Background Children are vulnerable to injury due to limited cognitive abilities and dependence. Annually, 4.4 million children die from injuries globally, features among the top ten causes of disability-adjusted life years (DALYs) and deaths in India. The wide discrepancy among findings in various studies and the lack of sufficient studies on hazard assessment for childhood injuries necessitated the present study.

Objective The study examines injury prevalence, patterns, and risk factors among under-five children in rural Odisha, India, with a special focus on the assessment of the built environment.

Materials and Methods A community-based cross-sectional study was conducted in the rural areas of Khordha district among 600 under-five children from February 2022 to December 2023. A multistage sampling technique was used to assess the prevalence, patterns, and factors associated with injuries using a semi-structured questionnaire, followed by an environmental hazard assessment of the built environment of the selected participants.

Results Childhood injury prevalence was 44.6% (95% CI 40.6–48.7). Falls contributed most (84.3% major and 88.9% minor) of injuries, with 87% of them occurring at home, mainly involving the lower extremities (51.8%). Only 19% of major injuries received formal care. The child’s age, parents’ awareness of injuries, and environmental hazard risk were found to be associated with the occurrence of injuries in multivariate analysis.

Conclusion Childhood injuries are frequent events of morbidity in the rural neighbourhoods of Odisha. Built environmental assessment plays a significant role in childhood injuries; thus, public health measures such as a safe built environment for households and neighbourhoods should be promoted.