Background: Malaria is the greatest cause of childhood mortality in Sub-Saharan Africa. The commonest presentation of uncomplicated malaria is fever. However all childhood fevers are not due to malaria. Objective: To determine what proportion of children presenting with fevers have actual malaria parasitaemia. Materials and Methods: A prospective study was on 1,096 children presenting with fever to the Rapha Specialist Children & General Clinic, Effurun, Nigeria. All these children are from birth - 18 years had their blood film (thin and thick film) done for malaria parasite identification and parasite density. Result: The result shows that the males had 470 (76.9%) positive for malaria parasite. Conclusion: The high malaria parasitaemia clearly indicates that malaria is obviously the leading cause of childhood fever in this part of the world. It is recommended that in every rural hospitals which may not be equipped with competent laboratory facilities and personnel the empirical use of antimalarial in children presenting with fever is justified if a cause is not obvious.