Currently, malaria is one of the major diseases that cause significant morbidity and mortality worldwide including Ethiopia. Therefore, the present study was conducted to determine the prevalence of malaria and its associated risk factors among febrile patients who visited Gela Matebia Health Center. A five-year retrospective malaria data was collected and analyzed to determine trends of malaria prevalence in Gela Matebia Health Center, Ebinat District, Northwest Ethiopia. Malaria is endemic in the area according to retrospective malaria data from health facility. Over the past five-year, the overall prevalence of malaria was 34.4% (3201/9313). From the total malaria prevalence, P. falciparum accounted 21.6% (n=2010), whereas P. vivax and mixed infection accounted 11.5% (n=1074) and 1.3% (n=117), respectively. A prospective, cross-sectional study was conducted from April to May, 2023. The blood samples were taken from randomly selected 422 febrile patients from Gela Matebia Health Center. Both thick and thin blood smears were stained with 3% Giemsa solution and processed according to the WHO guidelines. Relevant information about socio-demographic and associated risk factors of malaria was collected using structured questionnaire. Chi-square and logistic regression analysis were used to assess the possible association between dependent and independent variables. From a total of 422 study participants, 189 (44.8%) were positive for malaria. Out of this, the prevalence of P.falciparum, P.vivax and Mixed was 25.8% (109), 17.1% (72) and 1.9% (8), respectively. Multivariate logistic regression analysis revealed that family monthly income (p=0.002), house wall type (p=0.036), cattle in the house (p=0.001), knowledge on malaria control (p=0.011), clear mosquito breeding site (p=0.001), ITN using status (p=0.005) and chemical spray (p=0.001) were significant explanatory risk factors for occurrence of malaria among study participants in the study area. This high prevalence of malaria indicates that malaria remains a serious public health problem in the study area. Therefore, all concerned bodies should design practical action plans for effective prevention and control of malaria in the study area.