Background <p>Malaria remains a major public health challenge in Nigeria, particularly in endemic regions such as Ondo State. Over the past two decades, significant progress has been made in reducing the global burden of malaria through intensified control interventions. Although Nigeria contributes a substantial proportion of the global malaria burden, there is limited up to date facility-based data assessing the relationship between community knowledge, socioeconomic factors and confirmed malaria prevalence in Ondo State. This study determined the influence of demographic factors, environmental sanitation, socioeconomic status and preventive measures on malaria prevalence in Ondo State.</p> Methods <p>A facility-based cross-sectional KAP study was conducted among 469 participants recruited from selected health facilities across Ondo State. Well-structured questionnaires were administered to the participants to collect their demographic information and data on malaria knowledge, attitudes and preventive practices. Malaria test was done using Rapid Diagnostic Tests (RDTs) kits. Data obtained from the study was analyzed using SPSS version 26, with associations tested by Pearson’s Chi-square. Odds ratios and 95% confidence intervals were calculated with statistical significance set at <i>p</i> ≤ 0.05.</p> Results <p>Of the 469 participants enrolled, 98 participants tested positive for malaria, giving a prevalence of 20.9%. The dynamics of malaria transmission pattern was relatively uniform across the six study locations, ranging from 19.3% in Odigbo to 22.2% in Akure South with no significant difference (<i>p</i> = 0.997). Age was significantly associated with infection (<i>p</i> = 0.001), with children aged 6–15 years nearly twice as likely to test positive compared to young adults (OR = 1.889, 95% CI: 0.872–4.092), while older adults aged 56–65 years had markedly reduced odds (OR = 0.135, 95% CI: 0.043–0.429). Marital status was also a strong predictor, with single individuals almost three times more likely to contract malaria compared to married participants (OR = 2.792, 95% CI: 1.757–4.436). Occupation showed significant influence the risk of having malaria, as students had over threefold increased odds compared to artisans (OR = 3.339, 95% CI: 1.178–9.462). Household income was inversely associated with malaria risk, with participants earning above ₦50,000 significantly less likely to test positive (OR = 0.407, 95% CI: 0.235–0.705). Preventive practices showed mixed effects: ownership of mosquito nets was protective (OR = 0.553, 95% CI: 0.292–1.047), while sleeping under nets paradoxically increased odds (OR = 1.631, 95% CI: 0.784–3.391). Misconceptions about malaria causation and transmission were significantly linked to higher prevalence (<i>p</i> = 0.002).</p> Conclusion <p>Despite high awareness, malaria prevalence in Ondo State remains substantial. Socioeconomic vulnerability, younger age and poor knowledge significantly increase risk, while preventive practices are inconsistent and misconceptions persist. Strengthening community education, expanding access to reliable diagnostics and ensuring equitable interventions are key tools to reduce transmission and advance elimination goals.</p>