Community knowledge and practice related to malaria is important for the implementation of appropriate, effective and sustainable interventions. This study was carried out to assess knowledge and practices on malaria and identify factors contributing to the low mosquito net coverage in Simanjiro District in northern Tanzania. A combination of direct observation, focus group discussion (FGD) and questionnaire were employed in data collection. A sample of 200 respondents was selected randomly from 5542 people from the study village. The findings show that, although most (75%) of the respondents were informed that mosquitoes transmit malaria, the remaining quarter of respondents reserved a considerable doubt on the link between mosquitoes and malaria. Sixty five percent of the respondents were aware of the use of insecticide treated nets (ITNs). However, the coverage of any mosquito net and ITN was 12.5% and 5%, respectively. Affordability, unavailability and gender inequality were identified to be major factors associated with the low ITN coverage. The study recommends that, an advocated pluralistic approach of ITN delivery which encourages a coordinated public private alliance is required to ensure equitable and large scale distribution of ITNs in the village.