Contextualising under-five deaths in Bihar, India: Insights from primary and secondary data.

• Sharp decline of under-five mortality rate in Bihar since 2006 (launch of Janani Suraksha Yojana). • Mortality is worst in the flood affected, north-eastern districts of Bihar. • 83 % deaths occur in 12 months among all deaths under-five years in Bhagalpur. • 70% deaths happen in the first seven days among all infant deaths in Bhagalpur. • Wealth status and house types are the strong correlates of under-five deaths in Bhagalpur. The first objective is to examine the trends, patterns and socio-demographic factors associated with the under-five mortality in Bihar and Bhagalpur district. The second objective is to study the geographical differences in under-five mortality in Bihar. The study uses both secondary and primary data. The information of under-five mortality drawn from the secondary sources i.e. Sample Registration System (SRS) for 1981–2013 and the National Family Health Survey for 2015–16. The primary data was collected in 2019 from Bhagalpur district of Bihar. Trends of under-five mortality rates in Bihar are presented in line graphs. The spatial distribution of under-five mortality rates is presented in maps. Cox-proportional hazard model and logistic regression models are applied to assess the socioeconomic and demographic correlates of under-five mortality in Bihar and in Bhagalpur district respectively. Under-five mortality rate has decreased significantly since 2006 in Bihar, still it remains higher than the national average. Geographical patterns show the under-five deaths were disproportionately high in north-eastern regions of Bihar. This pattern of under-five mortality rates is considerably varied across the selected socioeconomic and demographic characteristics. The findings confirm that the mother's nutritional status (BMI) and level of education, wealth status, and caste were significant factors of under-five mortality. The regression analysis show that the likelihood of under-five mortality was 1.2 times higher among the women who are underweight, who belong to the scheduled caste compared to their counterparts. Besides, the female children are more likely to die during their childhood than their male counterparts. Similar patterns also found in Bhagalpur district. The study reveals that under-five mortality is a serious public health concern in Bihar and Bhagalpur. The high under-five mortality in the study area is associated to poverty, maternal illiteracy and malnutrition, and geographical regions of Bihar. The flood prone north-eastern parts of Bihar experiencing higher under-five mortality compared to other parts. To reduce under-five mortality in Bihar as well as Bhagalpur, women's education, work involvement, and empowerment need to be prioritised to achieve the sustainable development goal-3 by 2030. [ABSTRACT FROM AUTHOR]