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Neonatal, Infant, and Child Mortality in India: Progress and Future Directions

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Abstract

In India, considerable progress has been made in reducing child mortality rates. Despite this achievement, wide disparities persist across and socio-economic strata, and persistent challenges, such as malnutrition, poor sanitation, and lack of clean water. This paper provides a comprehensive review of the state of child health in India, examining key risk factors and causes of child mortality, assessing the coverage of child health interventions, and highlighting critical public health programs and policies. The authors also discuss future directions and recommendations for bolstering ongoing efforts to improve child health. These include state- and region-specific interventions, prioritizing social determinants of health, strengthening data systems, leveraging existing programs like the National Health Mission (NHM) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), and the proposed Public Health Management Cadre (PHMC). The authors argue that reducing child mortality requires not only scaled-up interventions but a comprehensive approach that addresses all dimensions of health, from social determinants to system strengthening.

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References

  1. Victora CG, Wagstaff A, Schellenberg JA, Gwatkin D, Claeson M, Habicht J-P. Applying an equity lens to child health and mortality: more of the same is not enough. Lancet. 2003;362:233–41.

    Article  PubMed  Google Scholar 

  2. Child Mortality Coordination Group. Tracking progress towards the millennium development goals: reaching consensus on child mortality levels and trends. Bull World Health Organ. 2006;84:225-32.

  3. Liu L, Chu Y, Oza S, et al. National, regional, and state-level all-cause and cause-specific under-5 mortality in India in 2000–15: a systematic analysis with implications for the sustainable development goals. Lancet Glob Health. 2019;7:e721–34.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lahariya C, Paul VK. Burden, differentials, and causes of child deaths in India. Indian J Pediatr. 2010;77:1312–21.

    Article  PubMed  Google Scholar 

  5. Lahariya C, Sudfeld CR, Lahariya D, Tomar SS. Causes of child deaths in India, 1985–2008: a systematic review of literature. Indian J Pediatr. 2010;77:1303–11.

    Article  Google Scholar 

  6. UNICEF. Levels & trends in Child mortality, estimates developed by the UN inter-agency group for Child mortality estimation. 2022. Available at: https://data.unicef.org/resources/levels-and-trends-in-child-mortality. Accessed on 14 Feb 2023.

  7. Dandona L, Dandona R, Kumar GA, et al. Nations within a nation: variations in epidemiologicaltransition across the states of India, 1990–2016 in the global burden of disease study. Lancet. 2017;390:2437–60.

    Article  Google Scholar 

  8. Millennium Development Goals: Final Country Report of India. 2017. Available at: https://www.mospi.gov.in/sites/default/files/publication_reports/MDG_Final_Country_report_of_India_27nov17.pdf. Accessed on 14 Feb 2023.

  9. Ministry of Health and Family Welfare, GoI. National Health Policy. 2017. Available at: https://main.mohfw.gov.in/sites/default/files/9147562941489753121.pdf. Accessed on 14 Feb 2023.

  10. India Newborn Action Plan. 2014. Available at: https://nhm.gov.in/images/pdf/programmes/INAP-progress_card_2020.pdf. Accessed on 14 Feb 2023.

  11. UN Department of Economic and Social Affairs. Sustainable Development Goal 3: ensure healthy lives and promote well-being for all at all ages. Available at: https://sdgs.un.org/goals/goal3. Accessed on 14 Feb 2023.

  12. Bora JK, Saikia N. Neonatal and under-five mortality rate in Indian districts with reference to sustainable development goal 3: an analysis of the national family health survey of India (NFHS), 2015–2016. PloS one. 2018;13:e0201125.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Dandona L, Kumar GA, Henry NJ, et al. India state-level disease burden initiative child mortality collaborators. Subnational mapping of under-5 and neonatal mortality trends in India: the global burden of disease study 2000-17. Lancet. 2020;395:1640–58.

  14. Laxminarayan R, Mohan BC, Vijay TG, Kumar KVA, Wahl B, Lewnard JA. SARS-CoV-2 infection and mortality during the first epidemic wave in Madurai, south India: a prospective, active surveillance study. Lancet Infect Dis. 2021;12:1665–76.

