Objective: To determine if passive gravitational sedimentation of blood samples, followed by buffy coat thin smear preparation could increase the sensitivity of malaria diagnosis when compared to conventional thin smear preparation without the additional cost of centrifuges or molecular diagnostics. Methods: Blood samples were collected from 205 patients. Each patient sample was analyzed using all three methods of sample preparation. Results: Buffy coat analysis of centrifuged blood samples greatly increased the sensitivity of malaria diagnosis when compared to standard thin smear techniques. Sensitivity between mechanically centrifuged samples and gravitationally sedimented samples showed equal improvement in sensitivity when compared to standard thin smear preparation. Conclusions: Passive gravitational sedimentation of red blood cells followed by buffy coat analysis dramatically improves the sensitivity of malaria diagnosis without the additional costs associated with centrifugation.