Children accounted for 11% of all ICU admissions with a mortality rate of 40%. This is similar to other African country ICUs [17, 18] , but considerably higher than in industrialised countries [19] . The lack of ventilators and accompanying resources in the paediatric high dependency unit at the Mulago hospital is one of the main reasons why children are admitted to the study ICU. Although our study cannot prove a causal relationship, it is likely that delayed initiation of mechanical ventilation and aggressive resuscitation could explain the high death rate in the paediatric patients in the study population There was a higher mortality in the paediatric medical group than in the surgical group, and we hypothesise that this is because a lot of the post-operative patients were elective surgical patients who were admitted for observation. Most paediatric referrals were, and continue to be, children with acute respiratory failure who are transferred from the paediatric high dependency unit because they are in need of mechanical ventilation. The relatively younger population in LICs and the fact that respiratory illness is the leading cause of deaths in under-5-year olds in such countries [20] , implies that more emphasis should be placed on strengthening paediatric critical care resources in LICs. Previous studies have suggested the need to estimate the cost effectiveness of critical care in this setting, given the relatively younger and economically active population. [1, 2] The fact that HIV is endemic in Uganda explains why HIV/AIDS was one of the most common reasons for admission in the study population. Due to the advent of easily accessible highly active anti-retroviral therapy, together with septrin prophylaxis, the incidence of HIVrelated diseases (such as pulmonary infection with Pneumocystis jiroveci, which usually presents as acute respiratory failure) has markedly decreased [21, 22] . In this survey, it was difficult to retrospectively determine from the medical records whether acute respiratory failure was due to infection or other causes. We could, however, determine that chronic obstructive pulmonary disease was a very rare cause of acute respiratory failure in our setting. Other rare HIV-related causes of ICU admission were viral encephalitis and liver failure.