Publications
Causes of neonatal and child mortality in India: a nationally representative mortality survey
Million Death Study Collaborators, Bassani DG, Kumar R, Awasthi S, Morris SK, Paul VK, Shet A, Ram U, Gaffey MF, Black RE, Jha P BACKGROUND:
Over 2.3 million (M) children died in India in 2005. All-cause mortality rates vary greatly across the regions of India and by gender. However, the major causes of child deaths have not yet been measured directly.
METHODS:
The Registrar General of India conducted a survey of all deaths occurring in 2001-03 in 1.1 M nationally representative homes. About 800 field staff interviewed households and completed standard questions and a half-page narrative about the events that preceded the death. Each field report was sent to two of 130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved via anonymous reconciliation and, if necessary, adjudication. Cause-specific mortality rates for 2005 were calculated nationally and for the six regions by combining the observed proportions for each cause among 10 892 deaths in neonates and 12 260 deaths at ages 1-59 months with United Nations population and death totals.
FINDINGS:
Three causes accounted for 78% (0.79 M/1.01 M) of all neonatal deaths in India: prematurity & low birthweight (0.33 M; 99%CI 0.31-0.35 M), neonatal infections (0.27 M; 99%CI 0.25-0.29 M) and birth asphyxia & birth trauma (0.19 M; 99%CI 0.18-0.21 M). Two causes accounted for 50% (0.67 M/1.34 M) of all deaths at ages 1-59 months: pneumonia (0.37 M; 99%CI 0.35-0.39 M) and diarrhoeal diseases (0.30 M; 99%CI 0.28-0.32 M). At these ages, girls in Central India had a five times higher mortality rate (per 1000 live births) from pneumonia (20.9) compared to boys in South India (4.1) and had four times higher the diarrhoeal disease mortality rate (17.7) compared to boys in the West (4.1). Pneumonia and diarrhoea accounted for about two-thirds (0.1 M/0.15 M) of the excess girl deaths at ages 1-59 months.
INTERPRETATION:
Five major causes accounted for nearly 1.5 M child deaths in India in 2005, with remarkable regional and gender differences. Lower access for girls to effective prevention and treatment health services are likely responsible for the marked gender differences in mortality.
FUNDING:
US National Institutes of Health, International Development Research Centre, Canadian Institutes of Health Research, Li Ka Shing Knowledge Institute, and US Fund for UNICEF.
