Abstract: In order to examine the current status of fish disease and health management practices in rural freshwater aquaculture, a questionnaire survey and Participatory Rural Appraisal (PRA) tools were used in five districts of Bangladesh namely Mymensingh, Comilla, Jessore, Natore and Dinajpur. A total of 500 farmers were interviewed and 25 PRA sessions were conducted. Most of the farmers (87.8%) interviewed had disease problem in their fishponds. Prevalence of fish disease varied with districts and the size of farms. Average prevalence of fish disease was highest in Jessore district (18.2%) followed by Comilla (13.4%), Mymensingh (11.4%) and Dinajpur district (10.4%). Minimum prevalence (5.5%) was recorded from Natore district. Small farms (0.4 ha) suffered from high disease prevalence (13.8%) followed by medium (0.2-0.4 ha) and large (>0.4 ha) farms with 12.4 and 9.3% of diseases, respectively. The most prevalent disease was tail and fin rot (20.5%), followed by epizootic ulcerative syndrome or EUS (18.9%), nutritional diseases (15.3%), red spot (13.0%) and gill rot (12.3%). Other conditions like argulosis, dropsy and white spot were also reported by the farmers but with lower incidence. The diseases occurred mainly in the winter season. Overall, the knowledge of the farmers on basic fish health management was found very poor. Most of the farmers (83.8%) used treatment measures in response to particular disease problem. For disease treatment, 46% farmers used combination of lime and potassium permanganate, 22.4% farmer used only lime and about 10% farmer used lime and salt together. This study identified some fish health management related problems in rural aquaculture, such as lack of assistance, poor technical knowledge and lack of suitable therapeutics and their proper uses.