Dissertation (MMED Pediatric and Child Health)The children with Severe Acute Malnutrition are at higher risk of getting severe infections compared to their counterparts due to state of immune deficiency. A cross-sectional analytical study was done at Dodoma and Iringa Regional Referral Hospitals and involved a total of 248 children aged 6 to 59 months. The structured questionnaires were used to collect social demographic, clinical and physical characteristics data. Urine samples taken were cultured according to standard operating procedures. The data were analyzed using SPSS version 26. Out of 248 participants; 148(59.7%) were males. The median age was 20.7(IQR: 14 – 30) months. The total of 50(20.16%) children had significant bacteriuria of gram-negative enteric bacteria. Escherichia coli 30/50(60%) and Klebsiella pneumoniae 15/50(30%) were predominant isolates. The susceptibility rate for E. coli was 29/30(96.67%), 30/30(100%), 30/30(100.00%), 26/30(86.67%), 5/30(16.67%), 19(63.33), 0(0.00%) for Ciprofloxacin, Meropenem, Amikacin, Amoxicillin/Clavulanic acid, Ceftazidime, Ceftriaxone and Gentamycin respectively. The presence of urine nitrite, urine sediments, increased frequency, painful urination, and female gender were predictors of positive urine culture (p <0.05). Gram-negative enteric bacteria resistant to Gentamycin and third- generation Cephalosporin constituted a common cause of significant bacteriuria in under-fives with Severe Acute Malnutrition.