1) The document discusses infant mortality rate (IMR) in India and Kerala, which is the number of infant deaths per 1000 live births. 2) IMR has declined significantly in India and globally since 1965, but Kerala has achieved particularly low rates, with a current IMR of 12. 3) The three main causes of infant deaths in Kerala are prematurity, congenital anomalies, and sepsis/birth asphyxia. Interventions are discussed to further reduce deaths from each cause.

2. You have to dream
before your dreams can
come true.
A.P.J.Abdul Kalam

3. SINGLE DIGIT IMR IN KERALA :
Dream or Reality
-Dr.Arjun.B (Final Year)

4. Contents
• IMR – What & Why ?
• Numbers : Past & Present
– India story
– Kerala story
• Kerala – Cause analysis
• Making dreams come true – how ?
• Conclusion

5. Infant Mortality Rate
• “Ratio of infant deaths registered in a given year to the total
number of live births registered in the same year;
• usually expressed as a rate per 1000 live births
• STRICTLY SPEAKING – NOT A ‘RATE’,
Infant Mortality Rate =
Deaths among Children <1 year
Number of live births
x1000
BUT A ‘RATIO’

6. Health Indicators
INFANT MORTALITY RATE

7. IMR – more than just deaths
• Proxy indicator of population health
• Reflect the socio-economic development of a country
• Sensitive indicator of perinatal care
• Sensitive indicator of the availability, utilization and
effectiveness of health care service and medical technology

8. Why focus on infant deaths
• Largest single age-category of mortality
• Deaths are due to a particular set of diseases & conditions;
different from adults
• Effect of health programmes on infant mortality is quick
compared to general death rate
• Affected by
– Biological
– Economic
– Social

9. Numbers : Past & Present

11. Global IMR trend
Source : United Nations Population Division's World Population Prospects
• 1965 – 114.8
2015 – 31.7
Year
IMR

12. GLOBAL
• 8.1% of all deaths
• 75 % of Under-5 deaths
• 4,500,000 Infant Deaths in 2015
Source : UN Inter-agency Group for Child Mortality Estimates
IMR – 31.7 / 1000 live births
12,329 Infants die every Hour

13. • HIGHEST – Angola (96)
• LOWEST (2)
– Japan
– Norway
– Singapore
– Sweden
– Finland

15. IMR trend in India
Source : United Nations Population Division's World Population Prospects / SRS 2014
• 1965 – 153
2015 – 38
Year
IMR
13 % of all Deaths,
as against 8.1% at global level.
HIGHEST – MP (52)
LOWEST :
•Goa
•Manipur
•Kerala
SRS 2014 – 39 (R – 43; U – 26)
(10)
(11)
(12)

17. Source : SRS

18. INFANT Deaths – A closer look
0 - 7 8 - 28 29 - 365
SRS 2014
Neonatal
Mortality Rate
(NMR)
Early Late
Post-Neonatal Mortality
Rate
365 days
12
5 1
6
6

19. Trend of Child Mortality Rates in India
SRS 2000 - 2012

20. Kerala – Setting Targets !
• 2/3 reduction by 2020 and, 50% reduction by 2030
• 2/3 reduction of
– IMR from 12 to 8 by 2020 and 6 by 2030,
– NMR from 7 to 5 by 2020, 3 by 2030,
– <5MR from 14 to 9 by 2020 and 7 by 2030
Target 3.2: By 2030 end preventable deaths of newborn and
children under-5 years (NMR<12 & U5MR to 25/1000 livebirths)

21. What are the infants dying of ?
Source : IAP report on ‘Why infants continue to die in the state of Kerala?”
[1]
[2]
[3]
≤28 days 75%
>28 days 25%

23. Source : *CBHI Health Profile 2015, *Census India report on Causes of death 2010-2013

24. Making Dreams come True – How ?

25. When the nation goes right,
we go left !
• Interventions need to be catered for the state
• Eg.
– ITN for prematurity, (No endemic malaria)
– JSY to improve Institutional delivery, (Kerala 99.9%)
*CES- 2009

26. 1.Prematurity
• 90% of preterm babies in LIC die within the first few days;
• Less than 10% in high-income settings.
• Causes :
– 45–50% are idiopathic.
– Multiple pregnancies
– Infections
– Chronic conditions, such as diabetes and high blood
pressure;
– Maternal factors (Young or advanced maternal age, short
inter-pregnancy intervals and low maternal BMI)
How many child deaths can we prevent this year. Child Survival Series. The Lancet.2003;362.

