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Background Pedestrians are vulnerable road users worldwide, but more African governments are setting up Safety Commissions. Objectives To examine the current pedestrian injury profile in the third most densely populated city in Africa with dysfunctional transportation and poorly responsive healthcare delivery system. Methods Emergency Room records were collated for 3 months prospectively for all pedestrians injured and brought to the busiest tertiary hospital centre in Lagos, Nigeria, (Lagos State University Teaching Hospital). Parameters checked included biodata, mechanism, location, and regions of injury; and outcome among others. Results Pedestrians were 214 (M: F=2.2 : 1, peak age 21–30 years) including students (22.9%), self- (23.4%) and government-employed (10%) persons. Vehicles involved include motorcycles (29.4%), buses (29.0%) and cars (23.4%). Pedestrians were injured on highways (55.6%), in the inner city (42.1%)—knocked down while crossing (55.1%), walking by pavement (21.5%), standing by bus stop (10.7%), at home-area (6.1%) and others (6.5%). Regions injured mostly were the head (39.3%), lower limb (30.4%) and multiple regions (15%). Patients were brought by relatives 43.0%, bystanders 29.3%, self 13.1%, ambulance 5.2%, and police 5.6%. Fifty-nine of the 80 lower limb injuries were fractures (73.8%). Twenty eight patients (13.1%) died, 10 of them brought-in-dead while 64 patients (29.9%) were transferred to another hospital. Significance Discounting the 29.9% patients referred; death rate was 28 in 150 (18.7%) meaning 1 in 5 injured pedestrians died. This could be one of the highest pedestrian death rates in the world; profile strongly emphasises continuous need for injury prevention by all stakeholders.