CHILD HEALTH INDICATORS IN INDIA

Knowledge of the vital statistics or health indicators in a population is important not only to know the present

TABLE 28.2: National Health Policy 2017 (Targets and Year of Achievement)

Disease elimination/control

*90% PLHA know their HIV status, 90% receive sustained antiretroviral therapy and 90% on antiretroviral therapy have viral suppression.

status but also to: (a) comparing the health status of two different populations, (b) assess the effectiveness of socioeconomic and cultural changes in a population as well as effectiveness of health interventions, and (c) identify the need for further high priority areas, requiring attention

Two most reliable sources of health indicators in India are: (a) National Family Health Surveys (NFHS) conducted country-wide every 5-7 years; and Sample Registration Surveys (SRS) conduced periodically in a pre-defined sample. Table 28.3 provides current status of some important health indicators related to child health in India.

Some important national health indicators are as follows: Infant mortality rate (IMR) is considered as the most reliable indicator of child health and MCH care in the community.

Definition: IMR is defined as quot;the ratio of deaths regis tered in a given year to the total number of live birthsquot;, expressed as a rate per 1000 live births, i.e.

IMR = Total deaths lt;1 year of age/Total live births ? 1000.

Current status: Current IMR in India is estimated to be

28/1000 live births (SRS 2020) or 35.2 (NFHS-5 2019-21),

source: *SRS Statistical report 2022 (reference 2020 data)

**NFHS-5 Fact sheet 2021 (reference 2019-21 data)

as compared to the 5-8/1000 in developed countries.

TABLE 28.5: Major causes of infant mortality in India

TABLE 28.4: States-wise distribution of key mortality indicators*

*Source: NFHS-5 Fact sheet 2021 (reference 2019-21 data)

Infancy includes two crucial periods of human life- neonatal period and post-neonatal period. IMR denotes a sum total of Neonatal mortality rate or NMR, i.e. deaths lt;28 days and Post-neonatal mortality rate or PNMR, i.e. deaths from 28 days 1 year (Ch 1.1). Analysis of data reveals that NMR accounts for gt; 70% of deaths in infancy. Interestingly, NMR is higher in males (? biologically

• Neonatal period

- Low birth weight and prematurity

- Birth asphyxia

- Congenital malformations

- Perinatal and neonatal infections

- Others: HDN, placental malformations

• Post-neonatal period

- Acute respiratory infections

- Diarrheal disorders

- Vaccine preventable diseases, e.g. measles

- Malnutrition

- Others: Accidents, congenital malformations

HDN: Hemolytic disease of newborn

fragile sex), while PNMR is higher in females due to sociocultural neglect.

Causes: Leading causes of infant mortality vary in neonatal and postneonatal period (Table 28.5). According to SRS report on causes of deaths 2017-2019, neonatal problems (53%), pneumonia (17%), diarrheal disease (5%) and other severe infections (4%) are leading cases of IMR in Indian children.

While most neonatal deaths are due to endogenous factors, e.g. prematurity, birth asphyxia and congenital malformations; majority of post-neonatal deaths may be attributed to exogenous factors, e.g.

Determinants: Infant mortality is multi-factorial in origin, affected by various biological, socioeconomic and environmental factors. Some important high-risk factors for IMR include:

• Biological factors: Low birth weight, maternal age lt;19 years or gt;30 years, first-born child, repeated pregnancies (gt;3rd birth order), short birth spacing (lt;1 year), etc.

• Socioeconomic factors: poverty, large family size, maternal illiteracy, girl child, illegitimate pregnancies, top feeding or other harmful customs/practices, etc.

• Environmentalfactors: overcrowding, lack of safe water supply, poor excreta disposal and hygiene, etc.

• Healthcare factors: unattended/untrained deliveries, inadequate perinatal care, poor immunization cover­age, limited health care and IEC activities, specially in rural regions, etc.

Interventional strategies: A multi-pronged approach is essential to reduce IMR in a given population, compri­sing following main measures:

• General measures:

- Socioeconomic development of community

- Improvement in environmental sanitation

- Promotion of female literacy

- Preconception family planning

• Specific measures:

- Antenatal care

- Deliveries by trained birth attendants

- Breastfeeding

- Immunization for vaccine preventable diseases

- Growth monitoring and promotional activities

- Promotion of oral rehydration therapy

- Early diagnosis and treatment of illnesses

• Strengthening of primary health care to manage common problems and identify at-risk cases for referral.

Under-5 mortality rate (child mortality rate) is consi­dered as the best single indicator of overall socioeconomic development and well-being of the community, as majority of its causes, e.g. malnutrition and infection are dependent on the socio-economic status, environmental hygiene and health awareness in the population.

Internationally, child mortality rate is defined as the annual deaths lt;5 years of age (IMR included) out of per 1000 live births in the same year. However, in India, it calculated as annual deaths lt;5 years of age out of per 1000 under-5 children.

In India, Under-5 mortality has shown exemplary decline in last few decades (242 in 1960 to 32 in 2020 as per SRS or 41.9 as per NFHS-5), largely due to decline in IMR and reduction in vaccine-preventable deaths.

Leading cause of childhood mortality beyond infancy include Injuries (218%), Pneumonia (18%), non­communicable diseases (14%) and diarrheal diseases 13%. (SRS-COD report 2017-19)

Two other important child health indicators Neonatal Mortality rate (NMR) or Perinatal Mortality rate (PNR) have been discussed in Ch 12.2.

28.3