Child, maternal malnutrition led to 68 per cent under-five fatalities in India

Child and maternal malnutrition were behind 68 per cent of the under-five fatalities in India, while low birth weight and short gestation led to83 per cent of neonatal deaths from 2000 to 2017, according tofindings of the India State-Level Disease Burden Initiative released on Tuesday.

The first comprehensive estimate of district-level trends of child mortality and child growth failure in India said though these indicators have improved substantially across India during 2000-2017, the inequality between districts has increased within many states, and that there are wide variations between districts ofIndia.

The findings, which are part of two scientific papers on child survival, have been published at a time when thecountry is fighting COVID-19 pandemic.

Health experts say that they remind us that while we must do all that we can to control coronavirus infection, other crucial health issues in India should also continue to receive attention commensurate with their contribution to health loss in India.

The studies stated that the under-5 Mortality Rate (U5MR) dropped in Indiasince 2000 by 49 per cent but there is a 6-fold variation in the rate between the states and 11-foldvariation between districts of India.

There were 1.04 million under-5 deaths in India in 2017, of which 0.57 million were neonatal deaths, down from 2.24 million under-5 deaths including 1.02 million neonatal deaths in 2000.

Neonatal Mortality Rate (NMR) has dropped by 38 per cent since 2000 but there is a 5-fold variation in the rate between the states and 8-fold variation between districts of India, the study stated.

"The reduction in NMR has beenless than for U5MR, and thisreduction has been quite variableacross states and districts," the study said.

Child growth failure, measured as stunting, wasting and underweight has improved in India since 2000, but their rates vary 4-5 fold between the districts of India and the inequality between districts within many states has increased, the study highlighted.

"If the trends observed up to 2017 were to continue, India would meet the SDG 2030 U5MR target but not the SDG 2030 NMR target.34 per cent of the districts in India would need higher U5MR reduction and 60 per cent districts would need higher NMR reduction to individually meet the SDG targets," it stated.

"The district-level trends reported in these papers provide useful guidance for identifying priority districts in eachstate that need the highest attention," Director General, ICMR Dr Balram Bhargava said.

Professor Rakhi Dandona, Professor at the Public Health Foundation of India and the lead author of thechild mortality paper said comparison of child mortality trends in each of the 723 districts of Indiawith the National Health Policy and SDG targets has identified the districts with high gap where moretargeted attention is needed.

Bringing down death numbers among newborns in the first month of life by addressing specific causes of death is crucial. Malnutrition continues to be the leading riskfactor for child death across India. Low birth weight is the biggest component in this risk factor.

Professor K Srinath Reddy, President, Public Health Foundation of India said, "Reductions in under-5 childmortality and neonatal mortality are promising as we move towards the SDG targets.

"Even neonatalmortality which was previously slow to change is now showing improvement. This decline needs to befurther accelerated. Child malnutrition is a major determinant along with maternal malnutrition forthese deaths and should be accorded highest priority for corrective action," he said,