Objective To determine the mortality burden associated with unintentional injuries among children younger than 5 years of age in India.

Methods The Registrar General of India conducted verbal autopsy for all deaths occurring in 2001–2003 in a nationally representative sample of over 1.1 million homes. These verbal autopsy reports were coded by two of 130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved through reconciliation and, if necessary, adjudication. The probability of death during the first 5 years of life (per 100 000 live births) was estimated from the 2005 United Nations' population and death estimates for India, to which the proportions of deaths from the mortality study were applied.

Results Unintentional injuries were the sixth leading cause of death among children under 5 years of age. In 2005, unintentional injuries led to 82 000 deaths (99% CI 71 000 to 88 000) among children under 5 years of age, a mortality rate per 100 000 live births (MR) of 302 (99% CI 262 to 323). Mortality was higher in rural areas (MR=339, 99% CI 282 to 351), mostly due to more drowning deaths, than in urban areas (MR=173, 99% CI 120 to 237), where falls were the leading cause of child injury mortality.

Conclusion Unintentional injuries, specifically drowning and falls, lead to substantial mortality in children younger than 5 years of age in India. There is a need for continued monitoring of the injury burden and investigation of risk factors for evidence-based effective injury prevention programmes.