Invasive Bacterial Disease study (IBD) seeks to understand the causes of life-threatening illness in neonates and children admitted to Hiwot Fana Comprehensive Specialized University Hospital (HFCSUH). It is one arm of a wider program called Child Health and Mortality Prevention Surveillance (CHAMPS-Ethiopia) that has established Clinical surveillance. This study determines the etiology, drug susceptibility pattern, treatment outcome and associated factors of IBD in children below five years of age admitted to HFCSUH.  Moreover, the study employs mixed methods to determine factors that influence under-five children’s Discharge Against Medical Advice (DAMA) and investigate the perspectives of doctors, nurses, and families on DAMA decision-making at HFCSUH.