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Prevalence of Tuberculosis among Children with Severe Acute Malnutrition at Ola during Children’s Hospital in Freetown Sierra Leone. Worldwide, pediatric tuberculosis account for about 1million cases, annually, accounting for 10-15% of all tuberculosis; with more than 100,000 estimated mortality annually, it is also one of the 10 most common causes of childhood mortality. Aim of this study was to determine the prevalence of tuberculosis among children with severe acute malnutrition at Ola During Children’s Hospital in Freetown Sierra Leone. It was a descriptive cross-sectional study, carried out at the therapeutic feeding center (TFC) of Ola During Children’s Hospital in 2018. An opportunistic sampling method in which every next patient whose mother gave consent was recruited until the number 74 was reached. Patients who met the World Health Organisation (WHO) criteria for diagnosis of severe acute malnutrition were admitted into the TFC and consecutively selected and interviewed using a structured questionnaire after obtaining written informed consent, from their mothers or caregivers. All the mothers approached during the study period consented for the study. Diagnosis of tuberculosis was both clinically and by laboratory investigations, 74 children whose mothers/caregivers consented for the study were recruited. Data was entered into an excel spread sheet and analyzed using Epi info version 7. There were 74 children with a median age of 11 months ± 9.9SD. Forty (54.1%) Males and 34(45.9%) Females, with a M:F ratio of 1.18:1. Prevalence of tuberculosis was 20%. Diagnosis of Tuberculosis was Original Research Article Ide; JAMMR, 30(3): 1-7, 2019; Article no.JAMMR.49949 2 based on clinical findings of extreme weight loss or failure to gain weight, Chest x-ray findings of perihilar infiltrates. Gene Xpert MTB RIF results were all negative 0(0%). Most of the mothers 59 (79.7%) were aged between 20-29 years, 45(60.9%) of them were petty traders, while 15(20.3%) had no formal education. The chi square was used to determine the statistical difference, there was no statistically significant difference between gender and TB, P= 0.3415, there is a statistically significant difference between no formal education and occurrence of tuberculosis in their children P= 0.0467. Conclusions/Recommendations: Prevalence of Tuberculosis is still high among children with severe acute malnutrition. Gene Xpert MTB RIF was unable to make a bacteriological confirmation. There are difficulties with making bacteriological confirmation of tuberculosis in resource poor settings. Guidelines requiring mainly clinical parameters need to be developed for use in resource limited countries.