Background: Severe malaria is a major cause of mortality and morbidity in patients with malarial fever.Early recognition of clinical Signs, Symptoms and laboratorial abnormalities of severe malaria helps in initiation of artesunate combination therapy at an early stage of disease progression thus significantly reducing disease mortality. Objective: To study the clinical presentation of severe malaria regarding age, sex, causative agent, clinical manifestation, risk factors, mortality and morbidity and to compare the clinical manifestation of sever malaria in patients infected with p.falciparum , p.vivax ,and mixed infection. Materials and Methods: This study was carried out on 60 patients diagnosed with severe malaria based on the national vector born disease control program (NVBDCP). Result: Most common cause of severe malaria is p.falciparum. Severe malaria mainly affects young individuals in the age of 20–40years and predominantly male. Fever is the most common presenting symptom. Most common manifestation of severe malaria is thrombocytopenia mainly caused by falciparum and other common manifestation being altered renal function, altered liver function severe anaemia, metabolic acidosis, ARDS, cerebral malaria. Mortality is more common with falciparum infection and most common cause being ARDS, other causes of death is renal failure, hepatic failure and hypotension. Early diagnosis, anticipation of complication, close monitoring of vital parameters and combination therapy to overcome drug resistant perhaps helped to curtail the extent of mortality in severe malaria. Conclusion: Of the 60–patient studied we came to conclusion that severe malaria is caused more commonly by falciparum mainly involving young male during rainy season with renal failure and metabolic acidosis as the most common manifestation of severe malaria. With high mortality rate for patients developing ARDS and favourable outcome for patients initiating early treatment.