Washington: A recent report has hailed India's work in preventing 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.

Nearly three times that number could have been saved if national progress in child health matched that reached in some states, wrote Dr Prabhat Jha, head of the Centre for Global Health Research of St Michael's Hospital in Toronto. 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 under age five died in 2015.

"You get the truth when you knock on doors and talk to parents," said lead investigator Dr Jha. "We knocked on the doors of 100,000 homes where children died. If the health system failed these families, they will tell you all about it. These are far more reliable numbers than models or projections from small studies."

The study, which is part of the Million Death Study, found a 3.3 percent annual decline in mortality rates of neonates (infants less than one month old) and 5.4 percent for those ages one month to 59 months. The declines accelerated starting in 2005 and were fastest between 2010 and 2015, and in urban areas and richer states. Per 1,000 live births, the mortality rates among neonates fell from 45 in 2000 to 27 in 2015. The one-59 month mortality rate fell from 45.2 to 19.6.

Looking at specific causes of death, mortality rates from neonatal tetanus and measles fell by at least 90 percent, neonatal infection and birth trauma fell more than 66 percent. For children ages one to 59 months, mortality rates from pneumonia and diarrhea fell more than 60 percent.

About 6 million children die around the world each year and progress in reducing that number depends greatly on India, which accounts for about a fifth of the deaths. About 29 million Indian children died between 2000 and 2015. Had the mortality rates of 2000 continued unchanged, about 39 million children would have died.

The authors noted that in the last decade the government of India has modestly increased its traditionally low level of public spending on health. The government launched a program to encourage women to give birth in hospitals and for children to have a second dose of measles vaccine.

Dr Jha said that to meet the United Nation's Sustainable Development Goals of halving its mortality rate" child mortality rates by 2030, India must maintain its current trajectory for children ages one to 59 months and accelerate declines in neonatal mortality. Reducing the number of neonatal deaths will require efforts to reduce 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 study is published in journal The Lancet.