By Laura Costica, Research Associate – ICTPH
The 27th Nov edition of The Lancet features a paper1 emerging from the Million Deaths Study2 Collaboration, in which the causes of deaths in children in India are analysed. This new evidence is presented for six regions of India, rural/urban areas, age groups (neonatal and 1-59 months) and boys/girls. In this post we review the paper and highlight key learnings and the implications for ICTPH’s work in Tanjavur.
3 conditions result in 78% of all neonatal deaths: prematurity and low birth weight, neonatal infections (pneumonia, sepsis and CNS infections) and birth asphyxia.
Neonatal infections account for a neonatal mortality rate (MR) of 3.8 per 1000 live births in the South, 4 times lower than the 14.5 in the Central region (presumably because of the high rate of institutional deliveries in the South); MR attributable to birth asphyxia is also the lowest in the country in the South (for the same reason). The South does have a high neonatal MR due to prematurity and low birthweight. This is especially relevant information for ICTPH, who plans to develop an intervention for maternal health. Prematurity might not be preventable, but low birth weight might be partially averted through better nutrition for the mother.
Deaths in children aged 1-59 months
Pneumonia and diarrhoeal diseases account for 50% of all deaths in children aged 1-59 months, and two-thirds of deaths in girls of the same age. Half of all these deaths are in the Central region, where the MR is 18 for pneumonia and 14.5 for diarrhoeal diseases. Data from a web-appendix with figures for major states reveals more positive news for Tamil Nadu: MR due to pneumonia is only 2 and due to diarrhoea 5.1, some of the lowest in the country (Kerala ranks first on both counts with 0.9 and 0.3 respectively). Pneumonia might not kill many children in the South, however, another recent paper3 from the Million Deaths Study finds that solid fuel use is associated with non-fatal pneumonia (boys: PR 1.54; girls: PR 1.94) and recommends better case management. Since over 90% of households in Thanjavur use solid fuels for cooking, we believe the prevalence of non-fatal pneumonia is quite high, giving us enough scope for achieving positive results though our community-based case management of pneumonia intervention.
Gender disparities: All-cause MR in children aged 1-59 months was found to be 36% higher in girls than in boys. To explain some of this disparity, the authors point to a prevailing social preference for boys in some regions of the country. Tamil Nadu is no exception: the MR for girls aged 1-59 months in rural areas is 27.1 per 1000 live births, whereas for boys it’s only 16.1 (the authors offer the following possible explanation: girls are taken to a health facility less often than boys are).
Using evidence is at the heart of ICTPH’s work and we will continue to learn from studies such as these in an attempt to provide the best service to the communities where we work.
i The Million Deaths Study Collaboration (2010) Causes of neonatal and child mortality in India: a nationally representative mortality survey The Lancet 376(9755):1953-60
ii The Prospective Study of 1 Million Deaths in India follows the lives and deaths of 1.1 million households or 6.3 million people throughout India between 2001 and 2014. The aim is to obtain information on the underlying causes of child and adult deaths, as well as key risk factors for these deaths (behavioral, physical, environmental, and, possibly, genetic).
iii Bassani, B., Jha, P., Dhingra, N. and Kumar, R. (2010) Child mortality from solid-fuel use in India: a nationally-representative case-control study BMC Public Health 10:491