Background: In endemic areas, children under five and pregnant women arernvulnerable to malaria and are likely to benefit most from the use of nets. Use ofrninsecticide-treated nets (ITNs) for protection against mosquito bite during sleeprnis highly effective. Kafta-Humera is one of the targeted Districts in the Regionrnfor ITNs intervention, but with limited information pertaining to priority ofrnutilization.rnObjective: to examine the status of children under five years of age and/orrnpregnant women ITNs possession and utilization and its determinants forrnmalaria control.rnMethodology: A comparative cross-sectional study was conducted in the ruralrnand urban areas of the District. Based on a systematic random sampling method,rn414 households were interviewed each from the selected Kebeles for bothrnsettings, regarding net possession and utilization by high-risk groups.rnQualitative data were also collected through focus group discussions (FGDs) tornidentify views of participants, pertaining to ownership and utilization. An earlyrnmorning survey was also carried out in order to observe the actual behavior ofrnthe community towards net use.rnResult: Net and ITN possession was 84.5% and 80.0% for rural, but 96.1% andrn91.1% for urban settings. Net possession was higher among urban (OR 3.33,rn95%CI 1.39, 7.98) compared to rural areas. Observed net and ITN use duringrnthe preceding night by children under five years of age was 68.6% and 67.0%rnfor rural; and 84.6% and 79.5% for urban areas. Likewise, similar practice forrnpregnant women was 52.1% and 64.7%, the same for net and ITN in rural andrnurban areas respectively. Net re-impregnation was 93.5% for rural and 94.1%rnfor urban areas. The FGD suggested that lower net possession in rural areasrncould be due to scarcity of net provision and inequity while distribution.rnOccupation, family size in rural areas; radio possession in urban areas andrnviirnrelative wealth and number of sleeping places had effect in both settings to ownrna net. Relative wealth, radio possession, malaria education message in rural andrnoccupation in both settings had a positive effect on net use.rnConclusions: Not all nets owned by the households were being utilizedrnproperly. Nevertheless, mal distribution, and scarcity were also observed withinrnthe settings. Effective IEC should be promoted and continues availability ofrnITNs should be in place in order to achieve effective control of malaria amongrnthe high-risk groups.