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INFANT AND CHILD MORTALITY IN INDIA

Saturday, 26th of November 2011

• INFANT AND CHILD MORTALITY IN INDIA

 

Infant and Child Mortality in India in the Last Two

Decades: A Geospatial Analysis

Abhishek Singh1, Praveen Kumar Pathak2*, Rajesh Kumar Chauhan3, William Pan4

1 Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India, 2 Department of Geography, Shivaji

University, Kolhapur, Maharashtra, India, 3 Population Research Centre, University of Lucknow, Lucknow, Uttar Pradesh, India, 4 Nicholas School of Environment and the

Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America

 

Abstract and excerpts from discussion, below. Full text, http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0026856

 

Background:

 

Studies examining the intricate interplay between poverty, female literacy, child malnutrition, and child mortality are rare in demographic literature. Given the recent focus on Millennium Development Goals 4 (child survival) and 5 (maternal health), we explored whether the geographic regions that were underprivileged in terms of wealth, female  literacy, child nutrition, or safe delivery were also grappling with the elevated risk of child mortality; whether there were any spatial outliers; whether these relationships have undergone any significant change over historical time periods.

 

Methodology: The present paper attempted to investigate these critical questions using data from household surveys like NFHS 1992–1993, NFHS 1998–1999 and DLHS 2002–2004. For the first time, we employed geo-spatial techniques like Moran’s-I, univariate LISA, bivariate LISA, spatial error regression, and spatiotemporal regression to address the research problem. For carrying out the geospatial analysis, we classified India into 76 natural regions based on the agro-climatic scheme proposed by Bhat and Zavier (1999) following the Census of India Study and all estimates were generated for each of the geographic regions.

 

Result/Conclusions:

 

This study brings out the stark intra-state and inter-regional disparities in infant and under-five mortality in India over the past two decades. It further reveals, for the first time, that geographic regions that were underprivileged in child nutrition or wealth or female literacy were also likely to be disadvantaged in terms of infant and child survival irrespective of the state to which they belong. While the role of economic status in explaining child malnutrition and child survival has weakened, the effect of mother’s education has actually become stronger over time.

Citation: Singh A, Pathak PK, Chauhan RK, Pan W (2011) Infant and Child Mortality in India in the Last Two Decades: A Geospatial Analysis. PLoS ONE 6(11):

e26856. doi:10.1371/journal.pone.0026856

Editor: Zulfiqar A. Bhutta, Aga Khan University, Pakistan

Received May 30, 2011; Accepted October 5, 2011; Published November 2, 2011

Copyright: _ 2011 Singh et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits

unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: These authors have no support or funding to report.

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: pkp_pathak@rediffmail.com

 

[From the discussion section]A key contribution of the study is the identification of hotspots (that is, regions with high poverty and high infant and under-five mortality; high child malnutrition and high infant and under-five mortality) and cold-spots (regions with low poverty and low infant

and under-five mortality; high female literacy and low infant and

under-five mortality). There is a general understanding among

researchers and policy-makers that infant mortality and under-five

mortality are lower in one group of states and higher in another

group of states. But this analysis shows that there are huge

disparities even within the states. This study clearly brings out

spatial contours where the poverty and infant and under-five

mortality are clustered, and where child malnutrition and

infant and under-five mortality are clustered. The findings depict

geographic regions that need immediate and careful attention of

the policy makers if India needs to achieve MDG Goal 4. This

study also brings out for the first time the fact that geographic

regions that were underprivileged in child nutrition were also likely

to be disadvantaged in terms of infant and under-five mortality

irrespective of the state to which they belong.

 

Another key finding of the study is the identification of

geographic regions that present inconsistent relationships between

the exposure variables and outcome variables (that is, regions that

showed high poverty but low mortality; regions that showed high

malnutrition but lower mortality). For example, the South Coast of

Andhra Pradesh showed a typical pattern with high poverty and

low mortality; high child malnutrition and low mortality; and high

percentage of safe delivery but high mortality. The North West

Plateau and South Plateau of Karnataka showed low poverty but

high infant and under-five mortality. Similarly, the ‘South East

Coast’ and ‘Kongunad and Nilgiri’ of Tamil Nadu depicted low

child malnutrition but high mortality during infancy and early

childhood. These regions particularly warrant carefully designed

studies to understand factors explaining such irregular patterns.

Such focus was lacking in the earlier studies conducted either in

India or in the other parts of the world.

 

Another finding of the study that needs attention is the

inconsistent relationship between the prevalence of child malnutrition

and mortality during infancy and early childhood. The

prevalence of child malnutrition was significantly and positively

associated with mortality during the first and the last survey

rounds, but was insignificant in the second survey round. Results

from earlier studies also support our findings [85]. This could

happen because there is no one to one correspondence between

child malnutrition and mortality. There is a possibility of time-lag

between the occurrence of child malnutrition and mortality during

infancy and early childhood. This could also be possible because of

the existence of mortality selection as the most undernourished

might have already died, and thus might have been eliminated

from the undernourished sample [86]. Therefore, the relationship

between child malnutrition and mortality must be accepted with

caution. Nonetheless, the findings are of immense value because

they point towards a possible clustering of child malnutrition and

mortality in certain geographic regions.

 

The accentuating negative association between female

literacy and mortality on the one hand, and the attenuating

positive association between poverty and mortality on the other

hand deserve particular attention. The indications are obvious.

With the heightened focus and increased investment by the

Government of India in maternal and child health programs

(Reproductive and Child Health Program, Janani Suraksha

Yojana under the National Rural Health Mission) and nutrition

programs (ICDS and mid-day meal schemes) and the availability

of these programs to those who are below poverty line [87–

90], there is every likelihood that being poor or rich does not

matter given that one has the capacity to access information

regarding such programs and that people demand for such

services. Under these circumstances the effect of literacy,

especially female literacy is likely to increase and the effect of

poverty is likely to reduce. However, we cannot completely

ignore the effect of poverty on child health. The Mahatma

Gandhi National Rural Employment Guarantee Scheme is a

welcome step in arresting poverty, especially in the rural areas

of the country [91]. It is also worth mentioning that the

Government of India is debating on the ‘National Food Security

Bill’ which is likely to cover 75 percent of the India’s population.

The draft ‘National Health Bill 2009’ is also under debate in the

Parliament for approval.