The Under-5 Mortality Rate in India has dropped by 49 per cent since 2000, but there is a six-fold variation in the rate between states and an 11-fold variation between various districts. These are the findings of two scientific papers on child survival by the India State-Level Disease Burden Initiative.
According to the papers, published on Tuesday, there were 1.04 million under-5 deaths in 2017, down from 2.24 million in 2000. Neonatal deaths reduced from 1.02 million in 2000 to 0.57 million in 2017.
Neonatal Mortality Rate (NMR) dropped by 38% since 2000, but there is a five-fold variation in the rate between the states and eight-fold variation between the districts of India, said Prof Lalit Dandona, director of the India State-Level Disease Burden Initiative.
One paper in The Lancet reports the first comprehensive estimates of district-level trends of child mortality in India from 2000, while the other paper in EClinicalMedicine reports detailed district-level trends of child growth failure.
The findings show that although child mortality and child growth failure indicators have improved substantially across India from 2000 to 2017, inequality between districts has increased.
The trends reported in these papers utilised all accessible georeferenced survey data from a variety of sources in India, which enabled more robust estimates, Dandona said.
As much as 68% of under-5 deaths in India are attributable to child and maternal malnutrition; the largest contributors within this risk factor are low birth weight and short gestation (46%) and child growth failure (21%), it was found. Eleven per cent of under-5 deaths are attributable to unsafe water and sanitation and 9% to air pollution. Meanwhile, 83% of the neonatal deaths are attributable to low birth weight and shorter gestation.
The leading causes of under-5 deaths in India are lower respiratory infections (17.9%), preterm birth (15.6%), diarrhoeal diseases (9.9%), and birth asphyxia and trauma (8.1%). The death rate for all major causes decreased between 2000 and 2017, with the highest decline for infectious diseases, intermediate decline for neonatal disorders, and the smallest decline for congenital birth defects. The current rates of the causes and magnitude of their decline vary widely between states.
Prof Rakhi Dandona, Professor at the Public Health Foundation of India and lead author of the paper on child mortality, told The Indian Express, “Comparison of child mortality trends in each of the 723 districts of India with the National Health Policy and SDG targets has identified the districts with high gap where more targeted attention is needed. Bringing down death numbers among newborn babies in the first month of life by addressing specific causes of death is crucial. Low birth weight is the biggest component in this risk factor. Focus on maternal nutrition during pregnancy needs to be a priority to improve birthweight of babies.”