Though 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, according to two papers on child survival published by India State-Level Disease Burden Initiative.
The papers published in Lancet and EClinicial Medicine note that 68% of the under-5 deaths in India can be attributed to child and maternal malnutrition and 83% of the neonatal deaths to low birth weight and short gestation.
The papers highlight comprehensive estimates of district-level trends of child mortality in India and detail the district trends of child growth failure in the country.
The Initiative is a collaborative effort among the Indian Council of Medical Research, the Public Health Foundation of India, the Institute for Health Metrics and Evaluation, and a number of other key stakeholders in the country.
The studies find that the under-5 mortality rate (U5MR) and neonatal mortality rate in the first month of life (NMR) have dropped substantially since 2000, but there is a 5-6 fold variation in the rates between the States and 8-11 fold variation between the districts.
“While U5MR and NMR have been decreasing in almost all districts of India, the progress in this decline has been highly variable because of which the inequality in these rates has increased between districts within many States,” notes the paper.
Child growth failure
It adds that child growth failure, measured as stunting, wasting and underweight has improved in India since 2000, but their rates vary 4-5 fold among the districts and the inequality between the districts within many States has increased.
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 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.”
R. Hemalatha, director, National Institute of Nutrition, ICMR, and the lead author of the child growth failure paper, said India had 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. 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,’’ she added.
Balram Bhargava, Secretary, Department of Health Research, Health Ministry, 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 provided useful guidance for identifying priority districts in each State that needed the highest attention.
K Srinath Reddy, president, Public Health Foundation of India, said child malnutrition was a major determinant along with maternal malnutrition for these deaths and it should be accorded highest priority for corrective action.