27. Interventions Reduction in NMR
Full antenatal care 10–20%
Detection and treatment of
asymptomatic bacteriuria
Incidence of prematurity or
low birth weight: 20–55%
Antenatal corticosteroids for
preterm labour
25 – 50%
Extra care for LBW infants: extra
warmth,
20 – 40%
Emergency neonatal care:
management of serious illness
15-50%
Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet Neonatal Survival series 2005

28. HUMAN MILK BANK
Bharadva K, Tiwari S, Mishra S, Mukhopadhyay K, Yadav B, Agarwal RK, Kumar V. Human milk banking guidelines. Indian
pediatrics. 2014 Jun 1;51(6):469-74.

29. 2.Congenital anomalies

30. Interventions
• Primary prevention :
– Periconceptional Folate
– Availability of genetic services for couples with a family
history
• Secondary prevention :
– prenatal screening and diagnosis
– followed by the offer of termination of pregnancies
affected by major anomalies
Czeizel, A. E. (2005). Birth Defects Are Preventable. International Journal of Medical Sciences, 2(3), 91–92.

31. 3.Sepsis and 4.Birth asphyxia
• Despite the fact that all deliveries are at hospitals (99.9%)
– Neonatal sepsis contributed to around 12% of infant
deaths.
• Despite a very high LSCS rate (43%),
– deaths are still happening due to birth asphyxias.
Infant Death audit to review current care against
standard of care

32. Dream or Reality ?Dream or Reality !

33. TOTAL RURAL URBAN
Total Male Female Total Male Female Total Male Female
12 10 13 14 12 15 10 8 11

34. Conclusion
1. So far, So good.
2. Why are the infants dying ? – Data gap
3. Focus on the neonates
4. Public health  Clinical
5. Strengthen facilities

35. References
1. Park’s Textbook of Preventive and Social medicine , 23rd
Edition
2. United Nations Inter-agency Group for Child Mortality Estimation. 2015. Levels & Trends in Child Mortality. Report 2015.
[http://childmortality.org/]. New York
3. World Health Organization, 2015, Health in 2015: From MDGs Millennium Development Goals to SDGs Sustainable
Development Goals, Geneva. [www .who.int/gho/publications/mdgs-sdgs/]
4. You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, Gerland P, New JR, Alkema L. Global, regional, and national levels and
trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the
UN Inter-agency Group for Child Mortality Estimation. The Lancet. 2015 Dec 11;386(10010):2275-86.
5. SRS 2011, 2012, 2013, 2014
6. Census 2011
7. An Analysis of Levels and Trends in Infant and Child Mortality Rates in India, National Institute of Public Cooperation and
Child Development
8. UN Inter-agency Group for Child Mortality Estimates
9. IAP report on ‘Why infants continue to die in the state of Kerala?”
10. How many child deaths can we prevent this year. Child Survival Series. The Lancet.2003;362
11. CBHI Health Profile 2015
12. Census India report on Causes of death 2010-2013
13. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet Neonatal Survival series
2005
14. Bharadva K, Tiwari S, Mishra S, Mukhopadhyay K, Yadav B, Agarwal RK, Kumar V. Human milk banking guidelines. Indian
pediatrics. 2014 Jun 1;51(6):469-74.
15. Czeizel, A. E. (2005). Birth Defects Are Preventable. International Journal of Medical Sciences, 2(3), 91–92.

36. THANK
YOU !