Changes in cause-specific neonatal and 1–59-month child mortality in India from 2000 to 2015: a nationally representative survey

Abstract

Summary Background Documentation of the demographic and geographical details of changes in cause-specific neonatal (younger than 1 month) and 1–59-month mortality in India can guide further progress in reduction of child mortality. In this study we report the changes in cause-specific child mortality between 2000 and 2015 in India. Methods Since 2001, the Registrar General of India has implemented the Million Death Study (MDS) in 1.3 million homes in more than 7000 randomly selected areas of India. About 900 non-medical surveyors do structured verbal autopsies for deaths recorded in these homes. Each field report is assigned randomly to two of 404 trained physicians to classify the cause of death, with a standard process for resolution of disagreements. We combined the proportions of child deaths according to the MDS for 2001–13 with annual UN estimates of national births and deaths (partitioned across India’s states and rural or urban areas) for 2000–15. We calculated the annual percentage change in sex-specific and cause-specific mortality between 2000 and 2015 for neonates and 1–59-month-old children. Findings The MDS captured 52 252 deaths in neonates and 42 057 deaths at 1–59 months. Examining specific causes, the neonatal mortality rate from infection fell by 66% from 11.9 per 1000 livebirths in 2000 to 4.0 per 1000 livebirths in 2015 and the rate from birth asphyxia or trauma fell by 76% from 9.0 per 1000 livebirths in 2000 to 2.2 per 1000 livebirths in 2015. At 1–59 months, the mortality rate from pneumonia fell by 63% from 11.2 per 1000 livebirths in 2000 to 4.2 per 1000 livebirths in 2015 and the rate from diarrhoea fell by 66% from 9.4 per 1000 livebirths in 2000 to 3.2 per 1000 livebirths in 2015 (with narrowing girl–boy gaps). The neonatal tetanus mortality rate fell from 1.6 per 1000 livebirths in 2000 to less than 0.1 per 1000 livebirths in 2015 and the 1–59-month measles mortality rate fell from 3.3 per 1000 livebirths in 2000 to 0.3 per 1000 livebirths in 2015. By contrast, mortality rates for prematurity or low birthweight rose from 12.3 per 1000 livebirths in 2000 to 14.3 per 1000 livebirths in 2015, driven mostly by increases in term births with low birthweight in poorer states and rural areas. 29 million cumulative child deaths occurred from 2000 to 2015. The average annual decline in mortality rates from 2000 to 2015 was 3.3% for neonates and 5.4% for children aged 1–59 months. Annual declines from 2005 to 2015 (3.4% decline for neonatal mortality and 5.9% decline in 1–59-month mortality) were faster than were annual declines from 2000 to 2005 (3.2% decline for neonatal mortality and 4.5% decline in 1–59-month mortality). These faster declines indicate that India avoided about 1 million child deaths compared with continuation of the 2000–05 declines. Interpretation To meet the 2030 Sustainable Development Goals for child mortality, India will need to maintain the current trajectory of 1–59-month mortality and accelerate declines in neonatal mortality (to >5% annually) from 2015 onwar...

Rethinking community based strategies to tackle health inequities in South Asia

“…While direct evaluation of the impact of this initiative is not available, an independent evaluation of neonatal mortality trends from the sample registration system in India shows that the neonatal mortality rate from infection fell by 66% (from 11.9 per 1000 livebirths in 2000 to 4.0 per 1000 livebirths in 2015) and the rate from birth asphyxia or trauma fell by 76% (from 9.0 per 1000 livebirths in 2000 to 2.2 per 1000 livebirths in 2015) 16. The expert committee on tribal health services in India has recommended having a trained CHW for each tribal hamlet of 250 people 17…”

Peripartum interventions resulting in reduced perinatal mortality rates, and birth asphyxia rates, over 18 years in a tertiary centre in South India: a retrospective study

“…4,5 The effect of improving quality of care during labour and delivery, will reflect in health indicators such as perinatal mortality and birth asphyxia rates. 3,4 It is clear that a multifactorial approach rather than any one single intervention is the key to improving quality of care provided, as so many factors are involved in making the peripartum period a safe one. With the current global estimates of perinatal mortality and birth asphyxia rates in India being 32/1000 births and 13/1000 births, respectively, as compared with 5/1000 births for both perinatal births and asphyxial rates in high-income countries the differences are significant.…”

“…[1][2][3] Poor quality of care contributes to morbidity and mortality, and therefore attention has shifted to the quality of care. 4,5 The effect of improving quality of care during labour and delivery, will reflect in health indicators such as perinatal mortality and birth asphyxia rates. 6 The disease burden is high, particularly in LMIC.…”

“…2 A significant contributor to the neonatal mortality rate was birth asphyxia, with only prematurity occurring more frequently. 3,4 It is clear that a multifactorial approach rather than any one single intervention is the key to improving quality of care provided, as so many factors are involved in making the peripartum period a safe one. 5 The incidence of stillbirths or neonatal deaths due to intrapartum asphyxia in a low-risk pregnancy is regarded as a sensitive measure of the quality of care given around the time of labour and childbirth.…”

Pursuing the limits of child survival in the most and least developed countries

“…The age-distribution of young deaths has not received much attention in the extensive literature on under-5 mortality trends in SSA and other low-and middle-income countries (Bendavid 2014;Mercer et al 2015;Burke, Heft-Neal, and Bendavid 2016;Wang et al 2016;Golding et al 2017Golding et al , 2017Abajobir et al 2017;Fadel et al 2017;Chao et al 2018), but just recently new methodologies have been developed that approximate child mortality patterns by age based on summary (Burstein et al 2018) or full (Mejía-Guevara et al 2019) birth history data. The importance of the age distribution of under-5 deaths has been underscored by methodological work (Guillot et al 2012) demonstrating that traditional life table models do not adequately approximate child mortality patterns in SSA, and by the use of age profiles of under-5 mortality to forecast mortality rates (Mejía-Guevara et al 2019) for the assessment of Sustainable Development Goals (SDGs) in SSA.…”