Causes of neonatal and child mortality in India: a nationally representative mortality survey

Abstract

Background: More than 2·3 million children died in India in 2005; however, the major causes of death have not been measured in the country. We investigated the causes of neonatal and child mortality in India and their differences by sex and region.

Methods: The Registrar General of India surveyed all deaths occurring in 2001-03 in 1·1 million nationally representative homes. Field staff interviewed household members and completed standard questions about events that preceded the death. Two of 130 physicians then independently assigned a cause to each death. Cause-specific mortality rates for 2005 were calculated nationally and for the six regions by combining the recorded proportions for each cause in the neonatal deaths and deaths at ages 1-59 months in the study with population and death totals from the United Nations.

Findings: There were 10,892 deaths in neonates and 12,260 in children aged 1-59 months in the study. When these details were projected nationally, three causes accounted for 78% (0·79 million of 1·01 million) of all neonatal deaths: prematurity and low birthweight (0·33 million, 99% CI 0·31 million to 0·35 million), neonatal infections (0·27 million, 0·25 million to 0·29 million), and birth asphyxia and birth trauma (0·19 million, 0·18 million to 0·21 million). Two causes accounted for 50% (0·67 million of 1·34 million) of all deaths at 1-59 months: pneumonia (0·37 million, 0·35 million to 0·39 million) and diarrhoeal diseases (0·30 million, 0·28 million to 0·32 million). In children aged 1-59 months, girls in central India had a five-times higher mortality rate (per 1000 livebirths) from pneumonia (20·9, 19·4-22·6) than did boys in south India (4·1, 3·0-5·6) and four-times higher mortality rate from diarrhoeal disease (17·7, 16·2-19·3) than did boys in west India (4·1, 3·0-5·5).

Interpretation: Five avoidable causes accounted for nearly 1·5 million child deaths in India in 2005, with substantial differences between regions and sexes. Expanded neonatal and intrapartum care, case management of diarrhoea and pneumonia, and addition of new vaccines to immunisation programmes could substantially reduce child deaths in India.

Funding: US National Institutes of Health, International Development Research Centre, Canadian Institutes of Health Research, Li Ka Shing Knowledge Institute, and US Fund for UNICEF.

Figure 1. Annual number of livebirths and deaths at age 0–4 years in India, by region, 2005

M=millions *These poorer states are known as the ‘Empowered Action Group plus Assam’ (EAGA) states.

Figure 2. Causes of death at age 0–4 years in India, by gender and by richer/poorer states, 2001-03

MR=under-five mortality rate *Poorer states are the EAGA states (Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttarakhand and Uttar Pradesh); richer states are the remaining 26 states/union territories.

Figure 3. Causes of death at age 0–4 years in India, by region, 2001-03

MR=under-five mortality rate

Figure 4. Mortality rates for the three leading causes of neonatal death in India, by region, 2005

*Includes pneumonia, sepsis, and infections of the central nervous system.

Figure 5. Mortality rates for the two leading causes of death at age 1–59 months in India, by region, 2005

*Boys from the South region have the lowest mortality rate for pneumonia by gender and region (at age 1–59 months), and girls from the Central region have the highest. † Boys from the West region have the lowest mortality rate for diarrhoeal diseases by gender and region (at age 1–59 months), and girls from the Central region have the highest.