More than 80% of all children with sickle-cell disease are born in Africa but there >90% of children with the disease die before the diagnosis is made. Bacterial infection is a major risk among all children with sickle-cell disease but it has been unclear what the main pathogens in Africa are. Now a study at Kilifi District Hospital on the Kenyan coast (Lancet 2009;374:1364–70; see also Comment, ibid 1308–10) has shown that the pathogens there are the same as those in the USA and Europe. In a 10-year case-control study (1998–2008) all children admitted to the hospital (apart from routine admissions and children admitted for observation after minor accidents) had a blood culture taken. Of 38441 children, 2157 (5.6%) had bacteraemia. The prevalence of sickle cell disease was 6.2% among children with bacteraemia and 0.7% among controls. Children with sickle-cell disease were 26 times more likely to have bacteraemia after adjustment for age. The most commonly isolated organisms from children with sickle cell disease were Streptococcus pneumoniae (41% of isolates), non-typhi Salmonella species (18%), Haemophilus influenzae type b (12%), Acinetobacter species (7%), and Escherichia coli (7%). Thus the most common pathogens were the same as those previously reported in the USA and Europe. Much morbidity and mortality from sickle-cell disease in Africa might be prevented by use of conjugate vaccines against H influenzae type …