Epidemiology of Under-five Child Death Review, Nabarangpur District, Odisha, 2017-2021

Under-five mortality remains a significant public health challenge in India, particularly in underserved districts such as Nabarangpur, Odisha, which reports a higher mortality rate than state and national averages.

This study analyses child death review (CDR) data from 2017 to 2021 to understand the epidemiological patterns, causes, and systemic delays contributing to under-five deaths in the district.

We also performed time-series analysis on mortality rates (neonatal mortality rate [NNMR], infant mortality rate [IMR], under-five mortality rate [U5MR]) using the Chi-square test for trend, and P < 0.05 were considered significant.

A total of 4871 under-five deaths were recorded: 47% neonates, 41% postneonates, and 12% aged 1-5 years. A significant gender disparity was observed, with 58% of deaths occurring among males (P = 0.0002). Most deaths (63%) occurred at home, indicating substantial barriers to healthcare access. The leading causes of death were low birth weight (28%), pneumonia (17%), and birth asphyxia (8%). Among identifiable delays, decision-making was most common (33%), followed by transport and hospital delays. Postneonatal deaths increased twofold over the 5-year period. Time-series analysis showed a steep decline in NNMR, IMR, and U5MR up to 2019, followed by stagnation and modest reversal of IMR and U5MR during 2019-2021. Poisson regression confirmed a nonsignificant upward slope in overall deaths in the later years.

This study demonstrates the utility of CDR data in informing evidence-based and context-specific interventions. Formal time-series analysis underscores both progress and recent setbacks. Strengthening antenatal care, immunization, and resilient maternal-child health services is critical to sustain reductions and achieve Sustainable Development Goal 3.