Child mortality, child growth failure indicators improve from 2000 to 2017: Study

Although child mortality and child growth failure indicators have improved substantially across India from 2000 to 2017, inequality between districts has increased within many states, and there are wide variations between the districts, according to findings of the India State-Level Disease Burden Initiative released on Tuesday.

The first comprehensive estimate of district-level trends of child mortality and child growth failure in India published in The Lancet and EClinicalMedicine stated that if the trends observed up to 2017 were to continue, India would meet the SDG 2030 under-5 Mortality Rate (U5MR) target but not the SDG 2030 Neonatal Mortality Rate (NMR) target.

"Thirty-four per cent of the districts in India would need higher U5MR reduction and 60 per cent districts would need higher NMR reduction to individually meet the SDG targets," it stated.

Child and maternal malnutrition were behind 68 per cent of the under-five fatalities in India, while low-birth-weight and short gestation led to 83 per cent of neonatal deaths.

The findings, which are part of two scientific papers on child survival, have been published at a time when the country is fighting COVID-19 pandemic.

Health experts say "they remind us that while we must do all that we can to control coronavirus infection, other crucial health issues in India should also continue to receive attention commensurate with their contribution to health loss in India".

The studies stated that the under-5 Mortality Rate (U5MR) dropped in India since 2000 by 49 per cent but there is a 6-fold variation in the rate between the states and 11-fold variation between districts of India.

There were 1.04 million under-5 deaths in India in 2017, of which 0.57 million were neonatal deaths, down from 2.24 million under-5 deaths, including 1.02 million neonatal deaths in 2000.

The NMR has dropped by 38 per cent since 2000 but there is a 5-fold variation in the rate between the states and 8-fold variation between districts of India, the study stated.

"The reduction in NMR has been less than for U5MR, and this reduction has been quite variable across states and districts," the study said.

Child growth failure, measured as stunting, wasting and underweight has improved in India since 2000, but their rates vary 4-5 fold between the districts of India and the inequality between districts within many states has increased, it stated.

Lower respiratory infections (17·9 pc), preterm birth (15·6 pc), diarrhoeal diseases (9.9 pc), and birth asphyxia and trauma (8.1 pc) were the leading causes of under-5 death in 2017

Preterm birth (27.7 pc), birth asphyxia and trauma (14.5 pc), lower respiratory infections (11 pc) and congenital birth defects (8.6 pc) were the leading causes of neonatal deaths in 2017. Also, 80 per cent of the neonatal deaths were in the early period of 0–6 days.

"The district-level trends reported in these papers provide useful guidance for identifying priority districts in each state that need the highest attention," ICMR Director General Balram Bhargava said.

Rakhi Dandona, Professor at 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 SDG targets has identified the districts with high gap where more targeted attention is needed.

Bringing down death numbers among newborns 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 and low birth weight is the biggest component in this risk factor.

K Srinath Reddy, President, Public Health Foundation of India said, "Reductions in under-5 child mortality and neonatal mortality are promising as we move towards SDG targets."

"Even neonatal mortality which was previously slow to change is now showing improvement. This decline needs to be further accelerated. Child malnutrition is a major determinant along with maternal malnutrition for these deaths and should be accorded highest priority for corrective action," he said,

While stark inter-state and inter-district differences in health and nutrition continue to be challenges, these gaps must be bridged through effective and equitable social development, nutrition and environmental health programmes.

"Our preoccupation with COVID-19 should not let these development imperatives slip into the shadows," he underlined.

The highest number of under-5 deaths in 2017 were in Uttar Pradesh (312,800 which included 165,800 neonatal deaths) and Bihar (141,500 which included 75,300 neonatal deaths).

The study stated U5MR and NMR were lower with the increasing level of development of the states. In 2017, there was 5.7 fold variation in U5MR ranging from 10 per 1000 live births in the more developed (high SDI) state of Kerala to 60 in the less developed (low SDI) state of UP, and 4.5 fold variation for NMR ranging from 7 per 1000 live births in Kerala to 32 in UP.

The annual rate of reduction from 2010 to 2017 for U5MR ranged among the states from 2.7 per cent in Nagaland to 6.5 per cent in Telangana, and for NMR from 1.8 per cent in Nagaland to 5.5 per cent in the high SDI state of Tamil Nadu.

The annual rate of reduction of NMR was lower than that of U5MR in all states during 2010-2017, but this varied considerably between the states, the study stated.