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Child mortality indicators in India
This document discusses key child mortality indicators in India such as the under-5 mortality rate and child death rate. It defines the indicators and describes trends over time. The top causes of under-5 deaths in India are prematurity, birth asphyxia, and neonatal sepsis. Pneumonia, diarrhea, and malaria are also major causes. Programs that can help reduce under-5 mortality include improving newborn care, immunization, and infant and young child feeding practices. The current under-5 mortality rate in India is 49 per 1000 live births.
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Child mortality indicators in India
- 1. Child mortality indicators: Childdeath rate & Under-5 mortality rate Dr. S. A. Rizwan, M.D., Asst. Professor, Dept. of Community Medicine, VMCHRI, Madurai
- 2. Learning objectives • Atthe end of this lecture you sh. be able to • Define each indicator (numerator/denominator) • Describe the meaning and importance of each indicator • List the major causes of such deaths • List the measures required to reduce these rates
- 3. Revision • What isan indicator? • What is a health indicator? • Name some health indicators from previous classes • How do health indictors help you?
- 4.
- 5.
- 6. Deaths in eachage group - 1986 20.9 1.7 1.0 1.7 2.1 2.3 2.4 3.3 4.0 7.3 11.8 18.0 27.2 38.2 88.1 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Mortality rates in 1986 in India
- 7. Deaths in eachage group - 2013 6.4 0.4 0.4 0.9 1.2 1.4 1.4 2.6 3.1 4.1 6.7 10.0 15.0 25.6 67.8 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Mortality rates in 2013 in India
- 8. Child death rate (mortalityin 1-4 years age group)
- 9. Definition of 1-4year MR •Child death rate = No.of child deaths aged 1−4 years Total no.of children aged 1−4 years x 1000
- 10. Description of 1-4year MR • More refined indicator of social situation of the country than IMR • Unlike IMR, it reflects exogenous causes • Reflects the influence of environment • Nutrition, Hygiene, Infection, Accidents • 50% deaths occur in 2nd year in this age group • 30-50 times greater in developing countries
- 11. How much 1-4year MR in India? • 2.8% of all deaths that occurred in 2012
- 12. Statewise variation in1-4 year MR 0.2 0.4 0.6 0.7 1.3 1.3 1.6 1.7 1.9 2.2 2.8 2.8 3.4 3.5 4 4.4 4.6 5.2 5.3 0 1 2 3 4 5 6 Kerala AndhraPradesh TamilNadu Maharashtra Punjab Karnataka WestBengal HimachalPradesh Haryana Chhattisgarh Gujarat India Orissa Rajasthan Jharkhand UttarPradesh MadhyaPradesh Assam Bihar 1-4 year mortality (% of all deaths)
- 13. Top causes of1-4 year MR No. Developing countries Developed countries 1 Diarrhoel diseases Accidents 2 Respiratory infections Congenital anomalies 3 Malnutrition Malignancy 4 Infections Influenza
- 14. Type of accidentsresponsible • Falls from stairs • Suffocation • Burns • Poisoning
- 15. Top causes of1-4 year MR in India Pneumonia 18.2% Diarrhoeal diseases 17.9% Injuries 16.9% Other noncommunicable diseases 10.6% Malaria 7.0% Fever of unknown origin 6.3% Other infectious and parasitic diseases 4.0% Congenital anomalies 3.5% Meningitis/encephalitis 3.5% Ill defined or cause unknown 3.2% All Other Remaining Causes 8.9% Top Ten Causes of Death Age 1 - 4 Years: 2010-2013 Pneumonia 18.2% Diarrhoea 17.8% Injuries 16.9%
- 16. Under-5 mortality rate (mortalityin 0-5 years age group)
- 17. Definition of U5MR •Childmortality rate = No.of child deaths aged 0−59 months Total no. of live births x 1000
- 18. Description of U5MR •Single best indicator of social development than national income • A major decline has been achieved in the past 2 decades, nearly 50% from 90 to 56 per 1000 LB • Major factor was the implementation of MDGs
- 19. Global picture ofU5MR in 2015
- 20. How much U5MRin India? • 49 per 1000 Live Births in 2013
- 21. Statewise variation inU5MR in India 12 23 26 26 31 35 35 40 41 41 45 45 48 49 53 54 57 64 66 69 73 0 10 20 30 40 50 60 70 80 Kerala TamilNadu Delhi Maharashtra Punjab Karnataka WestBengal Jammu&Kashmir AndhraPradesh HimachalPradesh Gujarat Haryana Jharkhand India Chhattisgarh Bihar Rajasthan UttarPradesh Orissa MadhyaPradesh Assam U5MR in India in 2013
- 22. Trends in U5MRin India
- 23. Top causes ofU5MR in 2012 - Global
- 24. Top causes ofU5MR in 2013 - India Rank Cause % 1 Neonatal period causes 44% 2 Pneumonia 13% 3 Diarrhoea 9% 4 Malaria 7% 5 Injury 5% 6 Meningitis 2% 7 Measles 2% 8 AIDS 2% 9 Others 16%
- 25.
