BACKGROUND: Data on causes of respiratory deaths in Africa are limited. METHODS: From January to April 2013, 28 African countries were invited to participate in a review of severe acute respiratory illness (SARI) deaths identified from influenza surveillance during 2009 - 2012. RESULTS: Twenty-three (82%) countries responded, 11 (48%) collect mortality data, and 8 provided data. Data were collected from 37,714 SARI cases and 3091 (8.2%, range by country 5.1-25.9%) tested positive for influenza. There were 1073 (2.8%, range by country 0.1-5.3%) deaths reported among whom 57 (5.3%) were influenza-positive. Case fatality proportion (CFP) was higher among countries with systematic death reporting than those with sporadic reporting. The influenza-associated CFP was 1.8% (57/3091) compared to 2.9% (1016/34,623) for influenza-negative cases (p<0.001). Among 834 (77.7%) deaths tested for other respiratory pathogens, rhinovirus (n=107, 12.8%), adenovirus (n=64, 6.0%), respiratory syncytial virus (n=60, 5.6%), and S. pneumoniae (n=57, 5.3%) were most commonly identified. Among 1073 deaths, 402 (37.5%) were aged 0-4 years, 462 (43.1%) aged 5-49 years, and 209 (19.5%) aged 50 years and older. CONCLUSIONS: Few African countries systematically collect data on respiratory hospitalization outcomes. Stronger surveillance for respiratory deaths may identify risk groups for targeted vaccine use and other prevention strategies.