Under-5 mortality in India: Different state, different result

India recorded an estimated 12.01-lakh deaths among children younger than five years in 2015—the highest among all countries.

Yes, this sure is a massive decrease from 25.16-lakh in 2000—the under-5 mortality rate in India decreased from 90·5 to 47·8 per 1000 live births during this period (a 47·2 per cent reduction).

And yet, despite this progress, India failed to meet the target of the Millennium Development Goals (MDG) of a two-thirds reduction in under-5 mortality rate between 1990 and 2015. For India, that would have meant reducing the under-five mortality rate to 39 deaths per 1,000 live births.

This is just like our failure to halve the proportion of people suffering from hunger, to increase the share of women in wage employment, and to reduce the maternal mortality rate under the MDGs. But let’s leave these topics for another day.

Researchers at the Johns Hopkins Bloomberg School of Public Health found large disparities in the child mortality rate between richer and poorer states.

In 2015, the highest under-5 mortality rates were recorded in the northeast and central region, with 63.8 and 60.6 deaths per 1000 live births.

And guess what, both the regions recorded more than twice the deaths in south India—29·7 deaths per 1000 live births.

Child survival disparities, measured by the ratio of the highest regional under-5 mortality rate (in the northeast region) to the lowest (southern region), increased from 1·4 to 2·1 in 2000–15.

The northeast region had the slowest decline in under-5 mortality rate, with an annual rate of reduction of 2·2 per cent compared to at least 4 per cent in other regions in this period.

States with the highest burden of under-5 deaths were mostly those clustered in the central and east regions, with half of all under-5 deaths occurring in three states: Uttar Pradesh, Bihar, and Madhya Pradesh.

Assam (73·1 per 1000 live births), Madhya Pradesh (67·1 per 1000 live births), and Odisha (64·1 per 1000 live births) recorded the highest under-5 mortality rates, whereas the lowest rates were in Goa (9·7 per 1000 live births), Kerala (12·5 per 1000 live births) and Tamil Nadu (21·7 per 1000 live births).

Such is the disparity that the under-5 deaths recorded in Assam were more than seven times the mortality rate in Goa.

About seven lakh (57.9 per cent) of the total 12.01 lakh under-5 deaths occurred in the neonatal period—first four weeks after birth—in 2015.

The analysis found that although most under-five deaths were due to preterm complications, preventable infectious diseases featured prominently as a cause of death in higher-mortality states.

Diarrhoea was the third leading cause in the northeast region, which had the highest under-5 mortality rate.

Among children aged 1–59 months, the three leading causes of death in 2000 were all related to infectious diseases: pneumonia, diarrhoea (including all cases), and measles.

Between 2000 and 2015, the measles-specific mortality rate declined rapidly and, by 2015, injuries had overtaken measles as the third leading cause of death in this age group.