5 avoidable causes account for nearly 1.5 million child deaths in India

November 12, 2010

An Article published Online First by The Lancet shows that five avoidable causes accounted for nearly 1•5 million child deaths in India throughout the year 2005 with substantial differences between regions and sexes. Expanded neonatal and obstetric care, case management of diarrhoea and pneumonia, and the addition of new vaccines to immunisation programmes could substantially reduce child deaths in India. The study was led by the Registrar General of India (RGI) and co-authored by Professor Prabhat Jha, Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Canada and Professor Rajesh Kumar, Head of the School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh.

Yearly child mortality rates in India have fallen between 1•7% and 2•3% in the past two decades. Despite this decrease, the United Nations (UN) estimates that about 2•35 million children died in India in 2005. This figure corresponds to more than 20% of all deaths in children younger than 5 years worldwide, which is more than in any other country.

Most deaths in India occur at home and without medical attention. To understand the causes of death among Indians, the RGI introduced in 2001 an enhanced form of "verbal autopsy" called RHIME--or routine, reliable, representative, resampled household investigation of mortality with medical evaluation--into its nationally representative sample registration system (SRS), which covered about 6•3 million people and monitored all deaths in 1•1 million homes.

These results are part of the Million Death Study, which seeks to assign causes to all deaths in the SRS areas during the 13 years from 2001 to 2013. In this report the authors present the causes of child deaths in India, separately for the neonatal period and at ages 1󈞧 months, for boys and girls, and for each of six major regions of India.

There were 10 892 deaths in neonates and 12 260 deaths in children aged 1󈞧 months in the study. When these numbers were projected nationally, three causes accounted for 78% (0•79 million) of all 1•01 million neonatal deaths: prematurity and low birthweight (0•33 million), neonatal infections (0•27 million,), and birth asphyxia and birth trauma (0•19 million). Two causes accounted for 50% (0•67 million) of all 1•34 million child deaths at ages 1󈞧 months: pneumonia (0•37 million) and diarrhoeal diseases (0•30 million). In children aged 1󈞧 months, girls in central India had a roughly five-times higher mortality rate (per 1000 livebirths) from pneumonia (21) than did boys in south India (4) and around four-times higher mortality rate from diarrhoeal disease (18) than did boys in west India (4).

The authors say: "Concern has been raised that neonatal death rates in India are not falling fast enough. However, our results suggest that almost half of India's neonatal deaths are caused by birth asphyxia and birth trauma, sepsis, pneumonia, and tetanus--most of which can be avoided by increases in delivery and postnatal care."

They add: "The substantial regional differences in cause-specific mortality, even in girls, could indicate the existence of some underlying social, behavioural, or biological risk factors for child deaths. However, at ages 1󈞧 months, girls in every region die more commonly than do boys, and inequities in access to care, rather than biological or genetic factors, are a more plausible explanation for these recorded differences between sexes."

They conclude: "Our results correspond to deaths before the wide-scale introduction of India's National Rural Health Mission (a major program designed to expand child health services to all of India) in 2006. That programme reports increases in institutional deliveries and in coverage of existing vaccines, and therefore might have reduced child mortality in India. Our study also suggests that specific interventions might be priorities for different regions--for example, expanded case management and introduction of newer vaccines into immunisation programmes would be particularly needed in central India, especially for girls. The changes in the sex-specific and region-specific rates and causes of neonatal mortality and mortality at ages 1󈞧 months will continue to be monitored and reported by the RGI, and should thus help to assess the effectiveness of the National Rural Health Mission and other efforts to reduce child mortality in India."

In a linked Comment, Dr Emmanuela Gakidou, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA, and Dr Alan D Lopez, School of Population Health, University of Queensland, Brisbane, QLD, Australia, say: "As verbal autopsy methods are developed further, the costs of implementing and analysing data from such systems will continue to decrease and the turnaround time from data collection to analysis and publication of findings can be shortened. What is urgently needed in countries without adequate vital registration systems is adoption of one of these low-cost approaches that can yield nationally representative cause-of-death estimates. The new study shows that this requirement is feasible; and, if done in a timely way, would be even more useful for guiding national health policy."
-end-
For Prof. Prabhat Jha, please contact Ms. Ansely Wong (North American media), mobile (+1) 416 662 1347 E) wongans@smh.ca OR Ms. Prabha Sati (Indian media), mobile (+91) 971 196 4550 E) satip@smh.ca

For Dr Emmanuela Gakidou, please contact either William Heisel or Jill Oviatt, IHME Communications. William Heisel T) +1 (206) 897-2886 / + 1 (206) 612-0739 E) wheisel@uw.edu Jill Oviatt T) +1 (206) 897-2862 /+1 (206) 861-6684 E) oviattj@uw.edu

For full Article and Comment, see: http://press.thelancet.com/indiachild.pdf

NOTE: THE ABOVE LINK IS FOR JOURNALISTS ONLY; IF YOU WISH TO PROVIDE A LINK TO THE FREE ABSTRACT OF THIS PAPER FOR YOUR READERS, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61461-4/abstract

Lancet

Related Public Health Articles from Brightsurf:

COVID-19 and the decolonization of Indigenous public health
Indigenous self-determination, leadership and knowledge have helped protect Indigenous communities in Canada during the coronavirus disease 2019 (COVID-19) pandemic, and these principles should be incorporated into public health in future, argue the authors of a commentary in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/lookup/doi/10.1503/cmaj.200852.

Public health consequences of policing homelessness
In a new study examining homelessness, researchers find that policy such a lifestyle has massive public health implications, making sleeping on the street even MORE unhealthy.

Electronic health information exchange improves public health disease reporting
Disease tracking is an important area of focus for health departments in the midst of the COVID-19 pandemic.

Pandemic likely to cause long-term health problems, Yale School of Public Health finds
The coronavirus pandemic's life-altering effects are likely to result in lasting physical and mental health consequences for many people--particularly those from vulnerable populations--a new study led by the Yale School of Public Health finds.

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality
US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

The Lancet Public Health: Access to identification documents reflecting gender identity may improve trans mental health
Results from a survey of over 20,000 American trans adults suggest that having access to identification documents which reflect their identified gender helps to improve their mental health and may reduce suicidal thoughts, according to a study published in The Lancet Public Health journal.

The Lancet Public Health: Study estimates mental health impact of welfare reform, Universal Credit, in Great Britain
The 2013 Universal Credit welfare reform appears to have led to an increase in the prevalence of psychological distress among unemployed recipients, according to a nationally representative study following more than 52,000 working-age individuals from England, Wales, and Scotland over nine years between 2009-2018, published as part of an issue of The Lancet Public Health journal on income and health.

BU researchers: Pornography is not a 'public health crisis'
Researchers from the Boston University School of Public Health (BUSPH) have written an editorial in the American Journal of Public Health special February issue arguing against the claim that pornography is a public health crisis, and explaining why such a claim actually endangers the health of the public.

The Lancet Public Health: Ageism linked to poorer health in older people in England
Ageism may be linked with poorer health in older people in England, according to an observational study of over 7,500 people aged over 50 published in The Lancet Public Health journal.

Study: Public transportation use linked to better public health
Promoting robust public transportation systems may come with a bonus for public health -- lower obesity rates.

Read More: Public Health News and Public Health Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.