A house to house survey of paediatric deaths which occurred from January to December 1991 in the village of Nko, Cross River State, Nigeria, was carried out. Among the 471 total deaths recorded, the leading causes were malaria (29%), protein-energy malnutrition, pneumonia and diarrhoeal disease (11% each), Neonatal deaths were largely due to septicaemia, tetanus and birth asphyxia. Poor domestic and human waste disposal, lack of potable water and basic health facilities appear to be the important related factors to child health problems in this community. The provision of public toilets, safe water, primary health care centres and health education can definitely improve the health status of this rural community. Events in other rural communities in Nigeria are most likely to be similar to that in Nko. Such populations need to be identified and their problems urgently addressed. ,