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