Pneumonia is one of the leading causes of morbidity and mortality in under-fives throughout the world, particularly in developing countries. About 20% of all deaths in children under five years of age has been reported to be happen due to acute lower respiratory infection (ALRI). About 90% of ALRI associated deaths takes place due to severe pneumonia. Death attributed to pneumonia has decreased since 2000 G.C., but it remains a major public health problem. Additionally, there are no enough data to describe pneumonia outcomes in low-income countries even in the era after vaccines have been introduced. Therefore, this study is crucial in identifying major determinants of severe pneumonia outcomes.