In 2015, India had seen more deaths among children under five than any other country and had large disparities in the under-five mortality rate between richer and poorer states.

‘Infectious diseases are still major causes of death for children under five in poorer Indian states. ’

"India can accelerate its reduction of under-five mortality rates by scaling up vaccine coverage and improving childbirth and neonatal care, especially in states where mortality rates remain high," says study co-lead author Li Liu, PhD, assistant professor in the Department of Population, Family and Reproductive Health at the Bloomberg School. 




The research team included scientists from the Bloomberg School, the London School of Hygiene & Tropical Medicine, World Health Organization (WHO), Indian government health and vital records agencies and other institutions. The other co-lead author was Yue Chu, MSPH, a research associate in the Department of International Health at the Bloomberg School.
Using data sources such as Indian government health surveys, the team assessed total mortality, mortality rates and causes of mortality for children under five in India's 25 major states. Such large analyses help governments gauge their progress and allocate resources as needed to reach public health goals. These goals include one of the United Nations Millennium Development Goals (MDG) set in the year 2000: to reduce the under-five mortality rate in 2015 to one-third of the 1990 figure. For India that would have meant reducing the under-five mortality rate to 39 deaths per 1,000 live births. The analysis showed, however, that despite great progress since 1990--and even since 2000 when the under-five mortality rate was 90.5 deaths per 1,000 live births--India in 2015 was still well above the MDG target, at 47.8 deaths per 1,000 live births.
Most (57.9 percent) of deaths among Indian children under five in 2015 occurred in the first four weeks of life--the neonatal period. Countrywide, the leading cause of death for children under five was preterm birth complications, which accounted for 27.5 percent of the mortality total. But second on the list for cause-of-death was pneumonia (15.9 percent of deaths), and infectious illnesses were more often among the top causes in the poorer, high-mortality states.
"Noncommunicable diseases such as preterm birth complications and congenital abnormalities were usually the leading causes in states with low under-five mortality," Liu says.
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To accelerate India's progress against child mortality, the team recommends more extensive use of childhood vaccines, particularly against pneumonia- and meningitis-causing Streptococcus and H. influenzae bacteria. They also advocate--especially for higher-mortality regions--a scaling up of standard care strategies for newborns, including "kangaroo care" in which the baby rests against the mother's skin, thermal care to reduce hypothermia and early initiation of breastfeeding.
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"Child deaths due to these pathogens have decreased since 2000, helped by the introduction of Hib vaccine which accelerated the decrease for disease caused by Hib," says Brian Wahl, PhD, MPH, an assistant scientist in the Department of International Health at the Bloomberg School and lead author of the study that examined under-five child mortality in India. "The introduction of pneumococcal conjugate vaccine would similarly help accelerate the reduction of deaths due to Streptococcus pneumoniae, which is one of the leading single killers of children in India."
Source-Eurekalert