It is one of the Eastern Cape Provincial priorities to reduce the child mortality rate and further deal with challenges which influence such rates. Hence, information on morbidity and mortality patterns is essential for decision making or planning purposes. The purpose of this study was to describe the morbidity and mortality patterns for the under-5 year old children who were admitted in 11 district hospitals in Eastern Cape Province from 2000 to 2004. Pre-transitional causes were accountable for more than third of morbidity and mortality which can be associated with low socio-economic and under- development status of the province. The most commonest causes of both morbidity and mortality were diarrheal diseases,lower respiratory tract infections,protein-energy malnutrition and pneumonia. More than 40% of those deaths occured within 24 hours of admission. Multi-sectoral approach is essential to deal with those poverty related diseases in the province.