A prospective study of acute bacterial meningitis in infants and children in Kumasi, Ghana identified 69 cases by culture or antigen detection. Of these, 50.7% (n=35) were S. pneumoniae, 34.8% (n=24) N. meningitidis and 14.5% (n=10) H. influenzae. The mortality for each pathogen was 36.4%, 17.4% and 30%, respectively, showing no significant difference. In pneumococcal meningitis, the most significant clinical factor associated with an increased mortality rate or subsequent neurological sequelae was a lowered level of consciousness at admission (chi-2=8.66, d.f.=1, p=0.003). Antibiotic susceptibilities were determined in the 40 positive isolates. Six cases of N. meningitidis and two of S. pneumoniae were penicillin-resistant, and there was a single case of chloramphenicol-resistant S. pneumoniae.