Pneumonia is the leading cause of childhood deaths in Bangladesh and a common cause of hospitalization. Limited studies have assessed the treatment cost of pneumonia and the mechanisms adopted by families to cope with the financial burden. We determined the out of pocket expenditure and coping strategies adopted by the families of children admitted in a hospital with pneumonia. Methods: We conducted a cross sectional survey with parents of 90 children below 5 years of age, who were admitted in

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... he only referral pediatric hospital in Bangladesh with pneumonia. We estimated total cost of illness of the event of hospitalization and conducted in-depth interviews with six families Results: The mean expenditure of the families for the illness episode was US$ 91.25 (±SD 52.49) and 66% reported to spend more than half of their total monthly expenditures on this hospitalization. Three fourth (68/90, 76%) families had to manage the expenditure by borrowing, selling or mortgaging assets; 64% had to borrow the full cost and 38% of them had borrowed from formal sectors (bank, money lender etc.) with a monthly interest rate of 8 to 10%. Families with lower socio-economic status (monthly expenditure US$ 57 dollars) to borrow money (OR = 10.0 (95% CI: 2.8-38.8). Half of the respondents were planning to repay loans by reducing spending on the type and amount of food, while 22% had planned to work extra hours. Conclusion: The out of pocket expenditure for treating children with pneumonia in hospital is high and the coping strategies adopted by the poor attributes to hardship in the future. Administration of effective vaccines (HIB, pneoumococcal) may reduce the disease burden of pneumonia and eventually the economic burden of the families.