Objective:To observe and assess the compliance to sulfadoxine-pyrimethamine(SP) one and a half years after phasing out chloroquine(CQ) in Mkuranga District,Coast region,Tanzania. Methods:A randomly controlled baseline community study was conducted in rural areas of Mkuranga district,Tanzania.Semi-structured questionnaire consisted of open-and closed -ended questions including home stocking,home use,last fever episodes and treatment of underfives with malaria using CQ or SP.Results:The prevalence of fever or reported fever rate during the last 48 hours by their mothers or guardians was high(70%).Of all 117 blood samples,only 8 children after drug analysis were found to have CQ and 13 had SP concentrations within their blood respectively.None of these blood drug levels were above therapeutic ranges. Conclusions:Community interventions are urgently needed in rural communities and should specifically target households nucleus on early malaria fever recognition and provision of recommended antimalarials for the sick underfive children.However,sadly,there was an increase in underweight and undernourishment in the study areas,probably because of malaria in the area and poverty which are associated with poor nutrition in these youngsters. Objective: To observe and assess the compliance to sulfadoxine-pyrimethamine (SP) one and a half years after phasing out chloroquine (CQ) in Mkuranga District, Coast region, Tanzania. Methods: A randomly controlled baseline community study was conducted in rural areas of Mkuranga district, Tanzania. Semi-structured questionnaire consisted of open-and closed-ended questions including home stocking, home use, last fever episodes and treatment of underfives with malaria using CQ or SP. Results: The prevalence of fever or reported fever rate during the last 48 hours by their mothers or guardians was high (70%). Of all 117 blood samples, only 8 children after drug analysis were found to have CQ and 13 had SP concentrations within their blood respectively. None of these blood drug levels were above therapeutic ranges. Conclusions: Community interventions are urgently needed in rural communities and should specifically target households nucleus on early malaria fever recognition and provision of recommended antimalarials for the sick underfive children.However, sadly, there was an increase in underweight and under nourishment in the study areas, probably because of malaria in the area and poverty which are associated with poor nutrition in these youngsters.