    Article  Google Scholar 

  15. Roberton T, Carter ED, Chou VB, et al. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health. 2020;8:e901–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shet A, Carr K, Danovaro-Holliday MC, et al. Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories.Lancet Glob Health. 2022;10:e186–e94.

  17. India sample registration system: office of the registrar general & census commissioner, India; 2020. Available at: https://censusindia.gov.in/census.website/node/294. Accessed on 14 Feb 2023.

  18. Perin J, Mulick A, Yeung D, et al. Global, regional, and national causes of under-5 mortality in 2000–19: an updated systematic analysis with implications for the sustainable development goals. Lancet Child Adolesc Health. 2022;6:106–15.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Countdown to 2030 Collaboration. Countdown to 2030. Tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet. 2018;391:1538–48.

  20. International Institute for Population Sciences. India National Family Health Survey (NFHS-4), 2015-16. Mumbai, India; 2017. Available at: http://rchiips.org/nfhs/nfhs4.shtml. Accessed on 14 Feb 2023.

  21. International Institute for Population Sciences. India National Family Health Survey (NFHS-5), 2019-21. Mumbai, India; 2021. Available at: http://rchiips.org/nfhs/nfhs5.shtml. Accessed on 14 Feb 2023.

  22. International Institute for Population Sciences. India National Family Health Survey (NFHS-3), 2005-06. Mumbai, India; 2007. Available at: http://rchiips.org/nfhs/nfhs3.shtml. Accessed on 14 Feb 2023.

  23. Sankar MJ, Neogi SB, Sharma J, et al. State of newborn health in India. J Perinatol. 2016;36:S3–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Stephenson R, Matthews Z, McDonald JW. Theimpact of rural–urban migration on under-two mortality in India. J Biosoc Sci. 2003;35:15–31.

    Article  PubMed  Google Scholar 

  25. Gupta M, Rao C, Lakshmi PV, Prinja S, Kumar R. Estimating mortality using data from civil registration: a cross-sectional study in India. Bull World Health Organ. 2016;94:10–21.

    Article  PubMed  Google Scholar 

  26. Kumar GA, Dandona L, Dandona R. Completeness of death registration in the civil registration system, India (2005 to 2015). Indian J Med Res. 2019;149:740–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Basu JK, Adair T. Have inequalities in completeness of death registration between states in India narrowed during two decades of civil registration system strengthening? Int J Equity Health. 2021;20:195.

    Article  PubMed  PubMed Central  Google Scholar 

  28. World Health Organization and UNICEF. Ending preventable child deaths from pneumonia and diarrhoea by 2025: The Integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). 2013. Available at: https://www.who.int/publications/i/item/9789241505239. Accessed on 14 Feb 2023.

  29. Wahl B, Knoll MD, Shet A, et al. National, regional, and state-level pneumonia and severe pneumonia morbidity in children in India: modelled estimates for 2000 and 2015. Lancet Child Adolesc Health. 2020;4:678–87.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kumar S. Challenges of maternal mortality reduction and opportunities under National Rural Health Mission–a critical appraisal. Indian J Public Health. 2005;49:163–7.

    PubMed  Google Scholar 

  31. Dhingra B, Dutta AK. National rural health mission. Indian J Pediatr. 2011;78:1520–6.

    Article  PubMed  Google Scholar 

  32. National Health Authority. GoI. About Pradhan Mantri Jan Arogya Yojana (PM-JAY). Available at: https://nha.gov.in/PM-JAY. Accessed on 14 Feb 2023.

  33. Gurnani V, Haldar P, Aggarwal MK, et al. Improving vaccination coverage in India: lessons from Intensified Mission Indradhanush, a cross-sectoral systems strengthening strategy. BMJ. 2018;363:k4782.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Taneja G, Sridhar VS, Mohanty JS, et al. India’s RMNCH+A Strategy: approach, learnings and limitations. BMJ Glob Health. 2019;4:e001162.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Rao N, Kaul V. India’s integrated child development services scheme: challenges for scaling up. Child Care Health Dev. 2018;44:31–40.

    Article  CAS  Google Scholar 

  36. Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation. Lancet. 2010;375:2009–23.

