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Background: Febrile episode remains the common clinical presentation responsible for hospital admission among children aged less than 5 years in sub-Saharan African. The overlapping of clinical signs and symptoms, with diverse aetiological agents implicated in febrile illness, tends to compound effective diagnosis and management approach in a low-resource healthcare setting. Objective: We retrospectively analysed malaria parasitemia and bacteremia results of febrile patients seen at a tertiary hospital in Nguru, Yobe state, Nigeria. Okon et al.; JAMMR, 25(4): 1-9, 2018; Article no.JAMMR.38781 2 Study Design: A retrospective study analysed malarial parasitemia and bacteremia of febrile patients aged less than 12 years. Place and Duration of Study: The study was conducted at the federal Medical center Nguru in the department of Medical Microbiology and Paediatric that spanned between January and December 2014. Methodology: Thick and thin blood smear examination for asexual malarial parasite, blood culture technique for bacterial pathogens isolation, and antibiotic susceptibility testing were employed for the study. Results: Malarial parasitemia was detected in 44(32.6%) cases, bacterial pathogens isolated in 51(37.8%) and co-infection prevalence of 16.3% respectively. Five different bacterial pathogens were isolated, Staphylococcus aureus accounted for 34(66.9%), Salmonella spp 10(19.6%), Escherichia coli 4(7.8%), Coliforms 2(3.9%) and Streprotococcus pneumoniae 1(2.0%) respectively. The significant statistical difference was observed between clinical details and microbiological indices, malarial parasite (P<0.001) and bacterial pathogens (P<0.0001). High malarial parasitemia and bacteremia was observed within the age-group of 1-11 months and >60 months. The bacterial pathogens demonstrated high resistance pattern to ampicillin and cotrimoxazole. Conclusion: These findings presented local epidemiological data of febrile episode that could optimized febrile illness diagnosis and management approach. Original Research Article