Background Although models of hospital-based palliative care are common in high-income countries, they are rare in low-income countries despite the high burden of progressive disease.

Aim To measure the proportion of all adult and child patients admitted with previously diagnosed active life-limiting disease, who therefore may be appropriate for palliative care provision, across all beds.

Design One-day 24 h census using chart review across every ward and department.

Setting/participants All admitted patients at a large tertiary referral hospital in sub-Saharan Africa.

Results Of 1763 reviewed patients, 663 (37.7%) had a diagnosed active life-limiting disease. Of these, 130 (19.6%) were children. The most prevalent diagnoses were HIV (41.7%), cancer (41.5%) and heart disease (9.2%). During the 24 h census period 19 patients died (population mortality rate 0.01%).

Conclusions In order to appropriately respond to need, hospital-based palliative care services in low-income settings must be of adequate size to respond to high prevalence of life-limiting illness, and to provide education and support to clinical colleagues managing all patients with life-limiting disease.