Maternal malnutrition, low birth weight and short gestation kill lakhs of Indian children every year

Nearly 68% of the under-5 deaths in India can be attributed to the child and maternal malnutrition whereas 83% of the neonatal deaths are due to low birth weight and short gestation, according to two new studies.

The prevalence of stunting among children under five years of age in India was 39% while under-weight is seen among 33% of kids.

Nearly 270 lakh children are born in India each year.

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Scrutinising India’s child mortality and growth failure in every state over the last 17 years, the studies report 8-11 fold variations among districts on the mortality and 4-5 times variations on child growth. As many as 11 districts of Uttar Pradesh and a few districts of Bihar, Odisha and Assam are the worst affected ones.

At a time when the focus is on battling the COVID-19 pandemic, the studies published in The Lancet and EClinicalMedicine underscored the need to pay attention to other aspects of healthcare that have been bereft of attention since the pandemic broke out.

Notwithstanding improvements in the last two decades, the child death numbers continue to be astoundingly high in India.

There were 1.04 million under-5 deaths in India in 2017, of which nearly 50% (0.57 million) were neonatal deaths. The highest number of under-5 deaths was in Uttar Pradesh (312,800 which included 165,800 neonatal deaths) and Bihar (141,500 which included 75,300 neonatal deaths).

Under-five mortality rates of 40 or more per 1,000 live births are reported in 88% of the districts in the less developed states, but only in 2% of the districts in the more developed states.

Similarly, the neonatal mortality rate was 20 or more per 1000 live births in 93% of the districts in the first group of states but only in 13% of the districts in the second category.

“Comparison of child mortality trends in each of the 723 districts has identified the districts with high gaps where more targeted attention is needed," said Rakhi Dandona, professor at the Public Health Foundation of India and the lead author of the child mortality paper.

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In Uttar Pradesh, which had the highest child mortality rate in 2017, the worst performing zone include a cluster of eight districts in the north-central part (Bahraich, Balrampur, Barabanki, Gonda, Hardoi, Kheri, Shravasti, and Sitapur), three districts in the south (Allahabad, Banda and Chitrakoot), and Lalitpur district in the south-west.

In Assam, which had the second-highest child mortality rate in 2017, the worst districts are concentrated in the southern side of the state (Cachar, Dima Hasao, Hallakandi, KarbiAnglong, Karimganj, and West KarbiAnglong). In Bihar, the priority districts are in the north-east (Kishanganj and Purnia) and the south-west (Aurangabad and Kaimur).

On the child growth front, seven districts of Odisha (Kalahandi, Koraput, Rayagada, Nuapada, Nabarangapur, Malkangiri and Balangir) and 13 in Uttar Pradesh (Pilibhit, Shahjanpur, Lakhimpur Kheri, Sitapur, Bahraich, Sravasti, Balrampur, Siddharth Nagar, Gonda, Barabanki, Faizabad, Basti, and Maharajganj) fared the worst on parameters to improve stunting, wasting and underweight among children.

“There are five-fold variations in the prevalence of these indicators (stunting, wasting and underweight) between the districts,” observed R Hemalatha, director, National Institute of Nutrition, Hyderabad and the lead author of the child growth failure paper.