Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and are a common cause of road traffic injuries. The aim of this study was to establish the prevalence, injury pattern and treatment outcome of motorcycle injuries among patients presenting to Bugando Medical Centre in Mwanza, Tanzania, between March 2009 and February 2010. Data was collected using a pre-tested, coded questionnaire. A total of 384 motorcycle injury patients were studied constituting 37.2% of all road traffic injuries. Over two-thirds (69.5%) of the patients were males (Male: Female ratio = 2.3:1). The mean age of the patients was 25.7 years (range: 4-87 years). The majority of patients were businessmen and students accounting for 68.8% and 42.2%, respectively. Motorcyclists accounted for the majority of motorcycle injury patients (212, 55.2%), followed by passengers (130. 33.9%) and pedestrians (42, 10.9%). Helmet use was recorded in 87 patients (22.7%). Most patients (352; 91.7%) sustained blunt injuries. Musculoskeletal (extremities) and head injuries were the most common body region injured affecting 234 (60.9%) and 212 (55.2%) patients, respectively. The majority of patients (244; 63.5%) were treated surgically. Wound debridement was the most common (86.9%) procedure performed. The overall mean length of hospital stay (LOS) was 19.23 days (range= 1-120 days). The LOS for non-survivors was 5.6 days (range= 1- 25 days). Patients with major trauma (ISS > 16), severe head injury (GCS 3-8) and those with long bone fractures stayed longer in the hospital and this was significant (P-value <0.001). Mortality rate was 16.7% (64 deaths). Age of the patient, non-helmeted patients, major trauma (ISS > 16), admission systolic blood pressure <90mmHg, severe head injury (GCS <9), need for intensive care unit admission and need for ventilatory support significantly influenced mortality (P-value < 0.001). Motorcycle injuries constitute a major but neglected emerging public health problem in Mwanza City and continue to be one of the most common cause or agent of road traffic injuries. The morbidity and mortality can be mitigated by encouraging use of protective gear like helmets and encouraging enforcement of traffic laws.