Dissertation (MMED Pediatric and Child Health)Invasive bacterial infection is a major contributor of the high morbidity and mortality observed in children with sickle cell disease (SCD). In limited resource settings where SCD is prevalent, identification of bacteraemia and prompt therapy for febrile children with SCD is not always possible due to lack of rapid clinical and laboratory predictors. The study was conducted to determine the prevalence and factors associated with bacteremia among febrile children with SCD admitted at Dodoma regional referral hospital. Hospital-based cross-sectional in which 185 febrile (axillary body temperature > 38°C) children with SCD aged 6 months to 18 years were conveniently enrolled. Demographic and clinical details were recorded using a pretested structured questionnaire. Laboratory tests were conducted including malaria rapid tests, complete blood counts and blood culture and sensitivity. Categorical variables were summarized using frequencies and percentages while continuous variables were summarized by mean and median. Logistic regression analysis was performed to determine factors associated with bacteremia using SPSS version 26. Of the 185 children enrolled, 61.62% (114/185) were male and median age of study participants was 4 years [IQR (3-7 years)]. Bacteria were isolated among 16.22% (30/185) of the children with Staphlococcalaureus, Escherichia coli and Salmonella species being the most common isolates. Factors independently associated with positive blood culture included age <5 years (AOR=2.9; 95% CI 1.05, 8.23; p=0.03), palmar pallor (AOR=3.03; 95% CI 1.15, 7.95; p=0.02), stroke (AOR=8.7,]; 95% CI 1.58, 47.92 p=0.01), and leucocytosis (AOR=8.03; 95% CI 1.26, 51.09; p=0.03). Over 75% of the isolates were sensitive to Amikacin, Meropenem and Ciprofloxacin. Bacteremia is remains to be a common cause of fever among children with SCD especially those under the age of five years, with palmar pallor, history of stroke and leucocytosis. Strengthening of antimicrobialstewardship program should be emphasized to reduce the antimicrobial resistance.