Malaria in Mozambique is one of the ten leading causes of morbidity and mortality. Malaria is responsible for up to 44% of all outpatient consultations, 57% of pediatric admissions and a leading cause of low birth weight in newborns. Consistent use of insecticide treated bed nets (ITNs) for malaria prevention is recommended, and the Mozambican government has scaled up the mass distribution of these nets in order to achieve 100% coverage. However despite these concerted efforts, low levels of usage of ITNs have been reported. The purpose of this study was to investigate the factors contributing to the low usage of ITNs in the Nicoadala district in Mozambique.