Background: In India under-five mortality (U5MR) has declined by 71% from 126 to 37 deaths per 1000 live births between 1990 and 2018. The Empowered Action Group (EAG) states accounts for 74% of the under-five deaths as compared to 26% among Non-EAG states. Method: National Family Health Survey round fourth (NFHS-4), 2015-16 was used for this study. A life table method and Cox Proportional Hazard (PH) model was used to examine the various factors associated with U5MR in EAG and Non-EAG states of India. Result: Overall, it was observed that U5MR is much higher in EAG compared to Non-EAG states. Absolute difference varies according to background characteristics. The highest difference was among mothers who had never breastfed (316 vs 150 U5MR per 1000 live births in EAG & Non-EAG states respectively). Factors—total children ever born to mother, household members, children never breastfed and size of the baby were found to be statistically significantly associated with under-five mortality after controlling for other factors in both EAG and Non-EAG states. Hazard of U5MR was two and half-times higher among birth order 4+ (AHR = 2.5, 95% CI = 1.8 - 3.3) compared to birth order ≤2 after controlling for other factors in EAG states. The risk of under-five mortality was found three times higher among mother having up to primary or no education (AHR = 2.9, 95% CI = 1.4 - 5.9) compared to mother having higher education in non-EAG states. Conclusion: The study revealed that both groups of states need health program interventions focused on high risk mothers, TT immunization and promoting basic health services and breastfeeding practices for the reduction U5MR.
References
[1]
The United Nations Inter-Agency Group for Child Mortality Estimation (2019) Levels & Trends in Child Mortality: 2019 Report.
https://www.unicef.org/media/60561/file/UN-IGME-child-mortality-report-2019.pdf
[2]
Yojna, J.S. (2005) National Health Mission, Ministry of Health and Family Welfare.
https://nhm.gov.in/WriteReadData/l892s/97827133331523438951.pdf
[3]
Kumar, C., Singh, P.K and Rai, R.K. (2012) Under-Five Mortality in High Focus States in India: A District Level Geospatial Analysis. PLoS ONE, 7, e37515.
https://doi.org/10.1371/journal.pone.0037515
[4]
Bora, J.K. and Saikia, N. (2018) 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, 13, e0201125.
https://doi.org/10.1371/journal.pone.0201125
[5]
(2011) Annual Report: 2010-11. Ministry of Health and Family Welfare, 1-2.
https://main.mohfw.gov.in/sites/default/files/26697288736.pdf
[6]
India, P. (2011) Census of India 2011 Provisional Population Totals.
http://censusindia.gov.in/2011-prov-results/prov_results_paper1_india.html
[7]
United Nations (2016) Goal 3: Ensure Healthy Lives and Promote Well-Being for All at All Ages. http://www.un.org/sustainabledevelopment/health
[8]
International Institute for Population Sciences (2017) National Family Health Survey (NFHS-4) (2015-16). http://rchiips.org/NFHS/NFHS-4Reports/India.pdf
[9]
Mosley, W.H. and Chen, L.C. (1984) An Analytical Framework for the Study of Child Survival in Developing Countries. Population and Development Review, 10, 25-45. https://doi.org/10.2307/2807954
[10]
Govindasamy, P. (1997) Maternal Education and the Utilization of Maternal and Child Health Services in India. Maternal Education and the Utilization of Maternal and Child Health Services in India, 5, 1-28.
https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.492.7189&rep=rep1&type=pdf
[11]
Mani, K. (2012) Determinants of Under-Five Mortality in Rural Empowered Action Group States in India: An Application of Cox Frailty Model. International Journal of MCH and AIDS, 1, 60-72.