- 26. Child survival index = 1000− U5MR 10 • Percentage of live born who survive to the age of 5 years
- 27.
- 28. Recap of causesof child mortality in India
- 29. Top causes ofchild deaths India - 2013 Rank Cause % 1 Prematurity 24% 2 Intrapartum compl. (birth asphyxia) 11% 3 Neonatal sepsis 8% 4 Congenital anomalies 5% 5 Others 5% 6 Pneumonia 2% 7 Neonatal tetanus 1% 1 Pneumonia 11% 2 Diarrhoea 10% 3 Others 14% 4 Injuries 3% 5 Measles 3% 6 Meningitis 2% 7 Malaria 1% 0-27days1-59months
- 30. How to reduceU5MR?
- 31. Measures to reduceU5MR • Different approached, different agencies, different outcomes • WHO - rapid scale up of key effective, affordable interventions • Care for newborns and their mothers • Infant and young child feeding • Vaccines • Prevention and case management of pneumonia, diarrhoea and sepsis • Malaria control • Prevention and care of HIV/AIDS
- 32. Measures to reduceU5MR • WHO four main strategies: 1. Appropriate home care and timely treatment of complications for newborns 2. Integrated management of childhood illness for all children under five years old 3. Expanded programme on immunization 4. Infant and young child feeding Complemented by skilled care during pregnancy & childbirth
- 33. 3 delays modelof child deaths
- 34. Main programme strategiesin India related to child health • NRHM, NUHM or NHM • RMNCH + A • ASHA • HBPNC • IYCF • BFHI • IMNCI
- 35. Interventions, neonatal -prematurity Pregnant Premature SurviveDie Treated bednets &materials* Intermittent preventive therapy Newborn temperature management Prevention Treatment Antinatal steroids Antibiotics for premature rupture of membranes * Indoor residual spraying may be used as an alternative
- 36. Interventions, neonatal -infections Exposure to infections Severe bacterial infection SurviveDie Breastfeeding Antibiotics for sepsis Prevention Treatment Clean delivery Antibiotics for premature rupture of membranes
- 37. Interventions by cause- pneumonia Exposure to pneumonia Pneumonia SurviveDie Hib vaccine Complementary feeding Antibiotics Prevention Treatment Future: Pneumococcal vaccine, zinc for therapy, reduction of indoor air pollution Breastfeeding Zinc
- 38. Interventions by cause- diarrhoea Exposure to diarrhoea Diarrhoea SurviveDie Breastfeeding Complementary feeding Treatment Zinc Future: rotavirus vaccine Vitamin A Antibiotics for dysentry Oral rehydration therapy Zinc Water/San/Hygiene Prevention
- 39. Cause based strategies:post- neonatal children Cause of death Risk factors Prevention Treatment Pneumonia, or other acute respiratory infections Low birth weight Malnutrition Non-breastfed children Overcrowding Vaccination Adequate nutrition Exclusive breastfeeding Reduction of IAP Appropriate care by trained provider Antibiotics Oxygen for severe illness Childhood diarrhoea Non-breastfed children Unsafe drinking water and food Poor hygiene practices Malnutrition Exclusive breastfeeding Safe water and food Adequate sanitation and hygiene Adequate nutrition Vaccination Low-osmolarity oral rehydration salts (ORS) Zinc supplements
- 40.
