Dissertation (MMed Pediatrics and Child Health)BACKGROUND Severe anemia is prevalent in most African countries and is highly associated with increased morbidity and mortality in under fives. Globally, iron deficiency is responsible for half of all the anemia, In Africa causes like malaria, hookworm and other helminthes, other nutritional deficiencies, chronic infections, and genetic conditions prevail and these causes differ from place to place. Exhaustive diagnostic evaluation is needed to establish causes of severe anemia however they are hampered by limited laboratory capacity in most developing countries. OBJECTIVE To determine the prevalence, etiology and factors associated with severe anemia among children aged 6-59 months with clinical features of anemia admitted at Dodoma Regional Referral Hospital with clinical features of anemia. METHODOLOGY A cross sectional hospital-based analytical study where a structured questionnaire was used to capture demographic and clinical characteristics, Hb level taken and investigations like MRDT, PITC, sickling test, FBP, peripheral smear, stool analysis, ferritin level and CRP were done to find the etiologies of severe anemia in children with Hb< 7g/dL . Data analyzed using SPSS version 23.Univariate and multivariate analysis was done to find factors associated with severe anemia and factors with value of< 0.05 on logistic regression was considered significant. RESULTS: A total of 310 children were enrolled, the prevalence of severe anemia was 27.4% (85/310) and sickle cell disease was the leading etiology of severe anemia 31.8% (27/85) followed by severe acute malnutrition 29.4% (25/85) and malaria 28.2% (24/85). Urban residency OR1.245 CI [1.226-2.665] p-value=0.037, vii having a known chronic disease such as cerebral palsy OR 2.781 CI [1.511-4.889] p value 0.001, clinical pallor OR 1.293 CI [1.178-2.449] p value 0.001, feeding plain porridge daily OR 1.829 CI [1.694-2.147] p value0.048 were significantly associated with development of severe anemia and with a case fatality rate of 12.9% (11/85). CONCLUSION: Severe anemia is prevalent among children admitted at Dodoma Regional Referral Hospital despite low prevalence of malaria to which has previously been attributed to. Causes other than malaria should be investigated in children with severe anemia. Sickle cell disease and severe acute malnutrition are among the leading causes of severe anemia in these children.