Under-5 Mortality Rate (U5MR) and Causes

Definition

• U5MR: Number of deaths of children under 5 years of age per 1,000 live births in a given year
• Formula: (Under-5 deaths / Live births) × 1000
• Sensitive indicator of overall child health, nutrition, sanitation, maternal education and quality of health services
• Includes neonatal (0–28 days), post-neonatal (29 days–1 year) and child (1–5 years) mortality

Current Status in India (2026 Context)

• SRS 2023: National U5MR = 29 per 1,000 live births (down from 32 in NFHS-5 2019–21 and 43 in 2014)
• Rural U5MR = 32; Urban U5MR = 21
• Neonatal Mortality Rate (NMR) accounts for ~60% of U5MR; Infant Mortality Rate (IMR) accounts for ~85% of U5MR
• SDG target: U5MR ≤25 by 2030; India on accelerated decline track under RMNCH+A strategy

Age-wise Distribution of Under-5 Deaths

• Neonatal (0–28 days): 58–62% (early neonatal 0–7 days: ~45%)
• Post-neonatal (29 days–11 months): 22–25%
• Child (12–59 months): 15–18%

Major Causes of Under-5 Mortality (SRS Cause-of-Death Report 2020–22 & NFHS-5)

Neonatal Period (0–28 days)

• Prematurity & Low Birth Weight (LBW): 31–33%
• Birth asphyxia & birth trauma: 10–12%
• Neonatal sepsis & infections: 8–10%
• Congenital anomalies: 5–7%
• Others: Respiratory distress syndrome, hypothermia, jaundice

Post-Neonatal & Child (1–59 months)

• Acute Respiratory Infections (pneumonia): 15–17%
• Diarrhoeal diseases: 8–10%
• Severe Acute Malnutrition (SAM) & micronutrient deficiencies: 6–8%
• Vaccine-preventable diseases (measles, pertussis, tetanus): 3–5%
• Injuries, poisoning & accidents: 4–6%
• Malaria, meningitis, tuberculosis, congenital heart disease

Key Determinants

• Biological: LBW/prematurity, male sex, multiple births
• Maternal: Young age, anemia, hypertension, inadequate ANC, short birth interval
• Socio-economic: Poverty, low female literacy, rural residence, poor sanitation, indoor air pollution
• Healthcare: Three-delays model (decision to seek care, reaching facility, receiving adequate care)
• Environmental: Climate change, vector-borne diseases, unsafe water

National Interventions Addressing U5MR

• RMNCH+A & LaQshya quality certification
• Facility-Based Newborn Care (FBNC): NBCC–NBSU–SNCU/MNCU
• SAANS Campaign (pneumonia)
• Anemia Mukt Bharat & POSHAN Abhiyaan
• Mission Indradhanush & U-WIN (immunization)
• Home-Based Newborn Care (HBNC) & RBSK (4Ds screening)
• Janani Shishu Suraksha Karyakram (JSSK) – free transport/drugs
• MusQan & ABDM for quality & digital tracking

Prevention Strategies (Pediatrician’s Perspective)

• Antenatal: ≥4 ANC visits, IFA, high-risk detection
• Intranatal: Skilled birth attendance, partograph, delayed cord clamping
• Postnatal: Essential Newborn Care, KMC for LBW, exclusive breastfeeding
• Community: ASHA home visits, danger-sign recognition, timely referral
• Nutrition & immunization: WIFS, biannual deworming, PCV/Hib/MR
• Convergence: RBSK/DEIC for congenital anomalies, NTEP for TB exposure, NPCCHH for climate/air pollution
• Surveillance: ABDM-linked high-risk follow-up