In 2010, an estimated 216 million cases and 655,000 deaths due to malaria occurred worldwide. Of these, about 81% and 91% respectively were reported from the African Region, mostly affecting children under-the age of five. In Tanzania, malaria remains to be the leading cause of high morbidity and mortality. It is responsible for more than one-third of all deaths, 39.4% of all health care visits, and 33.4% of all hospital admissions among children under the age of 5 years. The objective of this article was to provide a systematic review of the literature to summarize the knowledge of the most important aspects of prevention and management of malaria in under-five children in Tanzania. The focus was on health care seeking decision-making and understanding the magnitude of the gap between ownership and use of insecticide treated mosquito nets (ITNs). The review considered published and unpublished literature covering a period from 2002 to the end of July 2012. The information used in this review was obtained through a Google search using specific keywords. Results show that across zones the difference between ownership and use of ITNs among under-fives was insignificant. This finding is consistent with a reduction in the proportion of children with suspected of malaria taking antimalarial drugs. Nevertheless, differences exist between zones in terms of both coverage of ownership and use of ITNs. Regarding health care seeking-decision making the literature reviewed indicated that caretakers generally, had a good biomedical understanding of febrile illnesses both in terms of types and symptoms. However, a frequent belief was that symptoms related to convulsions were not associated with malaria, hence cannot be cured in modern health care system. Moreover, some caretakers self-treated symptoms, which trigger others to seek medical care, thus end up delaying to seek medical care. In additional, most of the studies reviewed were designed within the health belief framework. There is a dearth of evidence documenting adherence to prescribed medications.