Background: Intestinal helminthes and Plasmodium infections remain a major health problem in many developing countries in population with poor economy and sanitary setting especially in sub-Saharan Africa. Even though there was limited evidence on the prevalence of malaria and helminthes co infections in the area. Objective: To assess the prevalence of malaria helminthes co-infections and associated factors among febrile patients attending Pawe General Hospital, Benishangul Gumuz Regional State, North west Ethiopia in 2019. Method: A facility based cross-sectional study was conducted from October 2019-November 2019 among febrile patients who attend at Pawe General Hospital. A total of 428 participants were recruited in the study using systematic random sampling. A capillary blood and stool specimen was collected. Giemsa stained blood films were prepared for detection and identification of plasmodium species. Stool direct wet mount and formalin-ether concentration techniques were used for detection of helminthes parasites. Socio demographic and related data were collected using structured questionnaire. Data were cleaned and entered using Epi Info version 7 and analyzed using SPSS version 23.0 soft wares. Crude and adjusted odds ratio with 95% CI were calculated. P-value less than 0.05 was considered statistically significant. Result: Of 428 participants 194(45.3%) were positive for malaria, 200(46.7%) were positive for helminthes, and 118(27.6%) were co infected with both malaria and helminth. Hookworm was the most frequently co-existed helminth with malaria 80/118(67.7%). Bed net usage (AOR = 0.45:95%CI; 0.27-0.78), spray with insecticide (AOR=0.36:95%CI; 0.17-0.76), swampy area (AOR=1.75; 95%CI: 1.15-2.68), residence (AOR=2.46; 95%CI: 1.55-3.91) were factors found significant association with malaria infection. Whereas latrine availability (AOR=0.59; 95%CI: 0.35-0.99), residence (AOR=1.89; 95%CI: 1.16-3.07), age 5-14 years (AOR=4.66; 95%CI: 1.99-10.93), 15 years and above (AOR=3.32; 95%:1.54-7.17), method to treat water (AOR=0.55; 95%CI: 0.35-0.87) and wear shoes always (AOR=0.33; 95%CI: 0.17-0.63) were factors found significant association with helminth infection. . Conclusion: Malaria and helminthes co infection was the major health problem among febrile patients. Therefore: interventions like adequate supply of bed nets, regular spray with insecticide, health information, latrine construction, improving water quality and environmental sanitation programs should be implemented. Key words: Malaria helminthes Co infection, febrile patients, Benishangul Gumuz, Ethiopia