India prevented the deaths of about one million children under five in 2005-15, driven by significant reductions in the mortality rates of pneumonia, diarrhoea, tetanus and measles, says a new study published in Lancet.
The study stressed that India would need to maintain the rapid decline in mortality of children in the 1-59-month group and accelerate declines in neonatal mortality to over 5 per cent annually to achieve UN global goals of reducing child mortality to at least 25 per 1,000 live births by 2030.
Between 2000 and 2015, 29 million children below five died of different causes in India, data by the United Nations show.
"However, since 2005, the progress in terms of reduction in mortality accelerated. Had the mortality rates of 2000-2005 remain unchanged, 30 million children would have died by 2015," said Dr Prabhat Jha, one of the authors and head of the Centre for Global Health Research of St Michael's Hospital in Toronto.
The study noted that an increase in spending on public health by the Indian government, launching programmes to encourage women to give birth in hospitals and for children to have a second dose of measles vaccine could all have contributed to the improvement.
Published in the leading medical journal yesterday, the report, however, found a slower decline in malaria death rates in children in the 1-59-month group.
It also highlighted that mortality rates from low birth weight rose in rural areas and the poorer states. Neonatal mortality rates in rural areas were twice that in urban areas.
In this regard, the study stressed the need for giving special attention to maternal factors, including anaemia and tobacco chewing, which also play a role in low birth weights.
A steeper decline in the number of girls dying narrowed a previously observed girl-boy mortality gap, said Dr Jha. An almost equal number of boys and girls five died in 2015.
The research is a part of the Million Death Study, one of the largest studies of premature deaths in the world, done in collaboration with the Registrar General of India. It is based on 100,000 interviews with parents who lost a child.
"Hundreds of specially trained census staff in India knocked on the doors of more than 1.3 million homes to interview household members about deaths. Two physicians independently examined these 'verbal autopsies' to establish the most probable cause of death," Dr Jha said.
The study found a 3.3 per cent annual decline in the mortality rates of neonates (infants less than one month old) and 5.4 per cent for those aged one month to 59 months.
The declines started accelerating from 2005 and were the fastest between 2010 and 2015, and in urban areas and the richer states.
Per 1,000 live births, the mortality rates among neonates fell from 45 in 2000 to 27 in 2015, while the 1-59-month mortality rate fell from 45.2 to 19.6.
Pneumonia and diarrhoea mortality rates for the 1-59- month group declined substantially in 2010-15, at an average of 8-10 per cent annual decline nationally.
Mortality rates from vaccine-preventable diseases such as tetanus and measles fell by about 90 per cent from 2005 and neonatal infection and birth trauma by more than 66 per cent.
For the 1-59-month group, mortality rates from pneumonia and diarrhoea fell by more than 60 per cent.
Co-author of the study, professor Rajesh Kumar, Dean (Academic) at the Post Graduate Institute of Medical Education and Research in Chandigarh, said to meet the UN Sustainable Development Goals of halving child mortality rates by 2030, India must maintain its current trajectory for the 1-59-month group and accelerate declines in neonatal mortality.
Reducing the number of neonatal deaths will require efforts to bring down deaths caused by premature delivery and low birth weights, especially in poorer states, he said.
Both are strongly linked to largely modifiable maternal and prenatal factors such as health care during pregnancy, education, nutrition, anaemia and tobacco use.
The authors also stressed the need for a stricter assessment of child mortality at district levels.
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