2019-02-04T00:00:00Malaria is perhaps even tougher to combat than HIV or tuberculosis because of its multiple distinct life-cycle stages and its genetic complexity, which allows Plasmodium to adapt rapidly to drugs and to or immune system’s efforts to render it ineffective. With billions of parasites circulating in a single human host, Plasmodium species are poised to resist immunological and chemotherapeutic attacks. With the aid of mosquito vectors, a single infected can transmit to hundreds of other individuals within months, far outstripping the infection rate of HIV or tuberculosis. The aim of this study is to identify the challenges in malaria diagnosis and elimination among in-and-out patients of Kaltungo General Hospital, located in a local government area of Gombe state, Nigeria. It is a semi-urban community hospital which covers over 40 rural areas and serves as a secondary health facility for 15 Primary Health Care centers (PHCs) around the area. Findings show that 70% of the challenges in malaria diagnosis and elimination is due to the life-cycle of the causative agent, Plasmodium; the most common in this rural area being Plasmodium falciparum, 20% was due to the failure of early diagnosis as a result of the attitude of the community who do not come to the hospital until the case is near death, while 10% was also found to be due to the cost of treatment. Despite efforts by successive governments to provide malaria drugs and treated nets, sharp practices among health workers and non-adherence to drug usage has made the diagnosis and elimination of malaria a herculean challenge. Four-hundred and forty-five (445) patients were diagnosed during the period of this study representing 60% of both in-and-out patients in the hospital. 345 representing 77.5% were diagnosed as positive for P. falciparum (Positive =345; +100, ++245) while 100 representing 22.5% turned out as Not Seen (NS).