Abstract

Although consideration work has been done to understand the effect of individual level factors on under-five mortality, less is known about the community (neighbourhood) characteristics affect health outcomes for children, even though they have a prominent role in theoretical model. This study address important issues in under-five mortality in India. The objective of this paper is to determine the important of community, household and individual level effect on under-five mortality in India. Using data from the latest round of Demographic Health Survey (DHS)-2019-2021, known as National Family Health Survey (NFHS) in India, multilevel cox proportional hazard analysis was performed on a nationally representative sample of 232,920 children nested within 168,273 household who were also nested within 29,770 communities. Hazard ratio (HR) with 95% confidence interval (CI) were used to express measure of association among the characteristics. Variance partition coefficient (VPC) and Wald statistics were used to express measures of variation. The results indicate that pattern of under-five mortality were clustered within household and communities. The community level variables like region, place of residence, community poverty level, community education level, ethnic fractionalization index were significantly determine under-five mortality in India. The risk of under-five deaths were significantly higher for children residing in North (HR: 1.34; 95% CI: 1.15-1.60), East (HR: 1.84; 95% CI: 1.59-2.13) and West regions (HR: 1.45; 95% CI: 1.23-1.70) compared to South region. In addition, the proportion of women in community completing secondary school (HR: 0.58; 95% CI: 0.51-0.66) were significantly more likely to increase the child survival. The mother level variables like maternal education, BMI, mother age at birth and breast-feeding were significantly determine under-five mortality. The results suggest to address the contextual level factors to address under-five mortality in India. The findings also suggest the need to focus on community-level intervention aim at improving the socioeconomic conditions of mothers, especially disadvantage regions such as North, East and West.