Malaria is the most important parasitic disease in the world. It is one of the leading health problem in Ethiopia with varied intensities of transmission. The aim of this study was to assess knowledge, attitude, practice and prevalence of malaria among individuals visiting Merawi Primary Hospital. A hospital based cross-sectional study was conducted in Merawi Primary Hospital between January and February 2019. 422 respondents were selected using simple random sampling technique and then, both thick and thin blood films were prepared and examined for malaria, and also questionnaire were administered to 422 individuals. Moreover, to see the trend of the prevalence of malaria over the last three years (2016-2018) 8,898 blood films recorded from registration book of the hospital. The present study showed the overall prevalence of malaria at Merawi to be 2.2 %. Plasmodium falciparum (77.8%) infection was dominant over P. vivax (22.2%) infection. From variables studied, visiting malarious areas (χ and presence of mosquito breeding sites (χ 2 2 (1) = 80.75, p < 0.001) (1) = 12.2, P < 0.001) were found to show statistically significant association with occurrence of malaria. Logistic regression analysis revealed that the likelihood of getting malaria for individuals who visited malarious areas was 60 times higher than those individuals who did not visit malarious areas (COR = 60.154, 95% CI: 13.53-267.44) and the association was statistically significant (P < 0.001). Moreover, 71% of the study subjects associated malaria with mosquito bite as a mode of transmission, the attitude of study participants towards malaria was positive, and 49.5% of study subjects were avoiding stagnant water to prevent malaria. However, 84.7% of the study participants did not know the cause of malaria and 63.4% of the study subjects did not know how someone catch malaria. Generally, for the last three years malaria showed a decline pattern but during the study year (2019) malaria prevalence was increased. Continuous education should be given to the community to fully prevent and control the disease.