Using data on 825 under-5 children from the Ouagadougou Health and Demographic Surveillance System collected in 2010, this article examines the effects of aspects of the immediate environment on childhood fever. Logit regression models were estimated to assess the effects of the quality of the local environment on the probability that a child is reported to have had a fever in the two weeks preceding the survey, after controlling for various demographic and socioeconomic variables. While the estimated impact of some environmental factors persisted in the full models, the effects of variables such as access to water and type of household waste management decreased in the presence of demographic, socioeconomic and neighbourhood factors. The management of waste water was found to significantly affect the occurrence of childhood fever. Overall, the results of the study call for more efforts to promote access to tap water to households at prices that are affordable for the local population, where the threats to child health appears to be greatest.