National, regional, and state-level all-cause and cause-specific under-5 mortality in India in 2000–15: a systematic analysis with implications for the Sustainable Development Goals

Abstract

Summary Background India had the largest number of under-5 deaths of all countries in 2015, with substantial subnational disparities. We estimated national and subnational all-cause and cause-specific mortality among children younger than 5 years annually in 2000–15 in India to understand progress made and to consider implications for achieving the Sustainable Development Goal (SDG) child survival targets. Methods We used a multicause model to estimate cause-specific mortality proportions in neonates and children aged 1–59 months at the state level, with causes of death grouped into pneumonia, diarrhoea, meningitis, injury, measles, congenital abnormalities, preterm birth complications, intrapartum-related events, and other causes. AIDS and malaria were estimated separately. The model was based on verbal autopsy studies representing more than 100 000 neonatal deaths globally and 16 962 deaths among children aged 1–59 months at the subnational level in India. By applying these proportions to all-cause deaths by state, we estimated cause-specific numbers of deaths and mortality rates at the state, regional, and national levels. Findings In 2015, there were 25·121 million livebirths in India and 1·201 million under-5 deaths (under-5 mortality rate 47·81 per 1000 livebirths). 0·696 million (57·9%) of these deaths occurred in neonates. There were disparities in child mortality across states (from 9·7 deaths [Goa] to 73·1 deaths [Assam] per 1000 livebirths) and regions (from 29·7 deaths [the south] to 63·8 deaths [the northeast] per 1000 livebirths). Overall, the leading causes of under-5 deaths were preterm birth complications (0·330 million [95% uncertainty range 0·279–0·367]; 27·5% of under-5 deaths), pneumonia (0·191 million [0·168–0·219]; 15·9%), and intrapartum-related events (0·139 million [0·116–0·165]; 11·6%), with cause-of-death distributions varying across states and regions. In states with very high under-5 mortality, infectious-disease-related causes (pneumonia and diarrhoea) were among the three leading causes, whereas the three leading causes were all non-communicable in states with very low mortality. Most states had a slower decline in neonatal mortality than in mortality among children aged 1–59 months. Ten major states must accelerate progress to achieve the SDG under-5 mortality target, while 17 are not on track to meet the neonatal mortality target. Interpretation Efforts to reduce vaccine-preventable deaths and to reduce geographical disparities should continue to maintain progress achieved in 2000–15. Enhanced policies and programmes are needed to accelerate mortality reduction in high-burden states and among neonates to achieve the SDG child survival targets in India by 2030. Funding Bill & Melinda Gates Foundation.

Universal Implementation of Newborn Screening in India

“…In 2017, the IMR for Chandigarh was 14, Goa was 9, and Kerala was 10. In India, the three leading causes of infant mortality are (a) prematurity and low birth weight, (b) neonatal infections, and (c) birth asphyxia and birth trauma [14]. Even though the IMR rate has come down significantly from 53 in 2008, these are still the leading causes of death [15].…”

Protocol for a cluster randomised trial in Madhya Pradesh, India: Community health promotion and medical provision and impact on neonates (CHAMPION2); and support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2)

“…Despite India's rapid economic growth, there has been little progress in improving neonatal survival [2]. According to Sample Registration System Statistical Report 2017, India's neonatal mortality rate (NMR) is 23 per 1000 live births [3].…”

“…Participants will be aware as to whether they are in the CHAMPION2 or STRIPES2 intervention arm. Nevertheless, all doctors who will be assigning a cause of death using the World Health Organisation's verbal autopsy toolkit [45] in CHAMPION2, and the teams who will be carrying out testing in STRIPES2 (hired and trained by GH Training and Consulting) [2] will be blind to the randomisation.…”

Brought in dead cases to a tertiary referral paediatric emergency department in India: a prospective qualitative study

“…The failure was mainly due to the slower progress, high mortality rate and low resource and fund allocation in countries from sub-Saharan Africa and south Asia including India. India contributed to nearly 21% of the global under-five child deaths 2 3. Under-five mortality is an incisive indicator of a nation’s progress and a crucial affirmation of its priorities and values.…”

“…Hospital-based data have mainly focused on disease-specific mortality in children. WHO data and several other studies have listed preterm birth complications, pneumonia, diarrhoea and malaria as the top causes for neonatal and child mortality 2 4–8. Most child deaths are impacted by a chain of events including social, cultural, environmental and healthcare-related factors and not merely by the medical disease that is usually assigned as the cause of death.…”