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One of the socio-economic determinants, mother's education is recognized as a powerful factor affecting child survival. Mother's education plays the dominant role for the children of enjoying better diets and better overall care than the children of non-educated mothers, and there is a strong inverse relationship between mother's education and under-five mortality. The urban rural differences under-five mortality rate in Odisha has very high. The rural areas mortality rate is relatively higher as compared to the urban Odisha. Because the urban area occupied by greater availability of health care services, higher income and educational level, while rural Odisha, most of children’s death occurs due to diarrhoea, fever, respiratory and dropsy. In urban areas 79 percent of the children age 12-23 months received all basics vaccination against six major childhood illness (tuberculosis, diphtheria, pertussis, tetanus, polio, and measles). The coverage of health care services including with immunization, safe delivery of birth is more developed in an urban areas than the rural area in Odisha. From the above background, the present study attempts to examine the trends and analyse the determinants of socioeconomic factor affect Under-five mortality in the state of Odisha. Therefore, region wise differences in the patterns and determinates of Under-five mortality will provide valuable insight as to why under-five mortality rates are high in this states. And also identify factor affecting change the under-five mortality in last two decades.
II. DATA AND METHODOLOGY
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A. Data The data for the present study has been extracted from the various annual publications of Sample Registration system (SRS) and the National Family Health Survey (NFHS-4, 2015-16). The level, trends and regional differentials in under-five mortality have analysed from the SRS data. This source has been drawn the variation by sex and urban, rural differentials by the place of residence. The Sample Registration System was introduced as a pilot scheme in some selected Indian states in 1964–65 to generate reliable estimates of fertility and mortality at the national and state levels. It was converted into a full-scale system in 1969–70. Apart from this SRS bulletin, analytical study reports and the occasional paper published at half yearly intervals provides birth rates, death rates and also abridged life table for the states and India. The second part of the analysis is based on the National Family Health Survey –III (2005-06) and IV (2015-16). The NFHS is a large-scale, cross-sectional, multi-round survey conducted in a nationally representative sample of households throughout India, under the Ministry of Health and Family Welfare, Government of India. In Odisha NFHS-III and IV, information was collected based on 1781 and 11,106 observations from the kid file for the last five years with the women age group of 15-49. All the woman surveyed were asked to provide complete birth histories including sex, date of birth, and survival status for each live birth; the analysis uses the birth history data. A total of birth occurred to the woman in Odisha in the last five year preceding the survey. The outcome variable ‘under-five death’ was assigned a value of 1 if the child died before 59 months and 0 if the child was alive at least until age 59 month. 1) Outcome Variable: We used the information on birth in five year preceding survey data from NFHS- 4 in the analysis.
Mortality under the age of five years has taken as dependent variable. Our outcome variable ‘under-five’ was assigned a value of 1 if the child died before age 59 months and 0 if the child was alive at least until age 59 months. 2) Independent variable: The number of studies has highlighted the role of socioeconomic, demographic and community variables in explaining under-five mortality in various countries (Caldwell 1979; Caldwell and McDonald 1982; Trussell and
Hammerslough 1983; Mosley and Chen 1984). The socio-economic variables included in the analysis were household wealth index (poorer; middle; richer and richest), mother’s education (no education; primary; secondary and higher), mother’s exposure to mass media (not exposed; at least one exposed), place of residence (urban; rural), caste (Schedule Castes; Schedule
Tribes; OBC and others) of the household head. The bio-demographic variables included in the analysis were birth order (first birth order; second; third and fourth or more), mother’s age at birth of the index child, sex of the child, size of the baby at birth and BMI status of woman (less than 24.6; normal and more than 24.6). These variables have a significant association with the under-five mortality (Gubhaju 1985; Sastry 1996; Manda 1999; Kembo and Ginneken 2009; Poel, O‘Donnell, and Doorslaer 2009; Sastry and Burgard 2011). We also used the health care utilization variables for example that tetanus vaccinations (not taken; taken), place of delivery care (home; institutional), assistant at delivery (doctors/ nurse/midwife: others) and antenatal care (not visit: visit). The health care utilization factors strongly associated with long time child survival (O‘Donnell et al. 2008). Another important determine of region wise estimate of under-five mortality (Claeson et al. 2000; Subramanian et al. 2006; Saikia et al. 2011). Accordingly we divided in Odisha into four regions (western; northern; southern and central) based on NSS region classification.
