india

Updated: May 16, 2019 09:57 IST

India has more than halved the annual deaths among children under five years, from 2.5 million in 2000 to 1.2 million in 2015, but wide disparities remain between states, a Lancet study has found.

Assam’s under-5 death rate is close to eight times that in Goa, which reported 9.7 such deaths per 1,000 live births compared to Assam’s 73.1, found researchers from the Johns Hopkins Bloomberg School of Public Health after analysing government health survey data on the causes of under-5 deaths from 2000-2015.

India has the world’s biggest birth cohort, with 26 million babies born every year, and the largest number of child deaths.

The top causes of under-5 deaths are pre-term birth complications, preventable infectious diseases such as pneumonia and diarrhoea, followed by injuries, meningitis, measles and malaria, according to the study published in The Lancet Global Health.

“We were surprised and impressed with the rapid decrease in under-5 deaths, which was the result of better access to care, improved health services and appropriate treatment, and reduction in risk factors, such as under-nutrition, indoor air pollution and improved immunisation coverage in some states,” said study co-author Dr Brian Wahl, assistant scientist and faculty at the Johns Hopkins Bloomberg School of Public Health in the US.

Despite progress across India, disparities widened within states over 15 years, with the ratio between the highest regional mortality rate (northeast region) versus the lowest (southern region) increasing from 1.4 in 2000 to 2.1 in 2015, the study found.

“Even in the states doing well, there are intra-district variations. The government has taken impressive steps. Ayushman Bharat and strengthening public health infrastructure, including training mid-level providers and setting up 150,000 health and wellness centres, will further improve access, affordability and quality of care, but these gains take at least half a decade or one decade to show results,” said Raj Panda, additional professor, maternal and child health, Public Health Foundation of India.

“We know what works. Deaths from pneumonia and diarrhoea are largely vaccine preventable... Increasing access to these interventions and investing in strengthening health systems can help address these challenges,” said Wahl.

To accelerate reductions in deaths, the study recommends universal immunisation and promoting standard care strategies for newborns. “India can accelerate its reduction of under-five mortality rates by scaling up vaccine coverage, improving neonatal care,” said lead author Li Liu, assistant professor at the Bloomberg School.