Bacteraemia is a recognised complication of severe malaria and may increase mortality. We determined 1) the rate and pattern of bacteraemia in children with severe malaria; 2) the impact of bacteraemia on case-fatality rate; and 3) the rate and pattern of bacteraemia in following blood transfusion for severe malarial anaemia. For the first two objectives, a prospective study was undertaken involving children admitted consecutively to the Malaria Research Project ward between February 1996 and June 1999. Blood culture was performed on admission. Independent associations with bacteraemia and mortality were determined by logistic regression. Of 701 children with a final diagnosis of severe malaria, 36 (5.1%) had bacteraemia. A wide range of bacteria was isolated and the commonest was non-typhoidal Salmonella (NTS: n=18 or 50% of all isolates). The rate of bacteraemia was significantly higher in children with severe malarial anaemia without coma (11.2%) than in children with cerebral malaria without anaemia (3.2%) and this was due to the significant association of NTS bacteraemia with severe malarial anaemia (p