Objective: Under-five mortality is a major public health challenge particularly in developing countries like India. The study was undertaken a hospital-based cross-sectional study to see the pattern of childhood mortality in a tertiary care hospital of Eastern India.Methods: This study was a hospital-based cross-sectional study on under-five children, carried out in the Department of Pediatrics in a tertiary care hospital from January 2013 to December 2014. All the children admitted to the inpatient Department of Pediatrics from 1 month to 5 years were included in the study group and those who died were further explored.Results: Maximum number of death occurred due to central nervous system infection (25.5%) followed by acute respiratory tract infections (19.5%) and complicated malaria (17.2%). Death occurred due to measles and its complication was 1.1% during the study. The percentage of death was higher among rural children (65.2%), children belonged to joint families (63.3%), backward classes (82.8%), low education, and the 1st order birth (49.1%).Conclusion: Specific efforts to combat under-five mortality are needed. In order of priority, the promotion of female education, gender equity, family planning, and addressing the vast socioeconomic differentials in Odisha is important steps to improving under-five survival.