Neonatal and under-five mortality rate in Indian districts with reference to Sustainable Development Goal 3: An analysis of the National Family Health Survey of India (NFHS), 2015–2016

Abstract

Background and objectiveIndia contributes the highest global share of deaths among the under-fives. Continuous monitoring of the reduction in the under-five mortality rate (U5MR) at local level is thus essential to set priorities for policy-makers and health professionals. In this study, we aimed to provide an update on district-level disparities in the neonatal mortality rate (NMR) and the U5MR with special reference to Sustainable Development Goal 3 (SDG3) on preventable deaths among new-borns and children under five.Data and methodsWe used recently released population-based cross-sectional data from the National Family Health Survey (NFHS) conducted in 2015–2016. We used the synthetic cohort probability approach to analyze the full birth history information of women aged 15–49 to estimate the NMR and U5MR for the ten years preceding the survey.ResultsBoth the NMR and U5MR vary enormously across Indian districts. With respect to the SDG3 target for 2030 for the NMR and the U5MR, the estimated NMR for India for the period studied is about 2.4 times higher, while the estimated U5MR is about double. At district level, while 9% of the districts have already reached the NMR targeted in SDG3, nearly half (315 districts) are not likely to achieve the 2030 target even if they realize the NMR reductions achieved by their own states between the last two rounds of National Family Health Survey of India. Similarly, less than one-third of the districts (177) of India are unlikely to achieve the SDG3 target on the U5MR by 2030. While the majority of high-risk districts for the NMR and U5MR are located in the poorer states of north-central and eastern India, a few high-risk districts for NMR also fall in the rich and advanced states. About 97% of districts from Chhattisgarh and Uttar Pradesh, for example, are unlikely to meet the SDG3 target for preventable deaths among new-borns and children under age five, irrespective of gender.ConclusionsTo achieve the SDG3 target on preventable deaths by 2030, the majority of Indian districts clearly need to make a giant leap to reduce their NMR and U5MR.

Precision-weighted estimates of neonatal, post-neonatal and child mortality for 640 districts in India, National Family Health Survey 2016

“…However, we acknowledge that a future validation study should be performed comparing the estimates of different estimation methods by, for instance, quantifying their coefficients of variance. Nevertheless, many of the districts that were identified to have the highest NM in their study [ 23 ] aligned with our findings (Gonda, Sitapur, Budaun, Dakshin Bastar Dantewada, Kaushambi, Shahjahanpur), which were also consistent with the priority districts identified in the Ministry of Health and Family Welfare’s annual report on health [ 25 ].…”

“…The required sample size needed to achieve unbiased estimates from the synthetic cohort approach ranges from at least 500 [ 31 ] to thousands of observations [ 32 ]. Similarly, we present more reliable and appropriately conservative estimates compared to a recent study [ 23 ] that has also used the synthetic cohort probability approach to estimate district-wide NM. However, we acknowledge that a future validation study should be performed comparing the estimates of different estimation methods by, for instance, quantifying their coefficients of variance.…”

“…In order to produce robust district-wise estimations based on survey data, reliability and sampling variability resulting from the survey must be incorporated. While such precision-weighted estimations based on pooling data and borrowing strength is well-established for small area estimation [ 17 , 18 ], they have not been readily applied in global health research and certainly not in prior studies focused on district level mortality rates in India [ 11 , 19 - 23 ]. [REMOVED HYPERLINK FIELD]…”

District level inequality in reproductive, maternal, neonatal and child health coverage in India

“…This is analogous to the previous studies explaining the districts of high focused states having a higher gap in RMNCH coverage [7,22,25]. These districts are burdened mainly with the higher maternal and child morbidity and mortality [31]. A few of the reasons which were discussed in literature were, inadequate availability and accessibility of quality health services near the place of residence, availability of doctors and skilled health persons and poor health care awareness remain the top barriers for utilizing the health services in India [32,33].…”

Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys

“…The United Nations Sustainable Development Goals include a focus on the improvement of children’s health and survival as a global priority [ 1 ]. Such goals have led to an increase of investments aiming to promote the accessibility and affordability of childhood health intervention programs, particularly regarding vaccination services and nutrition.…”