Background The prevalence of malaria among Sub-Saharan countries has been great accounting for high mortality rate among pregnant women . Various policies have been enabled to decrease the prevalence , thus included the use of insecticide treated nets among pregnant women thus campaign in various countries on provision of free ITN has been implemented with still a low decrease in the prevalence thus a need to assess the knowledge among pregnant women on use of the ITN’s. Methodology A hospital based cross sectional study was done in KCMC hospital in ANC among pregnant women. Simple sampling method was used and a total of 176 participants obtained were 100 participants enrolled and met the inclusion criteria and enrolled in the study. Questionnaires was used to collect data of research. Data was analyzed with aid of computer using the SPSS software. Frequency and percentages was used to summarize categorical data. Results A total 100 participants aged between 15 and 44 years participated in the study. It showed majority 48.5% were secondary education. Seventy six representing 76% showed high aware of use of ITNs .Forty nine participants representing 48.5% showed possession of treated nets in their homes, 50.5% reported obtaining their knowledge from television. Conclusion The present study concludes that though the level of awareness concerning the use of ITNs b pregnant women attending antenatal clinic at KCMC was high, the possession of nets and use was goods showing low prevalence of malaria in Kilimanjaro. The public health implication is that more work needs to be done by government and health workers in KCMC hospital to further raise awareness through health education by using charts displayed on the wall, increase the accessibility and affordability of ITNs through mass importation so as to motivate more pregnant women to use them and finally to raise the level of formal education through compulsory.