The health burden and mortality caused by infections during childhood remain large in sub-Saharan Africa. We performed a review of the causes of hospitalization and death among children admitted to a pediatric teaching hospital in Bamako, Mali. Medical records of children admitted throughout 2000 were systematically sampled and abstracted for demographics, diagnosis, hospital course, and disposition. A sample of 1644 charts, from 5001 admitted children, were abstracted. The median age was 8 months. Half of the children had a febrile illness. All diagnoses were made clinically. The annual incidence per 100,000 and case fatality rates of the four most common serious infections, excluding malaria, were as follows: pneumonia, 165 (12 per cent); sepsis, 75 (37 per cent); meningitis, 71 (20 per cent); and enteric fever, 14 (12 per cent). An estimated 1300 children were admitted with thick-smear confirmed malaria; at least 64 per cent met World Health Organization criteria for severe malaria and 11 per cent died. Seventy-one per cent of admissions were due to infections. Overall 21 per cent of children admitted died in the hospital, most within the first 3 days of admission. Infectious diseases remain the primary cause of hospitalization among Malian children and frequently lead to death. A substantial proportion of this morbidity and mortality is probably attributable to vaccine-preventable diseases, such as Haemophilus influenzae type B, Streptococcus pneumoniae, and Neisseria meningitidis. Prospective surveillance using microbiological data is needed to delineate the organism-specific burdens.