Infant and child death in developing countries constitute the largest age category of mortality. This is because children under the age of five years are the group most vulnerable to diseases caused by inadequate child care, health risks, and poor environmental conditions. The overall aim of this study was to explore the demographic, environmental, socio-economic and health seeking behavioural factors contributing to childhood mortality in peri-urban communities. A cross-sectional analytical study was undertaken between January and May 2007 adopting both quantitative and qualitative approaches. Quantitative data was collected using a semi-structured questionnaire administered to 384 mothers aged 15 - 49 years and having children aged below five years alive or dead. Qualitative data was collected through focus group discussions and key informant interviews with selected participants. The main outcome measure was identification of the main determinants of childhood mortality at household level in the peri-urban communities based on proportions of children dead, correlation coefficients and multiple regression analysis. The study revealed that the main determinants of child health in peri-urban communities are maternal occupation and immunizations uptake (t = -5.094, P = 0.000 and t = -3.888, P = 0.012 respectively). Treatment of drinking water, source of drinking water and maternal age also had strong influence on child health (t = -3.647, P = 0.028 and t = -3.111, P = 0.034 respectively). Maternal occupation emerged as the main determinant of child health in peri-urban communities. Overindulgence of mothers in small scale businesses and casual work in urban centers compromises child care hence the high infant and child morbidity and mortality reported in peri-urban settings. This calls for focused health education and services targeting the mothers.