The study aimed at investigating the relationship between blood group type and severe disease in P.falciparum malaria in three Ethiopian malaria endemic localities. A total of 210 cases of malaria (70 severe and 140 uncomplicated) and 190 healthy controls participated in the study. In the severe malaria category, there were 25 (35.7%), 15 (21.4%), 14 (20%) and 16 (22.9%) blood group A, B, AB and O patients respectively. Blood group O was the dominant blood type in both uncomplicated malaria (45.7%) and healthy controls (41.6 %). As compared to the uncomplicated malaria, a case of severe malaria was almost twice as likely to be of type A as to be of type O (O vs. A, odds ratio 0.42, 95% confidence interval 0.2007- 0.8789), and more than twice as likely to be of type B as to be of type O (O vs. B, odds ratio 0.38, 95% confidence interval 0.1638-0.8973), and in both cases the difference was statically significant (P=0.019 for O vs. A; P= 0.02 for O vs. B). Furthermore, individuals with severe malaria were about seven fold less likely to be of O as to be of type AB (O vs. AB, odds ratio 0.19, 95%; P=0.0005). There was significantly low mean hemoglobin concentration in the severe malaria patients than the uncomplicated malaria and healthy controls (P