Pneumonia is one of the leading causes of morbidity and mortality due to environmental factors, health facility factors, and nutritional factors. It is a severe disease in under-five children in various localities of Ethiopia. This study aimed to assess the prevalence of pneumonia and its associated risk factors among under-five children visiting Ginde Woyin health center, Goncha Siso Enesie district, Northwest Ethiopia. A health center-based cross-sectional study was conducted, among 403 participants by systematic random sampling technique. Data were collected by questionnaire survey and sputum test laboratory diagnosis. The Data was analyzed using Statistical Package for Social Science (SPSS) version 26.0 and descriptive statics. All variables were used in the binary logistic regression. To determine potential predictors of under-five pneumonia variables with p- values less than 0.25 were further considered for multivariate logistic regression and P-value < 0.05 at 95% Confidence interval was declared statistically significant. The overall prevalence of pneumonia among under-five children in the study area was 24.3%, (95%CI: 20.1, 28.3). Using wood as source of fuel for cooking (AOR = 3.535; 95% CI: 0.829- 9.724; P= 0.047), cooking in kitchens without windows (AOR = 3.419; 95% CI: 0.140-10.253; P = 0.020), starting complementary food before six months of age(AOR = 1.513; 95% CI: 0.67- 4.482; P = 0.003),mixed breastfeeding (AOR= 1.213; 95% CI: 0.071- 0.641; P = 0.006), cough (AOR = 4.049; 95% CI: 1.014- 7.173; P < 0.0001), fast breathing rates (AOR= 2.022; 95% CI: 0.676, 5.701; P < 0.0001), chest tightness (AOR = 1.230; 95% CI: 0.703- 3.754; P = 0.015), and difficulty of breathing (AOR= 3.033; 95% CI: 0.9 - 8.117; P < 0.0001) were potential associated factors for under-five pneumonia. This study shows that the prevalence of under-five pneumonia was high. Thus, monitoring the breastfeeding habit, promoting using kitchen with windows, increasing using non-smoked materials as a fuel source are recommended.