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Scientific papers on child survival published: India State-Level Disease Burden Initiative

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The findings show that although child mortality, child growth failure indicators have improved substantially across India from 2000 to 2017

At this time when India is focussed heavily on how to deal with COVID-19, two important scientific papers on child survival have been published by the India State-Level Disease Burden Initiative. These publications remind us that while we must do all that we can to control COVID-19, other crucial health issues in India should also continue to receive attention commensurate with their contribution to health loss in India.

The paper in The Lancet reports the first comprehensive estimates of district-level trends of child mortality in India from 2000, and the paper in EClinicalMedicine reports detailed district-level trends of child growth failure. The findings show that although the child mortality and child growth failure indicators have improved substantially across India from 2000 to 2017, the inequality between districts has increased within many states, and that there are wide variations between the districts of India. The child mortality and child growth failure trends reported in these papers utilised all accessible georeferenced survey data from a variety of sources in India, which enabled more robust estimates than the estimates based on single sources that may have more biases. The district-specific findings described in these scientific papers highlight the extent of the effort needed in each district to achieve the national and global targets for the child mortality and child growth failure indicators.

Prof Vinod Paul, Member, NITI Aayog on the release of the findings said, “These research findings have shown that India has made positive strides in protecting the lives of newborns over the last two decades. Introduction of contextually relevant multi-sectorial actions by the Government of India and the State Governments like maternal nutrition programmes during pregnancy, access to skilled health providers during childbirth, and family / community-based care through postnatal home visits have shown to have made a difference. The district level data from this study will help in the planning and implementation of local action plans and set the course for further improvements in child mortality and child growth failure in India.”

Prof Balram Bhargava, Secretary, Department of Health Research, Ministry of Health & Family Welfare, Government of India and Director General, ICMR said, “This is India’s first comprehensive consolidated and detailed analysis of sub-national trends of child mortality and growth failure for all the districts and states in India. It is reassuring news for India that with the various governmental and other efforts under-five mortality rate has halved from 2000 to 2017. The district-level trends reported in these papers provide useful guidance for identifying priority districts in each state that need the highest attention. This approach can facilitate further reduction in child mortality in India.”

Prof Rakhi Dandona, Professor, Public Health Foundation of India and the lead author of the child mortality paper said, “Comparison of child mortality trends in each of the 723 districts of India with the National Health Policy and SDG targets has identified the districts with high gap where more targeted attention is needed. Bringing down death numbers among newborn babies in the first month of life by addressing specific causes of death is crucial. Malnutrition continues to be the leading risk factor for child death across India. Low birth weight is the biggest component in this risk factor. Focus on maternal nutrition during pregnancy needs to be a priority to improve birthweight of babies. The health system needs to track every pregnant women and every new born effectively to substantially reduce child deaths in India.”

Dr R Hemalatha, Director, National Institute of Nutrition, ICMR and the lead author of the child growth failure paper said, “India has had significant improvements in stunting, wasting and underweight among children since 2000. However, there continues to be a 5-fold variation in the prevalence of these indicators between the districts of India. 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.”

Lalit Dandona, Director, India State-Level Disease Burden Initiative, National Chair, Population Health, ICMR, Professor, PHFI, and senior author of these two papers said, “Over the past couple of years, the India State-Level Disease Burden Initiative has been reporting scientifically strong analyses of key diseases and risk factors for every state to inform health policy formulation. The district-level analyses of child mortality and child growth failure reported today are next in this series, providing robust evidence for policy to further improve child survival in India. Continuing this work, this year we are undertaking a comprehensive analysis of the disease burden caused by COVID-19 across India as well as district-level analyses of other indicators that are important for decentralised health planning to which India aspires.”

Dr Hendrik J Bekedam, WHO Representative to India said, “The complementary programmes –  National Health Mission, National Nutrition Mission and Swachh Bharat Abhiyaan – have helped in addressing the immediate and underlying causes of child mortality and child growth failure. Importantly, improving health indicators together with other socio development indicators through the Aspirational District Programme will result in greater reduction of child growth failure and resulting mortality in underperforming districts.”

Prof K Srinath Reddy, President, Public Health Foundation of India said, “Reductions in under-5 child mortality and neonatal mortality are promising as we move towards the SDG targets. Even neonatal mortality which was previously slow to change is now showing improvement. This decline needs to be further accelerated. Child malnutrition is a major determinant along with maternal malnutrition for these deaths and should be accorded highest priority for corrective action. While stark inter-state and inter-district differences in health and nutrition continue to be challenges, these gaps must be quickly bridged through effective and equitable social development, nutrition and environmental health programmes. Our pre-occupation with COVID-19 should not let these development imperatives slip in to the shadows.”

“These studies clearly indicate that, nationally, India has made impressive and substantial progress in reducing the rates of under-5 mortality, however there remain discrepancies in those rates among and within district-level geographies,” said Prof Christopher J L Murray, Director, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington stated, “Health policy makers throughout India will gain critical insights from these studies to help address those discrepancies as the nation seeks to meet the United Nations’ Sustainable Development Goals.”

The findings reported in the papers published are part of the Global Burden of Disease Study 2017. The analytical methods of this study have been refined over two decades of scientific work, which has been reported in over 16,000 peer-reviewed publications, making it the most widely used approach globally for disease burden estimation. These methods enable standardised comparisons of health loss caused by different diseases and risk factors, between different geographies, sexes and age groups, and over time in a unified framework.

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