In Niger, 54.4% of the population live below the poverty level (less than 750 FF per year per person). The government is currently implementing a policy to reduce medical costs, including those of hospitals. We carried out a study during the rainy and dry seasons of 1994-1995, of 80 children, randomly selected, who had been admitted to the pediatric ward of Niamey National Hospital. The total expenditure of their families, due to their hospitalization, was recorded and analyzed. The total expenses of the family were 151.8 (+/- 100.0) to 185.5 (+/- 118.9) FF depending on where the drugs were purchased (wholesale or private). Medical expenses accounted for 98.0 (+/- 48.3) to 119.8 (+/- 57.2) FF, that is 60.0 to 64.5% of total expenses. Non-medical expenses (transport, food, presents) accounted for 61.7 to 65.7 FF, 35.4 to 39.9%. Total daily expenses were 23 to 41.7 FF for the five main diseases. In 66 cases, the costs were paid by the father (82.5%), with the mother or another person paying in 7 cases (8.8%). Only 24 families (30%) paid the hospital fee (10.5 FF). Twenty-seven families were exempted and 22 avoided payment. The cost of medical analysis was 32.6 (+/- 31.3) FF and this was paid by the hospital. The total cost (total family expenditure + hospital expenditure) of a stay in a pediatric unit was 316.5 to 350.4 FF, which is equivalent to 8 to 10 times the mean annual individual expenditure on health in urban areas of Niger. Measures have already been introduced to encourage the prescription of generic drugs and a number of measures are currently under discussion for lowering the cost to families of hospital and health center care and for improving the cost effectiveness of treatment.