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This research was designed to assess the trends in morbidity and mortality of U5 admitted at the PCMH in the East-end of Freetown, Sierra Leone, from 2004 to 2008. To achieve this, the data used were obtained from review of records in PCMH. Of the data collected cases that shows high prevalence morbidity and mortality include: Malaria, Acute Respiratory Infections (ARI), Anaemia, Diarrhoea, Convulsion and undiagnosed cases. Findings show that there is no significant improvement in the reduction of both U5 morbidity and mortality rate compared with previous study. The high prevalence of U5 morbidity in 2008 compared to the other years in review justified the trend in U5 morbidity and mortality. Malaria still poses a challenge as the leading cause of both morbidity and mortality among children U5 over the years; followed by ARI, Anaemia, Diarrhoea, Convulsion and Undiagnosed cases.