Background: Malaria still attacks millions of people predominantly in sub Saharan Africa,rnincluding Ethiopia. The contribution of house proximity to water bodies, the role of migration,rnmalaria information and child age on malaria transmission dynamics have not yet been examinedrnin detail in northwest Ethiopia. Identification of malaria vectors in meso-endemic settings with arnhigh potential of introduced malaria has not also been done in the study setting. The ownershiprnand use of LLINs is one of the primary prevention strategies for malaria transmission control andrnelimination. In Ethiopia, evidences showed the presence of major gaps between LLIN ownershiprnand compliance. However, the reasons that influenced consistent utilization of LLINs have notrnyet explored qualitatively in Amhara region, particularly in the study area. Identifying factors forrnimported and locally acquired malaria, malaria vectors, and exploring barriers of consistentrnutilization of LLINs are useful to facilitating the effort for malaria elimination.rnObjectives: This study aimed at investigating the contribution of house proximity to a waterrnbody, individual and household-level drivers of imported and locally acquired malaria, malariarnvector species and barriers of consistent LLINs utilization in meso-endemic villages around LakernTana, northwest Ethiopia.rnMethods: A combination of approaches, including matched case-control study designs,rnentomological survey and phenomenological qualitative method were undertaken in 12 kebelesrnaround Lake Tana, northwestern Ethiopia. Health facility-based matched case-control studiesrninvolving 303 and 81 matched pairs among all age groups and under-five children werernconducted from October 10, 2016, to June 30, 2017, respectively. Anopheles mosquito larvaernsampling was done from April 30, 2017, to June 24, 2017, from 7 potential breeding sites in thernstudy area using the standard dipping method. A phenomenological qualitative approachrncomprising 23 community interviewees and 38 key informants was conducted from April to Junern2017. Households for cases and controls, household proximate water bodies, health centers andrnlarvae survey sites were geo-referenced. A semi-structured questionnaire was used to collect datarnfrom households. Collected larvae were reared to adulthood at an insectary. Each adult wasrnindividually identified at the species and species complex levels using standard adult mosquitornmorphological identification keys. In-depth interviews were carried out to explore the localrncontexts and reasons that influenced consistent use of LLINs. Quantitative data were entered and rnXrncleaned in EpiData Version 3.1 software. Qualitative data were managed and analyzed usingrnNVivo Version 10 software. Principal component analysis was performed to estimate householdrnwealth. Stratified analyses were used to confirm confounding and effect modification.rnMultivariable conditional logistic regression models were fitted to identify independentrnpredictors of malaria occurrence. Thematic analysis was used for the interview data to code andrnidentify themes. Statistical analyses were performed using ExcelÂ®rn, SPSS statistical softwarernversion 22 and STATA version 14.0. The maps were plotted using ArcGIS 10.5.rnResults: Of 303 malaria cases, 59 (19.5%) were imported malaria whereas 244 (80.5%) werernlocally acquired. Travel to malarious lowlands in the preceding month (adjusted mOR = 7.23;rn95% CI: 2.38-22.00), household memberâ€˜s travel to malarious lowlands (adjusted mOR = 3.04;rn95% CI: 1.14-8.08), and inadequate malaria information (adjusted mOR = 1.56; 95% CI: 1.02-rn2.37) were observed as independent predictors of malaria occurrence in the study area. Stratifiedrnanalyses confirmed that travel to malarious lowlands had a confounding effect on malariarnoccurrence in the study area.rnChildren aged 36-59 months (adjusted mOR = 3.88; 95% CI: 1.55-9.74) were at increased risk ofrnlocally acquired malaria among under-five children. Presence of water body within a 500mrnradius from a house was not a statistically significant predictor of local malaria. The malariarnvectors, Anopheles gambiae complex, An. pharoensis and An. funestus group were identified inrnmalaria meso-endemic villages around Lake Tana.rnThe qualitative investigation explored wrong perceptions about LLINs, malaria and mosquitoes;rnbedbug infestation; structural inconvenience; unintended uses; weather conditions; problem inrndistribution of nets; and socio-cultural and economic factors as critical barriers for consistentrnutilization of LLINs. Killing ability of nets against arthropods other than mosquitoes reportedlyrnmade use of LLINs a favored malaria prevention method despite their ineffectiveness after 3rnmonths. Circular-shaped nets were preferred due to their compatibility with varied sleepingrnstructures. Unintended uses were often associated with local needs and seldom linked with socialrnissues and deficiencies in information about malaria and LLINs. Collateral benefits werernconsidered equally important, principally in terms of short-term disinfestations of bedbugs.rnConclusions: In this study, travel to malarious lowlands and inadequate malaria informationrndetermined the occurrence of malaria infection in villages around Lake Tana. Children aged 36-rnXIrn59 months old continued to be at increased risk of local malaria in these villages where An.rngambiae complex is present. Non-consistent bed net use in villages around Lake Tana wasrnassociated with inconvenient bed net design and early damage; non-potency of the insecticidernagainst other arthropods; facilitation of bedbug infestation; unintended uses; wrong perceptionsrnabout malaria, mosquitoes, and LLINs; and inadequate follow-up regarding LLINs utilization.rnRecommendations: National malaria control & elimination programmers and health authoritiesrnshould design improved effective and integrated interventions that consider imported malariarncases. Malaria information that involves IEC and SBCC should be given to optimize coveragernand adequacy of information by considering the educational status of the community. Incrementrnof long-acting insecticide spraying coverage and frequency, use of repellents until sleep underrnnets and equal management of both child age groups while applying LLINs utilization should bernconsidered to reduce local malaria in children aged 36-59 months. Vector control interventionsrnshould be designed in accordance with malaria vector species present in a locality. The provisionrnof nets that are structurally compatible with sleeping spaces and the delivery of adequaterninformation about malaria and its vectors, and the properties and proper uses of LLINs to therncommunity indicate substantial accumulation of knowledge that may guide effective LLINrnprograms in the study area.