Introduction: Malaria is an issue that has beset humanity for way too long. Many treatments have been proposed for the eradication of the illness. Despite efforts, the issue remains found in our healthcare systems. Recently, the World Health Organization (WHO) has deemed thrombocytopenia not of importance when discussing severe malaria. Thrombocytopenia (platelet count less than 150 x 109/L) is a common platelet abnormality and hematological change as well as a common feature of malaria due to all plasmodium species more recently, low platelet counts have been associated with mortality in patients with P. falciparum and P. vivax infection. However, other studies have not demonstrated an association between thrombocytopenia and significant clinical risk. This analysis was conducted to establish the comparative platelet counts of patients infected by the different Plasmodium species and to define the associated risks of morbidity and mortality. Objectives: General objective: To study the association of malaria with thrombocytopenia in children at Ibrahim Malik Teaching Hospital. Specific Objectives: The general objective was to determine Thrombocytopenia among children with malaria as well as to determine common symptoms of malaria in children at Ibrahim Malik teaching hospital to identify the complications of malaria with thrombocytopenia, and finally to identify the outcome(s) of malaria and thrombocytopenia. Materials and methods: This was an analytical case-control hospital-based study that was conducted in Ibrahim Malik Teaching Hospital. The study was conducted on pediatric patients diagnosed with malaria in Ibrahim Malik Teaching Hospital. This was a multi-stage systematic sampling. A structured data collection sheet was filled by researcher. Results: A total of 334 cases of malaria were included in this study. Amongst those, the prevalence of thrombocytopenia was 28.4 % (95 cases). The mean platelet count was 247.42 ± 187.89. The range was between 7 and 704. The mean age of participants was 6 years old ±5.13 the range was between 1 year and 17 years. In other words, 182 of our participants (52%) were under 5 years of age and were the largest group of our participants, followed by participants aged 6-10 years of age at 80 (23%), followed by 11-14 years olds at 63 (18%), with the remainder 25 (7%) being 15-18 years of age. 182 (52%) of our participants were female, while the remainder 48% were male. Thrombocytopenia was most found in males ages 5 and under, more specifically in the age range of 2-3. Of our participants, 68.8% were of urban residence, while the remainder 31.2% were of rural residence. Of our participants, 52% (182) were ill for 4-7 days, while 31% (110) of them were ill for 1-3 days prior to hospitalization. Finally, 17% (59) of our participants were ill for 8 days or more. Mean duration of illness was 6.04 days ± 4.13. All participants were symptomatic. The most commonly reported symptom was fever, which was reported in all 334 (100%), followed by vomiting reported in 58.3% (203). The 3rd most commonly reported symptom was diarrhea, which founded in 37.5% (131). The 4th most reported symptom was headache, reported in 20.8% (73). This was followed by fatigability, which affected 12.5% (44). Finally, the least reported symptom was nausea which founded in 4.2% (15). Of importance, 56.2% (197) of our participants had at least 1 symptom of severe malaria. The parasite count found in this study showed that 66.7% (233) had a parasite count of one cross (+), only 6.3% (22) had a parasite count of two crosses (++), 23% (88) had a parasite count of three crosses (+++), while only 4.2% (15) had a parasite count of four crosses (++++). These are illustrated in figure 4.7 below. In so far as parasite count is concerned, a significant correlation was found between hyperparasitemia (four crosses (++++)) and thrombocytopenia. As per platelets are concerned, 219 (62.5%) had a platelet count of over 150,000 platelets per microliter of blood, 36 (10.4%) had a platelet count of 100,000-149,999 platelets per microliter of blood, 44 (12.5%) of them had a platelet count of 50,000-99,999 platelets per microliter of blood, 36 (10.4%) had a platelet count of 20,000-49,999 platelets per microliter of blood. Finally, only 4.2% (15) had a platelet count of less than 20,000 platelets per microliter of blood. Mild thrombocytopenia (100,000-150,000) was found in 10.4%, moderate thrombocytopenia (50,000-99,999) in 12.5%, while severe thrombocytopenia was found in 14.6%, divided as follows, 10.4% had a platelet count of (20,000-49,999) and 4.2% had a platelet count of under 20,000. The mean total WBC count was 9.94, with an SD of 4.73. 35 participants (10.42%) founded leucopenia, while 202 (60.4%) had leukocytosis. In so far as total WBC count is concerned, 54.2% (190) of our participants had a high total, 35.4% (124) of them were of normal range, and the remainder 10.4% (36) founded a low total WBC count. The mean Hemoglobin count was 8.42 ±2.91 g/dl. No significant correlation was found between HB levels and thrombocytopenia. The data illustrated a significant correlation between the listed symptoms of severe malaria which founded in our population and thrombocytopenia as well as a significant correlation between high total White Blood Cells (WBCs) and thrombocytopenia. No significant correlation was found between Renal Function Test (RFT) and thrombocytopenia. No significant correlation was found between Liver Function Test (LFT) and thrombocytopenia. A statistically significant correlation was found between rural residence and thrombocytopenia. A significant correlation was found between the youngest age group (under 5 years of age) and thrombocytopenia. A significant correlation was found between the male gender and thrombocytopenia. Our findings showed that 58.3% (204) of our participants were treated using artisunate (injection). Conclusion: In conclusion, our study found a significant correlation between severe malaria and thrombocytopenia. Additionally, it was found that high total WBC count was significantly correlated with thrombocytopenia in malaria. Furthermore, we found that thrombocytopenia was significantly correlated with rural residence, young age (namely under 5), and male gender. In addition, no correlation was found between thrombocytopenia and Renal Functions and Liver Functions. We, therefore, find it appropriate to conclude that thrombocytopenia was associated with a number of signs and symptoms (as well as laboratory investigations) of malaria. Recommendation(s): The immediate recognition of thrombocytopenia as a marker of severe malaria In the context of absence of investigations for malaria (e.g.: Blood Film For Malaria (BFFM)), the above findings can be used to hypothesize the presence of malaria Seeing to it that pediatricians recognize the importance of thrombocytopenia in the context of malaria Authorities reminding doctors of the importance of observing platelet counts in malaria patients The establishment and funding of further research in this topic (thrombocytopenia in malaria)