    Article  PubMed  Google Scholar 

  37. Prinja S, Sharma A, Nimesh R, et al. Impact of National Health Mission on infant mortality in India: An interrupted time series analysis. Int J Health Plan Manag. 2021;36:1143–52.

    Article  Google Scholar 

  38. Lahariya C. “Ayushman Bharat” Program and Universal Health Coverage in India. Indian Pediatr. 2018;55:495–506.

    Article  PubMed  Google Scholar 

  39. Lahariya C. Health & wellness centers to strengthen primary health care in India: concept, progress and ways forward. Indian J Pediatr. 2020;87:916–29.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Dandabathula G, Bhardwaj P, Burra M, Rao PVVP, Rao SS. Impact assessment of India’s Swachh Bharat Mission - Clean India Campaign on acute diarrheal disease outbreaks: yes, there is a positive change. J Family Med Prim Care. 2019;8:1202–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Reddy DN, Reddy AA, Bantilan C. The impact of Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) on rural labor markets and agriculture. India Rev. 2014;13:251–73.

    Article  Google Scholar 

  42. Greer SL, Falkenbach M, Siciliani L, McKee M, Wismar M, Figueras J. From health in all policies to health for all policies. Lancet Public Health. 2022;7:e718–20.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Mor N, Shukla SK. Estimating funds required for UHC within Indian States. Lancet Reg Health Southeast Asia. 2023;13:100165.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Singh S, Shekhar C, Acharya R, et al. The incidence of abortion and unintended pregnancy in India, 2015. Lancet Glob Health. 2018;6:e111–20.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Sonderegger S, Bennett S, Sriram V, Lalani U, Hariyani S, Roberton T. Visualizing the drivers of an effective health workforce: a detailed, interactive logic model. Hum ResurHealth. 2021;19:32.

    Google Scholar 

  46. Tiwari R, Negandhi H, Zodpey S. India’s public health management cadre policy. Lancet Reg Health Southeast Asia. 2022;4:100053.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Taylor CE, Parker RL. Integrating PHC services: evidence from Narangwal India. Health Policy Plan. 1987;2:150–61.

    Article  Google Scholar 

  48. Bhandari S, Wahl B, Bennett S, Engineer CY, Pandey P, Peters DH. Identifying core competencies for practicing public health professionals: results from a Delphi exercise in Uttar Pradesh India. BMC Public Health. 2020;20:1737.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Dr. Chandrakant Lahariya at the Foundation for People Centric Health Systems, New Delhi for technical inputs on the early draft of this manuscript and for technical support at various stages of the manuscript’s development.

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Authors and Affiliations

  1. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Brian Wahl, Raghukul Ratan Pandey, Tushar Garg, Aman Mohan Mishra, Swati Srivastava, Sana Ali, Shival Kishore Verma, Daniel J. Erchick & Molly Sauer

  2. International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Brian Wahl & Molly Sauer

  3. Johns Hopkins India, Lucknow, Uttar Pradesh, India

    Brian Wahl, Raghukul Ratan Pandey, Tushar Garg, Aman Mohan Mishra, Swati Srivastava, Sana Ali & Shival Kishore Verma

  4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

    Norah Nama

  5. Department of Microbiology, King George’s Medical University, Lucknow, Uttar Pradesh, India

    Raghukul Ratan Pandey

  6. Department of Community and Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India

    U Venkatesh, Anil Koparkar & Surekha Kishore

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Contributions

BW led the manuscript development, created figures, and drafted the initial version. NN conducted the literature review and contributed to manuscript writing. RRP, TG, AMM, SS, SA, SKV, DJE, MS, UV, AK, and SK reviewed the manuscript and contributed to data interpretation. All authors revised the manuscript and approved the final draft for publication. BW will act as the guarantor for this manuscript. 

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Correspondence to Brian Wahl.

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Wahl, B., Nama, N., Pandey, R.R. et al. Neonatal, Infant, and Child Mortality in India: Progress and Future Directions. Indian J Pediatr 90 (Suppl 1), 1–9 (2023). https://doi.org/10.1007/s12098-023-04834-z

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