NEW DELHI :
Even as India struggles against the spread of covid-19, the country’s structural fault lines in health continue to be a cause of concern. Despite the government’s efforts to fight malnutrition among women and children, 68% of under-five-year deaths in India can be attributed to child and maternal malnourishment, while 83% of neonatal deaths is due to low birth-weight and short gestation, a Lancet paper published on Tuesday revealed.
The study done by India State-Level Disease Burden Initiative, a collaboration of the Indian Council of Medical Research (ICMR), Public Health Foundation of India (PHFI), and Institute for Health Metrics and Evaluation (IHME), ministry of health and family welfare other Indian institutions, is the first comprehensive estimate of district-level trends of child mortality. Another scientific paper child growth failure was published in EClinicalMedicine.
The findings show that although child mortality and child growth failure indicators have improved substantially across the country between 2000 and 2017, inequalities between districts have increased in many states.
“The under-5 mortality rate (U5MR) and neonatal mortality rate in the first month of life (NMR) have dropped substantially in India since 2000, but there is a 5-6 fold variation in the rates between the states and 8-11 fold variation between the districts of India," the Lancet paper said
While U5MR and NMR have been decreasing in almost all districts of India, the progress in this decline has been highly variable because of which the inequality in these rates has increased between districts, the report said.
In Uttar Pradesh (UP), for instance, 48% of all districts fell in the highest priority category for NMR and recorded low rate of reduction for the nationwide distribution of district-level rates. The most affected districts of UP, which had the highest child mortality rate in 2017 among states, included a cluster of eight districts in the north-central part (Bahraich, Balrampur, Barabanki, Gonda, Hardoi, Kheri, Shravasti and Sitapur), three districts in the south (Allahabad, Banda and Chitrakoot), and Lalitpur district in the south-west.
In Assam, which recorded the second-highest child mortality rate in 2017, such districts included Cachar, Dima Hasao, Hallakandi, Karbi Anglong, Karimganj and West Karbi Anglong. In Bihar, the highest priority was found in the north-eastern parts (Kishanganj and Purnia), and in south-west (Aurangabad and Kaimur).
“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," said Dr R. Hemalatha, director, National Institute of Nutrition, ICMR, and the lead author of the child growth failure paper.
“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." If the trends observed up to 2017 were to continue, the Lancet study said, India will not be able to meet the Sustainable Development Goals NMR target by 2030.