Background: Pneumonia is inflammation of the lungs parenchyma due to various etiologies and is a major cause of childhood morbidity and mortality worldwide. Every year approximately 158 million cases of pneumonia reported worldwide and out of which, 154 million pneumonia cases occurring in developing countries. The clinical presentation of childhood pneumonia varies depending upon the causative factors and host susceptibility and immune status of the subjects. Treatment options of pneumonia depend on severity of disease, causative factors and resistivity of pathogens (MDR) for drugs. Aim: To investigate the factors associated with treatment outcome of severe non multidrug resistant pneumonia in children less than 5 years of age in the Jimma region of Ethiopia. Methodology: A cross sectional study, included children aged 2-59 months with severe pneumonia. Data was collected using standard questionnaires recorded by face to face interview with parents/caretakers and all the clinical history of the patients were recorded from treatment data sheets. Results: Out of 107 children with severe pneumonia, 22 (20.6%) were lived in urban and 85 (79.4%) in rural areas. The male to female ratio were 1.18:1. Only 52.34% of the subjects were vaccinated as per WHO guidelines. 61.7% of the children were lived in houses with attached kitchen in living room. 6 (5.6%) were sero-positive for HIV. Malnutrition was found significantly high in subjects with pneumonia (p<0.05). A remarkable number (48.6%) of the children had family member with symptoms of URTI and 12 (11.2%) of the children had previous history of pneumonia. Only 8 (7.5%) of the children had history of cigarette smokers in the house. Conclusion: The risk factors for poor outcome in childhood pneumonia include rural residence and poor infrastructure, parental literacy rate, vaccination, nutritional status, household environment, co-residents with upper respiratory tract infections (URTI). Parental education, diet counseling, avoidance to contact with infected person will reduce the prevalence of pneumonia and will be helpful in better hospitalization outcomes.