India recorded 1.04 million under-5 deaths in 2017, which was a 49 per cent drop from the 2.24 million under- 5 deaths it recorded in 2000 while neonatal deaths in the country went down from 1.02 million in 2000 to 0.57 million in 2017. These findings were revealed in the India State-Level Disease Burden Initiative.
These are the second set of findings as part of this initiative. The first were released in November, 2017. The findings were published on comprehensive estimates of district-level trends of child mortality from 2000 were published in the The Lancet journal and another paper on the district-level trends of child growth failure was published in EClinicalMedicine.
Under-five mortality rate refers to the probability of dying between birth and exactly five years of age. Neonatal mortality rate is the probability of dying between birth and first 28 days if life expressed per 1,000 live births.
Even though the under-5 death mortality rate (U5MR) has dropped between 2000 and 2017, the study also found a six fold variation in the rate between the states and 11 fold variation between the districts of India. This indicated that some districts were lagging far behind compared to other districts on the parameters of U5MR, neonatal mortality and child growth failure.
Lower respiratory infections (17.9 per cent), pre-term birth (15.6 per cent), diarrhoeal diseases (9.9 per cent), and birth asphyxia and trauma (8.1 per cent) were the leading causes of under-5 death in India. Moreover, 11 per cent of the deaths could be attributed to unsafe drinking water and lack of sanitation and 9 per cent to air pollution.
U5MR varied 10.5 times between the 723 districts of India in 2017, ranging from 8 to 88 per 1,000 live births, and NMR (Neonatal Mortality Rate) varied eight times, ranging from 6 to 46 per 1,000 live births. The highest district level U5MR and NMR in 2017 were comparable to the highest rates globally among some Sub-Saharan Africa countries.
Among states, Uttar Pradesh, Assam and Bihar had high rates of U5MR and NMR. The highest number of under-5 deaths in 2017 recorded in Uttar Pradesh (3, 12,800 of which included 1, 65,800 neonatal deaths) and Bihar (1, 41,500 which included 75,300 neonatal deaths).
In Uttar Pradesh, the districts in highest priority category of high NMR and U5MR with a low reduction included a cluster in the north-central part – Bahraich, Balrampur, Barabanki, Gonda, Hardoi, Kheri, Shravasti and Sitapur. Three districts in southeast of the state – Allahabad, Banda and Chitrakoot and Lalitpur in southwest corner were also part of the highest priority category. Assam recorded the second highest child mortality rate in 2017 and the high priority districts in the state were Cachar, Dima Hasao, Hallakandi, Karbi Anglong, Karimganj, and West Karbi Anglong. In Bihar, the highest priority was scattered in the north-east Kishanganj and Purnia and the south-west of the state – Aurangabad and Kaimur.
Professor Rakhi Dandona, from the Public Health Foundation of India and the lead author of the child mortality paper said, “Comparison of child mortality trends in each of the 723 districts of India with the National Health Policy and Sustainable Development Goal 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. Malnutrition continues to be the leading risk factor for child death across India.”
About the India State-Level Disease Burden Initiative
The India State-Level Disease Burden Initiative was launched in 2015 as a collaborative effort between the Indian Council of Medical Research, Public Health Foundation of India, Institute for Health Metrics and Evaluation, and a number of other key stakeholders in India, including academic experts and institutions, government agencies and other organisations, under the aegis of the Ministry of Health and Family Welfare. Over 300 leading scientists and experts representing about 100 institutions across India are engaged with this collaborative work.