INTRODUCTION: Tracheostomy is one of the oldest surgical procedure known which is dated back to 3600BC. It still remains a life saving procedure worldwide until today particularly in health resources limited settings like ours where patients are likely to present late with upper airway obstruction. OBJECTIVE: Little has been done in our environment so far concerning this subject; hence, the purpose of this study is to analyze tracheostomies performed at ENT department KCMC in order to get insight into the prevalence, demographic distribution, indications and complications derived from the procedure. The purpose is also to compare the findings with those published in the most recent literature. METHODOLOGY: This was a hospital based descriptive retrospective cross sectional study review of patients’ files whom had tracheostomies performed at ENT department KCMC during the three year period between January 2013 to December 2015 and analyzed using SPSS computer software version 20. Ethical approval to conduct the study wa obtained from the relevant authorities before commencement of data collection. RESULTS: A total of 75 patients were studied. The male to female ratio was 2.6:1. The majority of patients were in the fifth and sixth decades of their lives. The prevalence of tracheostomy among patients attending ENT services at KCMC was 1.7% averaging at 25 cases per year The most common indication for tracheostomy was upper airway obstruction secondary to neoplastic causes in 53.3% of all patients with the most common malignancy being laryngeal tumors which made up 56% of the neoplastic causes. This was followed by prolonged intubation in 13.3% of total cases. The majority of tracheostomy cases (85.3%) were performed as an emergency with the remaining 14.7% performed as elective. There were no significant complications recorded intraoperatively or postoperatively. The mortality rate was 16% and all of the deaths were due to the underlying diseases, none was tracheostomy related. CONCLUSION: Upper airway obstruction secondary to neoplastic causes; especially laryngeal tumors followed by prolonged intubation are the most common indications for tracheostomy at KCMC.