Background: To know why India has failed to achieve Millennium Development Goal (MDG) 4. This aims at reducing U5MR by two- third between 1990-2015. Aim: To know the cause of paediatric death in North Maharashtra (Khandesh region) with 70% of Rural population. Measures to be taken to achieve MDG 4. To achieve clinico-pathological correlation in the cause of paediatric death. Material and Methods: A total of 124 cases were received for histopathological examination in the period of three year span from January 2014 to December 2016. 4 cases were completely autolysed. Hence 120 cases were included in the study. 9.6% cases belonged to neonatal age group, in whom perinatal asphyxia was the common cause. 15.3% belonged to infant and 71.7% belonged to childhood deaths. In both the age group, infection 78% was the main cause of death. On clinical correlation 16.6% discrepancy was present in neonate, 5.2% in infant and 4.4% in childhood. Medico-legal cases were seen in adolescent age group. Results: Prolonged labour and home delivery was the reason for perinatal asphyxia, which was the main cause of perinatal death in our study. Hence a good obstetric care in primary health centre along with educating mother is need in rural India. Effective intervention will be helpful in decreasing the mortality due to infection in infant and childhood deaths. Educating teenagers for hormonal changes is important in rural area too. Thus an autopsy study of paediatric deaths is informative and it can form baseline information for Promise of Renewal Movement.

Keyword: Millennium Development Goal (MDG ) 4.