New Delhi: The progress in the reduction of under-5 and neonatal mortality rates (U5MR AND NMR) is highly variable as there is persistence of disparity that has increased between districts of many states in India, the India State-Level Disease Burden Initiative in the report, “First comprehensive estimates of district-level trends of child mortality and child growth failure in India from 2000 to 2017.”
Vital health issues are continuously getting highlighted as they point towards the health loss in India. With the coronavirus curve not seeming to flatten in the metropolitan cities, the country needs to solve its other health related problems to help in improving the overall health of the people. Two important scientific papers on child survival were published on Tuesday by the India State-Level Disease Burden Initiative. The paper in The Lancet reports the first comprehensive estimates of district-level trends of child mortality in India from 2000, and the paper in E-Clinical Medicine reports detailed district-level trends of child growth failure.
The findings show that although the child mortality and child growth failure indicators have improved substantially across India from 2000 to 2017, the inequality between districts has increased within many states.
There is a six-fold variation in the rate between the states and 11-fold variation between the districts of India. There were 1.04 million under-5 deaths in 2017, down from 2.24 million deaths in 2000. Neonatal deaths in India have gone down from 1.02 million deaths in 2000 to 0.57 million deaths in 2017.
In India, 2 million children die before their fifth birthday. Half of these children die even before they are 28 days old, accounting for one-fourth global infant deaths. Of the 5.3 million child deaths worldwide annually, one-third occur in India. On average, 15 000 children under-5 die each day compared with 34 000 in 1990 globally.
83 per cent of the neonatal deaths occur as a result of low birth weight and shorter development. 11 per cent of the under-5 deaths in India are caused due to unsafe water and sanitation and 9 per is accredited to air pollution. The leading roots of under-5 death in India are due to 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).
Reductions are seen in these numbers in the recent time in some states. The highest decline was seen in infectious diseases, intermediate decline for neonatal disorders, and the smallest decline for congenital birth defects.
Prof Rakhi Dandona, 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.”
She added, “Bringing down mortality 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. Low birth weight is the biggest component in this risk factor. Focus on maternal nutrition during pregnancy needs to be a priority to improve the birthweight of babies. The health system needs to track every pregnant women and every new born effectively to substantially reduce child deaths in our country.”
In India, during 1968–70, the level of IMR was stable at 130 deaths per 1000 live-births. Following the Alma Ata declaration of 1978, the Government of India envisaged a national goal for the attainment of an IMR of 60 by the year 2000. Since then, substantial resources have been put into the child survival programmes over the past 25 years.
Prof Balram Bhargava, Secretary, Department of Health Research, Ministry of Health & Family Welfare, and Director General, ICMR said, “This is India’s first comprehensive consolidated and detailed analysis of sub-national trends of child mortality and growth failure for all the districts and states in India. The district level trends reported in these papers provide useful guidance for identifying priority districts in each state that need the highest attention. This approach can facilitate further reduction in child mortality in India.”
The report says if the trends observed up to 2017 were to continue, India would meet the Sustainable Development Goal (SDG) 2030 U5MR target but not the Sustainable Development Goal (SDG) 2030 NMR target; 34% of the districts in India would need higher U5MR reduction and 60% districts would need higher NMR reduction to individually meet the SDG targets.
According to the report, 68% of the under-5 deaths in India can be credited to child and maternal malnutrition, 83% of the neonatal deaths to low birth weight and short gestation.
Dr R Hemalatha, Director, National Institute of Nutrition of ICMR and the lead author of the child growth failure paper said, “India has had significant improvements in stunting, wasting and underweight among children since 2000. However, there continues to be a 5-fold variation in the prevalence of these indicators between the districts of India. The relative inequality of this prevalence between districts has increased within several states, indicating that efforts targeting poorly performing districts as identified by our analysis can potentially help hasten overall improvements in child growth failure in India.”
According to a report from 2015 by the President of Indian Academy of Pediatrics of the time, S Sachidananda Kamath, the goal for 2020 was to reach a target of 20 IMR, “Indian Academy of Pediatrics (IAP) has joined handswith Government in many initiatives, and has beeninvolved in critical appraisal of Child health programsinitiated by Central and State Governments. IAP hasproposed mission 20/20 to accelerate the reduction inIMR with a target to achieve an IMR of 20 by the year2020. By initiating Mission 20/20, the IAP has expressedits willingness to dedicate its efforts and resources tocatalyze the reduction of IMR in the country. We believethat this initiative will boost the energy and enthusiasmof all stakeholders to accomplish the noble mission ofattaining the target IMR of 20 by 2020.”
