Between 1990 and 2015, deaths of children under five have gone down by half worldwide but India has had the highest number of such deaths at 1.3 million in 2015. India has pulled down maternal deaths but Bangladesh has done better, according to the Global Burden of Disease 2015 study published in The Lancet, detailing key drivers of illness, disability and death in countries.
The number of under-5 deaths has gone down from 12.1 million in 1990 to 5.8 million in 2015. India at 1.3 million was followed by Nigeria with 726,600 and Pakistan with 341,700. Over 30 per cent of these under-5 deaths took place in South Asia. Neonatal mortality (death in the first month of life) has fallen slower than child mortality, from 4.6 million in 1990 to 2.6 million in 2015 globally. The decrease is 42 per cent, compared with 52 per cent for under-5 deaths.
“Under-5 mortality fell at an annual average rate of 3 per cent between 1990 and 2015 – compared with 4.4 per cent rate required to achieve the Millennium Development Goal (MDG) target. Another 14 million children would have survived had the target been met,” Kevin Watkins of Save the Children wrote in an editorial comment in The Lancet.
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Pre-term birth complications and birth asphyxia and trauma were the leading causes of deaths in children younger than 5 years worldwide. Lower respiratory infections are the third leading cause of child deaths overall. These infections account for around 16 per cent of mortality, with diarrhoeal diseases (the fourth leading cause of death in 2015) accounting for another 9 per cent.
In first-ever estimates of the number of stillbirths, the study counted 2.1 million such instances in 2015. The number of stillbirths in India was estimated at 0.61 million.
Of 195 countries studied, 122 countries have met the Sustainable Development Goal (SDG) target to reduce the number of women dying from pregnancy-related causes to less than 70 for every 100,000 live births by 2030.
Bangladesh has improved faster than expected while India has shown a slower pace in reduction of such deaths. Bangladesh had 7,663 maternal deaths in 2015, a two-thirds drop from its 21,789 in 1990, while India’s maternal deaths dropped by half to 63,861 in 2015 from 1,32,239 in 1990. Globally, maternal deaths decreased by a third from 390,185 in 1990 to 275,288 in 2015.
“Increasing use of reproductive health services was one of the driving factors behind establishment of the Janani Suraksha Yojana conditional cash transfer programme in India. Janani Suraksha Yojana has been successful at increasing reproductive health-care services, but despite its popularity this programme has not been as effective at reaching poor rural women, the socio-demographic group that is already at highest risk of adverse pregnancy outcomes,” the GBD 2015 study said.
A total of 1,870 independent experts in 127 countries as part of the GBD 2015 study collaboration analysed 249 causes of death, 315 diseases and injuries and 79 risk factors in the 195 countries between 1990 and 2015.
A total 10,287,692 deaths were registered by the GBD 2015 study in India. Ischaemic heart disease accounted for 15.7 per cent of these deaths (1,610,122), chronic obstructive pulmonary disease (COPD) for 10 per cent (1,041,713) and stroke for 7.8 per cent (802,000).
The average life expectancy for men has increased to 65.2 years in 2015 and that for women to 69.5 years. Globally, it is 69.0 years for men and 74.8 years for women.
Globally, trends suggest that noncommunicable diseases will pose a major challenge of longer survival accompanied by an expansion of morbidity that health systems have to deal with. Dr K Srinath Reddy, one of the co-authors of the study, said that even as primary prevention has to be vigorously promoted, the demands of secondary prevention for people who live with NCDs will increase.
Worldwide, life expectancy has risen but 7out of 10 deaths are now due to non-communicable diseases. The number of annual deaths has increased from roughly 48 million in 1990 to almost 56 million in 2015 and 70 per cent of global deaths were due to NCDs including ischaemic heart disease and stroke. Headaches, tooth cavities, and hearing and vision loss each affect more than 1 in 10 people .
The study also went into deaths due to natural disasters. Between 2004 and 2010, 74 700 people died in earthquakes in India and Pakistan. In 2015, natural disasters caused 11,800 deaths, mainly in the Nepal earthquake and floods in India.