Background: According to the WHO, in 2019, of the 384,000 deaths due to malaria globally, Uganda has accounted for 5% of total deaths. This study aims to estimate the fraction of severe malaria cases, and socio-demographic characteristics associated with severe malaria among children aged 0–59 months who are positive for malaria in Uganda. Methods: This is a population based cross sectional study conducted among 1627 children aged  0-59 months who were positive for malaria Rapid Diagnostic Test. Data for this analysis was extracted from Uganda Malaria Indicator Survey 2019. Multivariate logistic regression was used to investigate the prevalence of severe malaria and its association with different background characteristics. The study was conducted using SPSS software version 27. Results: The prevalence of severe malaria symptoms was in 11.7% of included children. Multivariate logistic regression revealed significantly increased odds for children aged 12-23 months (aOR: 2.0;95% CI: 1.3 – 3.3)  and 24 – 35 (aOR: 1.93;95% CI: 1.2 – 3.1) months, children living in urban settings (aOR: 4.9;95% CI: 2.2 – 10.7) , and children belonging to the middle (aOR: 1.9;95% CI: 1.3 – 2.9)  wealth quantile also had significantly higher odds of having one or more symptoms of severe malaria Conclusion: Ages 12–35 months, living in urban areas, and belonging in the middle wealth quantile were significantly associated with increased odds of having one or more symptoms of severe malaria. The results of which suggest a need for malaria intervention policies to address the needs of younger children and urban communities in Uganda.