To assess household and socioeconomic factors associated with childhood febrile illnesses and treatment seeking behaviour, a study was conducted in Adami Tulu district in Ethiopia during the peak malaria transmission season in 2003. All mothers/caretakers of children <5 years of age were interviewed regarding their household characteristics, history of febrile illness (malaria) among children and actions taken 2 weeks prior to the survey. Of 3873 children, 21% had experienced fever in the past 2 weeks. Household ownership of a mosquito net (odds ratio (OR)=0.4, 95% CI 0.3-0.7) and prior spraying of the house with aerosols (OR=0.7, 95% CI 0.5-0.9) or DDT (OR=0.8, 95% CI 0.6-0.9) were associated with lower risk of febrile illnesses, whilst sharing the house with livestock increased the risk (OR=1.3, 95% CI 1.1-1.6). Treatment was sought for 87% of febrile children, with public facilities, private clinics and community health workers accessed fairly equally (26-27%). Home management was uncommon (6.4%). More febrile children from households in the middle (37.1%) and highest (44.6%) wealth categories sought treatment within 24h compared with the lowest category (18.3%). Widescale use of vector control measures such as mosquito nets and insecticide spraying of houses can effectively reduce the incidence of febrile illnesses among children.