BACKGROUND: Severe malaria accounts for up to nearly 1 million deaths annually in under-fives in Africa. AIMS: To give a clinical and laboratory description of the under-fives admitted with suspected malarial infection in a rural Tanzanian hospital, and to learn the use of some statistical analyses and learn how to interpret our findings critically. METHODS: This study included 21 consecutive patients below the age of 5 years in whom malaria was suspected because of fever. Patients were clinically investigated and mothers questioned on related clinical aspects, and laboratory investigations on parasitaemia and anaemia were done. RESULTS: The study suggests that girls were underrepresented among the admitted patients and may indicate that guardians seeking help at this hospital waited longer with girls, than with boys. Furthermore, results indicate that guardians tried other care strategies for girls first. However, boys in this study seemed to have a more dramatic clinical picture on the time of admission. CONCLUSIONS: This study demonstrates a possible gender difference in health care seeking and malaria presentation. However, our study population was very small for quantitative analyses, and results must be interpreted with great caution, even when there are statistically significant associations. Further studies are required in order to reveal gender differences in health care seeking behavior in this area of Tanzania.