Council(MRC) Village Reporter who carries out sensitization for MRC activities. The bednet coverage in NBR was estimated to be 50%. However, during the study, details of bed net usage by the community were assessed.