Background: Malaria remains a leading cause of morbidity and mortality among children in sub-Saharan Africa. Vitamin A plays an important role in immune regulation and antioxidant defense, and its deficiency may influence susceptibility to severe malaria. Aim: To determine and compare serum vitamin A levels in children with cerebral malaria and those with uncomplicated malaria in Sokoto, Nigeria, and to assess the relationship between vitamin A status and malaria parasite density. Materials and Methods: This comparative cross-sectional study was conducted between June 2018 and March 2019 at Usmanu Danfodiyo University Teaching Hospital, Sokoto. A total of 221 children aged 6 months to 15 years were enrolled, including 111 with cerebral malaria and 110 with uncomplicated malaria. Clinical and socio-demographic data were obtained using a structured proforma. Malaria diagnosis and parasite density were determined by microscopy, and serum vitamin A levels were measured by colorimetric assay. Data were analyzed using SPSS version 23, with statistical significance set at p ≤ 0.05. Results: The mean serum vitamin A level was significantly lower in children with cerebral malaria (31.0 ± 17.7 µg/dl) compared with those with uncomplicated malaria (39.3 ± 15.5 µg/dl; p = 0.0001). Mean malaria parasite density was markedly higher in cerebral malaria (251,855 ± 120,853 parasites/µl) than in uncomplicated malaria (5,602 ± 4,020 parasites/µl; p = 0.0001). Serum vitamin A levels showed a weak but significant negative correlation with parasite density (r = −0.253, p = 0.0001). Moderate vitamin A deficiency independently predicted hyperparasitaemia. Conclusion: Children with cerebral malaria had significantly lower serum vitamin A levels and higher parasite densities than those with uncomplicated malaria, suggesting a possible role of vitamin A status in malaria severity.