Inequalities in Child Mortality in India

Bhattacharya, Prabir C.; Chikwama, Cornilius

doi:10.1080/17441730.2011.608985

Cited by 13 publications

(16 citation statements)

References 21 publications

(17 reference statements)

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“…Our attempt is consistent with recent studies that focused on exploring macro-level determinants of child health (Gouda et al 2015;Goli and Jaleel 2014;Bhattacharya and Cornilius 2011). We have tried to show that there is a high degree of spatial clustering in IMR.…”

Section: Introductionsupporting

confidence: 70%

Spatial clustering and risk factors of infant mortality: district-level assessment of high-focus states in India

Gupta

Ladusingh

Borkotoky

2016

Genus

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The study analyzes the spatial clustering and risk factors of infant mortality across high-focus states of India, using the Annual Health Survey (2010-2011), Census of India (2011), and District Level Household and Facility Survey-3 (2007-2008. Research has found substantial spatial autocorrelation across the districts and identified the "hot spots" characterized by higher infant mortality rate (IMR) in the districts of the central region (Uttar Pradesh and Madhya Pradesh) of India. This study has considered several theoretical perspectives and implements a series of spatial regression models that allows accounting for household amenities and mother/child and health facility variables to determine the key risk factors of infant mortality. Our empirical analysis underscores the importance of the infrastructure of the health facility in improving the infant mortality scenario of the districts. The regression results show that the districts with a higher proportion of 24-h functioning primary healthcare centers have overall less infant mortality. In addition, the absence of drinking water from a treated source, unavailability of toilet facilities, and higher proportion of people in the bottom wealth quintile in the household were adversely associated with the IMR. In conclusion, reduction of infant mortality would be possible only if area-specific measures would be adopted on those clusters of districts where infant mortality is high irrespective of the state they belong to.

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Section: Introductionsupporting

confidence: 70%

Spatial clustering and risk factors of infant mortality: district-level assessment of high-focus states in India

Gupta

Ladusingh

Borkotoky

2016

Genus

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“…This kind of analysis has already been used while assessing child health inequality with economic development by districts in India. 19 …”

Section: Analytical Approachmentioning

confidence: 99%

Association of child health and household amenities in high focus states in India: a district-level analysis

2015

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ObjectivesTo assess household amenities in districts of high focus states and their association with child health in India.DesignThe data for the study are extracted from Annual Health Survey (AHS) and Census 2011.SettingsDistricts in high focus states in India.ParticipantsInformation regarding children below 5 years of age and women aged 15–49 has been extracted from the AHS (2010–2011), and household amenities information has been obtained from the Census (2011).MeasuresHousehold amenities were assessed from the census at the district level in the high focus states. Child health indicators and wealth index were borrowed from AHS and used in this study to check their linkage with household amenities.ResultsAbsence of drinking water from a treated source, improved sanitation, usage of clean cooking fuel and drainage facility in the household were adversely associated with the incidence of acute respiratory infection, diarrhoea, infant mortality rate (IMR) and under 5 mortality rate (U5MR). The mean IMR declined from 64 to 54 for districts where a high proportion of household have improved sanitation. The result of ordinary least square regression shows that improved sanitation has a negative and statistically significant association (β=−0.0067, p<0.01) with U5MR.ConclusionsAlthough child healthcare services are important in addressing child health issues, they barely touch on the root of the problem. Building toilets and providing safe drinking water, clean cooking fuel and drainage facilities at the household level, may prevent a number of adverse child health issues and may reduce the burden on the healthcare system in India.

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“…However, efforts to identify determinants of U5MR at the district level are often restricted to selected states only [ 10 ] or to a single census. The work of Bhattacharya [ 16 ]—which refers to the period before 2000—and that of Bhattacharya and Chikwama [ 17 ]—which refers to the period until 2001—are two noticeable exceptions. These last two studies suggest that variables related to modernization and economic development (such as access to medical facilities and access to urban areas through paved roads) together accounted for more than 40% of the decline in U5MR during the 1981–1991 period.…”

Section: Introductionmentioning

confidence: 99%

Continuities and changes in spatial patterns of under-five mortality at the district level in India (1991–2011)

Singh

Masquelier

2018

Int J Health Geogr

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BackgroundIndia has the largest number of under-five deaths globally, and large variations in under-five mortality persist between states and districts. Relationships between under-five mortality and numerous socioeconomic, development and environmental health factors have been explored at the national and state levels, but the possible spatial heterogeneity in these relationships has seldom been investigated at the district level. This study seeks to unravel local variation in key determinants of under-five mortality based on the 1991 and 2011 censuses.MethodsUsing geocoded district-level data from the last two census rounds (1991 and 2011) and ordinary least squares and geographically weighted regressions, we identify district-specific relationships between under-five mortality rate and a series of determinants for two periods separated by 20 years (1986–1987 and 2006–2007). To identify spatial groupings of coefficients, we perform a cluster analysis based on t-values of the geographically weighted regression.ResultsThe geographically weighted regression analysis shows that relationships between the under-five mortality rate and factors for socioeconomic, development, and environmental health factors vary spatially in terms of direction, strength, and extent when considering: female literacy and labor force participation; share of scheduled castes and scheduled tribes; access to electricity; safe water and sanitation; road infrastructure; and medical facilities. This spatial heterogeneity is accompanied by significant changes over time in the roles that these factors play in under-five mortality. Important local determinants of under-five mortality in 2011 were female literacy, female labor force participation, access to sanitation facilities and electricity; while the key local determinants in 1991 were road infrastructure, safe water, and medical facilities. We identify six different clusters based on geographically weighted regression coefficients that broadly encompass the same districts in both periods; but these clusters do not follow the regional boundaries suggested by the previous studies. In particular, the high mortality states of India that are often typically classified as high focus states were classified into three different clusters based on the relationship of the factors associated with under-five mortality.ConclusionThis study demonstrates the utility of combining geographically weighted regression and cluster analyses as a methodological approach to study local-level variation in public health indicators, and it could be applied in any country using aggregate-level information from census or survey data. Identifying local predictors of under-five mortality is important for designing interventions in specific districts. Additional reduction in under-five mortality will only be possible with intervention programs designed at the local level, which take into consideration local level determinants of under-five mortality.

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Inequalities in Child Mortality in India

Cited by 13 publications

References 21 publications

Spatial clustering and risk factors of infant mortality: district-level assessment of high-focus states in India

Spatial clustering and risk factors of infant mortality: district-level assessment of high-focus states in India

Association of child health and household amenities in high focus states in India: a district-level analysis

Continuities and changes in spatial patterns of under-five mortality at the district level in India (1991–2011)

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