Under-five and neonatal mortality: Variation between states offsets India’s achievement

68.2 per cent of all children deaths due to malnutrition, rates comparable to sub-Saharan Africa: Lancet paper

By DTE Staff
Published: Tuesday 12 May 2020
Photo: Samrat Mukherjee / CSE

India has managed to decrease under-five mortality rate (U5MR) in children and neonatal mortality rate (NMR) but high inter-state and intra-state variations may off set this achievement, according to a paper published in the Lancet on May 12, 2020.

U5MR in India decreased from 83.1 in 2000 to 42.4 per 1,000 live births in 2017, according to the paper. It varied 5.7 times between the states and 10.5 times between the 723 districts of India in 2017.

The NMR has gone down to 23.5 per 1,000 live births from 38.0. It varied 4.5 times between the states and 8.0 times among all the districts of the country.

The difference within states could be understood by the following: In Kerala, one of the best performing states, the difference within districts was to the tune of 10.4 times in terms of U5MR. While the corresponding figure for Uttar Pradesh is 59.7 times.

In terms of NMR, the intra-state difference in Kerala is 4.5 times while that in UP is 31.7. The difference is not only in terms of prevalence of mortality rates but also their annual rates of reduction.

The inequality among the districts increased in 23 states for U5MR and 24 for NMR, with the largest increase in Odisha and Assam among the low socio-demographic indicator (SDI) states.

“If the trends observed up to 2017 were to continue, India would meet the SDG-2030 U5MR target but not the SDG-2030 NMR target. It would also fail to meet National Health Policy-2025 targets for NMR,” the paper said.

The leading causes of deaths included lower respiratory infections, neonatal preterm birth, neonatal jaundice, diarrhoeal diseases, birth asphyxia, congenital birth defects, injuries and neonatal sepsis.

The death rate for most causes of under-five death in 2017 had a significant inverse correlation with increasing levels of SDI, except for congenital birth defects, other communicable disease, and other noncommunicable disease.

“But the most dominant risk factor for under-five death was child and maternal malnutrition, to which 68.2 per cent of all child deaths in India could be attributed. The point estimates for the proportion of under-five deaths attributable to child and maternal malnutrition, unsafe water and sanitation, and air pollution were highest for the low SDI state group,” the paper read.

The highest district-level U5MR and NMR in India in 2017 were comparable to the highest rate globally among some countries in sub-Saharan Africa.

The variation is perceptible not in prevalence of these death rates but also in their annual rate of reduction. Among the low socio-demographic states, Assam had the lowest annual rate of reduction from and Madhya Pradesh the highest.

In the middle SDI states, Andhra Pradesh and Tripura had a similar U5MR in 2017, but quite different annual rates of reduction from 2010 to 2017.

Incidentally, the annual rate of reduction of NMR was lower than that of U5MR in all states during 2010–17, but varied considerably between the states.

UP was on the top as far as the total number of under-five and neonatal deaths in 2017 were concerned. It was followed by Bihar.

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