This paper, using focus group discussions and questionnaires in Enugu State, Southeast Nigeria, examines the implications of consumer malaria perceptions and behaviour for measuring the disease burden and improving its treatment. The results show that, because peoples' understanding of the disease was related to its symptoms, this could lead to overestimation of the economic burden of malaria, based only on surveys without diagnostic confirmation. Survey-based estimations of the burden of malaria should control for the different local terminologies of malaria, and health personnel should be aware of these in order to improve the appropriate use of antimalarial drugs in presumptive treatment of malaria.