Background: Lower respiratory tract infections (LRTI) are among the leading causes of morbidity and mortality. A severe form of atypical pneumonia, Q fever, has been found in Northern Tanzania. Assessment of the quality of health care for lower respiratory tract infection from the clinicians’ performance has rarely been performed.

Methods: A cross sectional descriptive study using the qualitative and quantitative approaches for assessing clinicians and patient files from 11 health facilities of Kilimanjaro region. The facilities were of 4 different levels of public health care delivery and 1 private independent hospital.

Results: Medications for LRTI were highly variable in 346 files and from attempts of treatment reported in 53 clinician’s interviews. No file showed attempts for assessing the severity of Pneumonia. Only 6 (11.1%) clinicians could mention causes of atypical pneumonia. Only 7 clinicians (13.0%) were aware of Q-fever and could mention the cause. The quality of clinical records for monitoring the progress was not the same in all levels of care and the difference in availability was statistically significant as level of mental state χ2 (4) = 139.4; P value < 0.001, blood pressure χ2 (8) = 75.2; P value < 0.001, temperature χ2 (4) = 78.7; P value < 0.001, pulse rate χ2 (4) = 139.1; P value < 0.001, respiratory rate χ2 (4) = 197.7; P value < 0.001, auscultation χ2 (4) = 92.2; P value < 0.001.

Conclusion: National guidelines for LRTI in Tanzania shall include severity assessments and how to rule out atypical pneumonia using evidence base approaches.