Background: Pneumonia is a major cause of under-five morbidity and mortality in Sudan. Pneumonia standard case management has been followed in Sudan through the National ARI Programme. No studies have thus far looked at the inpatient case management of children admitted with pneumonia.Objectives: The study aims to describe the health care that children under five receive before reaching a first referral hospital, and the case management they receive when admitted as inpatients.Methods: In a cross-sectional descriptive study, children between 2 months and five years who were admitted in any of 3 referral hospitals from September to December 2005 in Jebel Awlia locality in Khartoum were enrolled. Interviews using structured questionnaires were used with caretakers to determine care seeking patterns prior tohospitalization. Patient records were used to determine case management; hospital registers, equipment and staffing levels were checked.Results: A total of 224 children were enrolled in the study. One of the 3 hospitals was the provider at which 61% of the caretakers sought care at first. Thirty percent of thecaretakers bypassed a health centre or another hospital within 5km of their homes; in a third of those, unavailability of services at facilities bypassed was the reason for this bypass. Of the children reaching the hospitals after being referred from otherfacilities, 53% were given a pre-referral treatment. At the hospitals, pneumonia constituted 38% of children under five admitted. Incomplete assessments of children'ssigns, particularly danger signs, lead to 90% of the children to have an inadequate classification and to a discrepancy between classification and treatment. Monitoring of the children's progress was inadequate.Conclusion: The findings suggest that areas to improve case management at hospitals include training health workers on assessment, classification, inpatient treatment and monitoring; in addition to complete recording of findings.