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Background: Household expenditure on health is increasingly becoming a major source of health care financing in Nigeria. Recognizing the limitations of this pattern of financing health care, the government has introduced a social health insurance scheme policy that has provided for government meeting the health care costs of children. However, there is a dearth of information on the pattern and costs of under-five illnesses at community level. This study therefore sought to determine the magnitude and causes of illnesses among under-fives, sources of healthcare and out of pocket expenditure among children under-five in Layin Zomo, a semi-urban area of Northern Nigeria Methodology: A cross-sectional community-based descriptive study design was used to study a population of under-fives in the settlement. A 50% sample of all under-fives in the settlement was drawn using systematic sampling method. Information was sought from the mothers/caregivers on illness episodes in the three months preceding the study, place and cost of treatment among the 324 sampled population. Result: The findings showed that 26. 9% of the children had been ill within three months of the study with fever; cough and diarrhoea being the leading causes of illness. Majority of respondents, 41.7% sought treatment from patent medicine vendors. The median out of pocket expenditure on treatment per illness episode was 171 Naira ($ 1.2) and the estimated annual per capita out of pocket treatment cost per child was 255 Naira ($1.8). Conclusion: While the study has provided some data for computation of the out of pocket health expenditure for treatment of under-five illnesses, the poverty context within which such expenditures are incurred limits the utilization of such information to determine the premium rate for the proposed children under five programme under the National Health Insurance Scheme.