[12]
Abir, T., Agho, K.E., Page, A.N., Milton, A.H. and Dibley, M.J. (2015) Risk Factors for Under-5 Mortality: Evidence from Bangladesh Demographic and Health Survey, 2004-2011. BMJ Open, 5, e006722.
https://doi.org/10.1136/bmjopen-2014-006722
[13]
Singh, R. and Tripathi, V. (2015) Under-Five Mortality among Mothers Employed in Agriculture: Findings from a Nationally Representative Sample. PeerJ, 3, e710.
https://doi.org/10.7717/peerj.710
[14]
Hossain, M.M., Mani, K.K.C. and Islam, M.R. (2015) Prevalence and Determinants of the Gender Differentials Risk Factors of Child Deaths in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey, 2011. PLoS Neglected Tropical Diseases, 9, e0003616. https://doi.org/10.1371/journal.pntd.0003616
[15]
Ezeh, O.K., Agho, K.E., Dibley, M.J., Hall, J.J. and Page, A.N. (2015) Risk Factors for Postneonatal, Infant, Child and Under-5 Mortality in Nigeria: A Pooled Cross-Sectional Analysis. BMJ Open, 5, e006779.
https://doi.org/10.1136/bmjopen-2014-006779
[16]
Singh, R. and Tripathi, V. (2013) Maternal Factors Contributing to Under-Five Mortality at Birth Order 1 to 5 in India: A Comprehensive Multivariate Study. SpringerPlus, 2, Article No. 284. https://doi.org/10.1186/2193-1801-2-284
[17]
Zanini, R.R., Moraes, A.B., Giugliani, E.R.J. and Riboldi, J. (2011) Determinantescontextuais da mortalidade neonatal no Rio Grande do Sulpordoismodelos de análise. Revista de SaúdePública, 45, 79-89.
https://doi.org/10.1590/s0034-89102011000100009
[18]
Pandey, M.K. (2009) ASARC Working Paper 2009/12: Maternal Health and Child Mortality in Rural India.
https://crawford.anu.edu.au/acde/asarc/pdf/papers/2009/WP2009_12.pdf
[19]
Uddin, M.J. and Hossain, M.Z. (2010) Predictors of Infant Mortality in a Developing Country. Asian Journal of Epidemiology, 3, 84-99.
https://doi.org/10.3923/aje.2010.84.99
[20]
Kaldewei, C. (2010) Determinants of Infant and Under-Five Mortality—The Case of Jordan (Technical Note, February 2010).
https://www.un.org/en/development/desa/policy/capacity/country_documents/jordan_desa_mdg4_technote_mar2010.pdf
[21]
Alonso, V., Fuster, V. and Luna, F. (2005) Causes of Neonatal Mortality in Spain (1975-98): Influence of Sex, Rural-Urban Residence and Age at Death. Journal of Biosocial Science, 38, 537-551. https://doi.org/10.1017/s0021932005026957
[22]
Perianayagam, A. and Abhishek, G. (2008) Neonatal Mortality in the Empowered Action Group States of India: Trends and Determinants. Journal of Biosocial Science, 40, 183-201. https://doi.org/10.1017/s0021932007002623
[23]
Blencowe, H., Lawn, J., Vandelaer, J., Roper, M. and Cousens, S. (2010) Tetanus Toxoid Immunization to Reduce Mortality from Neonatal Tetanus. International Journal of Epidemiology, 39, i102-i109. https://doi.org/10.1093/ije/dyq027
[24]
Chowdhury, A.H. (2013) Determinants of Under-Five Mortality in Bangladesh. Open Journal of Statistics, 3, 213-219. https://doi.org/10.4236/ojs.2013.33024
[25]
Adhikari, R. and Podhisita, C. (2010) Household Headship and Child Death: Evidence from Nepal. BMC International Health and Human Rights, 10, Article No. 13. https://doi.org/10.1186/1472-698x-10-13
[26]
Nasejje, J.B., Mwambi, H.G. and Achia, T.N.O. (2015) Understanding the Determinants of Under-Five Child Mortality in Uganda Including the Estimation of Unobserved Household and Community Effects Using Both Frequentist and Bayesian Survival Analysis Approaches. BMC Public Health, 15, Article No. 1003.
https://doi.org/10.1186/s12889-015-2332-y
[27]
Dejene, T. and Girma, E. (2013) Social Determinants of Under-Five Mortality in Ethiopia: Event History Analysis Using Evidence from Ethiopian Demographic and Health Survey (EDHS). Health, 5, 879-884.
https://doi.org/10.4236/health.2013.55115
