Aims A prospective descriptive study was carried out to determine the causes and associated risk factors for childhood death,in a large government hospital in Malawi, Africa.

Method: A proforma was written based on the South African Child Healthcare Problem Identifier form, a form devised to audit deaths in order to reduce mortality. We completed the proforma for every death that occurred in the study hospital between December 2015 and August 2016, collecting data on age, sex, HIV status, nutritional status, cause of death, blood and CSF culture, underlying medical factors and any other modifiable factors that may have affected the outcome. Date was collected contemporaneously and from patient files.

Results There were 376 inpatient deaths out of 11 086 admissions, giving a mortality rate of 3.4%. There were an additional 58 children brought in dead. One third of deaths (128) occurred in the first 24 hours of admission.

There were 186 male deaths and 188 female deaths (n=374). Thirteen percent of deaths (48) occurred in the neonatal period (under 28 days), with a large proportion in the under ones (43%, 159).

The most common cause of death was sepsis (85, 23%, of which 28 were neonatal sepsis), followed by lower respiratory tract infection (50, 13%), gastroenteritis (32, 9%),meningitis (29, 8%) and malaria (27,7%). In those children who were brought in dead it was gastroenteritis (14, 24%) followed by malaria (8, 14%) and sepsis (6, 10%).

Of the patients with a known HIV status, 106 (38%) were either HIV positive or exposed at birth, compared with 1%–2% of the paediatric population in Malawi. Seventy-six patients (20%) had evidence of malnutrition (marasmus, kwashiorkor or marasmus-kwashiorkor).

Conclusion This study highlights the ongoing burden of infectious disease in Malawi, with the top 5 causes of death all being infection related and a very high proportion of deaths in HIV infected or exposed patients. However, it does show a much lower hospital mortality rate then was seen in adults patients in Malawi in 2009 (14.6%) and is comparable to the paediatric South African death rate of 2.4%.