Background: Bacterial meningitis is an inflammation of the meninges that occurs in response to bacteria causing a significant number of morbidity and mortality worldwide. Diagnosis of bacterial meningitis combines a high index of clinical suspicion and laboratory confirmation through cerebrospinal fluid analysis. Despite following the recommended management of treating bacterial meningitis, still many patients end up with serious neurological sequelae and death hinting on the possibility that the causative microbes have developed resistance to the antimicrobial agents that we are using. Objective: To determine prevalence, aetiological agents and antimicrobial sensitivity pattern among children aged less than 13 years with bacterial meningitis at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania. Methodology: This was a hospital based cross sectional study carried out in children presenting to KCMC Paediatric ward from December 2013 to May 2014. All children less than 13 years of age who met the eligibility criteria were consecutively recruited. Cerebrospinal fluid (CSF) samples were collected for microscopy, culture, sensitivity, and polymerase chain reaction (PCR) test. Lumber puncture for CSF collection was done for 80 who met the eligibility criteria. Confirmation of acute bacterial meningitis was done by isolation of causative bacteria from CSF culture or positive Gram reaction and/or polymerase chain reaction. PCR was done in 48 randomly selected patients. Data was collected by structured questionnaires and laboratory data sheet. Data was entered and analyzed using statistical package of social sciences version 20.0. Results: Out of 80 patients studied; overall 19 children had acute bacterial Meningitis as identified using both confirmation methods (Gram stain, culture and PCR). Standard Gram stain and Culture technique methods together identified 2 (2.5%) cases out of 80 patients; whereas PCR confirmed infection in18 (37.5%) out of 48 patients whose samples undergone CSF analysis using PCR. Two organisms were isolated with Escherichia coli (n=18) being the commonest organism followed by Streptococcus pneumonia (n=1). Both isolated organisms were sensitive to the common used antibiotics; Ampicillin, Chloramphenicol, Gentamycin and Cephalosporins. Conclusion: The commonest causative agent for Bacterial meningitis in our population was Escherichia coli which were mostly identified by PCR. Streptococcus pneumonia was rarely isolated, only one case. The isolated organisms were sensitive to the empirical used antibiotics treatment (Ampicillin, Gentamycin, Chloramphenical). Therefore the empirical antibacterial treatment used for meningitis can still continue to be used for management of meningitis in our set up.