PIP: The author reports findings from an assessment of the extent to which injections are used by mothers in Ghana, Kenya, Uganda, and Zimbabwe to treat cough and fever in their children as well as the factors which influence their use. Two rationales are presented for conducting the study. First, the prevalence of HIV infection in many countries and the potential for infection using contaminated needles points to the need to minimize injections except when necessary and under only the most sterile conditions. Second, participation by intended groups in immunization programs has been less than complete, partly due to mothers' fear of the link between injections and subsequent paralysis in children documented in the literature since 1950. Knowledge on which factors determine parents' use of injections for treating childhood diseases could be used to help convince parents that injections for immunization against childhood diseases are beneficial. The author applied the Andersen Behavioral framework of predisposing, enabling, and need factors to Demographic and Health Survey (DHS) data collected in the four countries during 1988 and 1989. Nationally representative sample sizes ranged from 4201 respondents in Zimbabwe to 7150 respondents in Kenya. Morbidity data were collected from the mother for all living children under five years of age using a standard questionnaire. The percentages of children reported to have had cough or difficult breathing in the four weeks preceding the survey are as follows: 20.6% in Ghana, 17.5% in Kenya, 22.2% in Uganda, and 48.0% in Zimbabwe. Children aged 6-11 showed the highest prevalence of respiratory symptoms followed by children aged 12-23 months. The prevalences of fever during the four weeks preceding the survey were 36.4% in Ghana, 42.7% in Kenya, 44.2% in Uganda, and 7.0% in Zimbabwe. The prevalence rates of fever were higher among children aged 6-11 months and markedly lower among children aged 1-5 months. Prevalences of respiratory problems and fever were both considerably higher in rural areas than in urban areas. Approximately 20% of children with respiratory problems and 30% of children with fever were treated with injections. Multivariate analyses found that the effects of predisposing and enabling characteristics upon the use of injections were consistently higher than those of the need component, suggesting the existence of great inequities in the health care system. Previous research has found that such injections are often given by various people including untrained health personnel, itinerant drug peddlers, traditional healers, and new forms of injection doctors who specialize in giving all types of injections. Such practice combined with the fact that injection drugs can be bought over the counter demands the tighter control of drug sales and drug reform in these countries. Health education programs for consumers are also called for.