- 41. % of deathspreventable by each intervention in India 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Breastfeeding Complementary feeding Clean delivery Hib vaccine Clean water, sanitation, hygiene Zinc Vitamin A Antenatal steroids Newborn temperature management Tetanus toxoid Antibiotics for PRM Measles vaccine Nivirapine and replacement feeding Insecticide-treated materials Antimalarial IPT in pregnancy Intervention Percent
- 42.
- 43. Review 1 • Whichone of the following is the leading cause of death in the under 5 age group in developing countries? a) Malaria b) Acute Respiratory Infections c) Hepatitis d) Prematurity
- 44. Review 2 • Allare true about child mortality rate in India EXCEPT a) Almost half of IMR occurs in neonatal period b) Almost 3/4th of U5MR occurs in first year c) 1 in 13 children die before the age of 5 d) NMR is higher in females
- 45. Review 3 • Childsurvival index is calculated from a) MMR b) IMR c) NMR d) U5MR
- 46. Review 4 • Allare important causes of PNMR EXCEPT a) Diarrhea b) ARI c) Malnutrition d) Tetanus
- 47. Review 5 • ChildDeath Rate is a) Child Mortality Rate b) 1-5 years mortality c) 0-4 years mortality d) 13-48 months mortality
- 48. Review 6 • ChildDeath Rate is reflective of a) Quality of perinatal care b) Availability of world class ICUs c) Environmental factors of child health d) All the above
- 49. Review 7 • Singlelargest age category of mortality is a) 1st year b) 2nd year c) 5th year d) 80th year
- 50. Review 8 • Whatproportion of deaths occurred in the 1-4 year age group in India in 2012 a) <3% b) 1% c) 50% d) 4%
- 51. Review 9 • Allthe following states have a proportion of child deaths that is higher than the national average EXCEPT a) Bihar b) Orissa c) Madhya Pradesh d) Gujarat
- 52. Review 10 • MDGgoals for the U5MR in India has been achieved a) True b) False
- 53. Review 11 • Topcauses of child deaths are all EXCEPT a) Prematurity b) Birth Asyphxia c) Pneumonia d) Diarrhoea e) Congenital anomalies f) None of the above
- 54. Review 12 • Topneonatal causes of child deaths are all EXCEPT a) Prematurity b) Birth Asyphxia c) Pneumonia d) Diarrhoea e) Congenital anomalies f) None of the above
- 55. Review 13 • Toppost-neonatal causes of child deaths are all EXCEPT a) Pneumonia b) Diarrhoea c) Injuries d) Measles e) None of the above
- 56. Review 13 • Toppost-neonatal causes of child deaths are all EXCEPT a) Pneumonia b) Diarrhoea c) Injuries d) Measles e) None of the above
- 57. Review 14 • Prioritystrategies for reduction of child mortality in India include (PGI type Q) a) Skilled birth attendant b) Promotion of IYCF practices c) Immunization d) IMNCI e) Injury prevention
- 58. Review 15 Rank thestrategies in order of highest to lowest impact on reduction of U5MR 1. Skilled birth attendant 2. Measles vaccine 3. Promotion of IYCF (BF and CF) 4. Sanitation & hygiene a) 1, 2, 3, 4 b) 2, 3, 4, 5 c) 4, 1, 2, 3 d) 3, 1, 4, 2
- 59. Review 16 • Whatis the current U5MR in India? a) 50 per 1000 Births b) 49 per 1000 Live Births c) 52 per 1000 Live Births d) 37 per 1000 Live Births
- 60. Thank you Send yourqueries to sarizwan1986@outlook.com