NEW DELHI: Even as the government has launched many schemes to improve food and nutrition access, especially for women and children, 68% of the under-five deaths in India are caused due to child and maternal malnutrition, a Lancet paper revealed. Low birth weight and short gestation lead to 83% of the neonatal deaths.
The Lancet report has the first comprehensive estimates of district-level trends of child mortality in India since 2000 and details district-level patterns of child growth failure.
The findings of the India State-Level Disease Burden Initiative show that though the child mortality and child growth failure indicators have improved substantially across India from 2000 to 2017, the inequality and variations among districts have risen.
“The under-five mortality rate (U5MR) and neonatal mortality rate (NMR) in the first month of life have dropped substantially in India since 2000, but there is a five-six fold variation in the rates among states and 8-11 fold variation among the districts," the study said.
According to the paper, while U5MR and NMR have been decreasing in almost all districts of India, the progress in this decline has varied because of which the inequality in these rates has increased among districts within many states and the worst hit are Uttar Pradesh, Bihar and Assam.
In Uttar Pradesh, 48% of the districts fell in the highest priority category of high NMR and low rate of reduction for the nationwide distribution of the district-level rates. In Uttar Pradesh, which had the highest child mortality rate in 2017 among the states, the districts in the highest priority category of high NMR and U5MR and low annual rate of reduction included Bahraich, Balrampur, Barabanki, Gonda, Hardoi, Kheri, Shravasti, Sitapur, Allahabad, Banda, Chitrakoo and Lalitpur.
In Assam, which had the second highest child mortality rate in 2017, the highest priority category of high U5MR and NMR and low annual rate of reduction was concentrated in the southern part of the state--Cachar, Dima Hasao, Hallakandi, Karbi Anglong, Karimganj, and West Karbi Anglong.
In Bihar, the highest priority districts were in the northeast, Kishanganj and Purnia, and in Aurangabad and Kaimur in the southwest.
“India has had significant improvements in stunting, wasting and underweight among children since 2000. However, there continues to be a five-fold variation in the prevalence of these indicators between the districts of India," R Hemalatha, director, National Institute of Nutrition, Indian Council of Medical Research (ICMR) and the lead author of the child growth failure paper said.
“The relative inequality of this prevalence between districts has increased within several states, indicating that efforts targeting poorly performing districts as identified by our analysis can potentially help hasten overall improvements in child growth failure in India," she said.
Child growth failure, measured as stunting, wasting and underweight, has improved in India since 2000, but their rates vary four-five fold among districts and the inequality among districts within many states has increased, the paper said.
If the trends observed till 2017 were to continue, the study pointed out that India would not meet the Sustainable Development Goals (SDG) 2030 NMR target, adding that 34% of the districts in India would need higher U5MR reduction and 60% districts would require higher NMR reduction to individually meet the SDG targets
“Comparison of child mortality trends in each of the 723 districts of India with the National Health Policy and SDG targets has identified the districts with high gap where more targeted attention is needed. Malnutrition continues to be the leading risk factor for child death across India," said Rakhi Dandona, professor at the Public Health Foundation of India and the lead author of the child mortality paper.