New Delhi: Amid COVID-19 when millions of children in the country do not have access to proper meals, maternal and child malnutrition has been a reason for 68% of the under-five deaths in India, reveal the first-ever such estimates mapping trends from 2002 to 2017, published in The Lancet on May 12, 2020.

There has been a decline in child mortality and an improvement in children’s growth, but this improvement is inconsistent across states and districts, the estimates by Indian Council of Medical Research (ICMR), Ministry of Health and Family Welfare (MoHFW), Public Health Foundation of India (PHFI) and Institute for Health Metrics and Evaluation (IHME), show.

“While we must do all that we can to control COVID-19, other crucial health issues in India should also continue to receive attention commensurate with their contribution to health loss in India,” the report warns.

Its major findings on child mortality in India:

  • The under-5 mortality rate (U5MR) reduced by 49% from 83 deaths per 1,000 live births in 2000 to 42 deaths in 2017
  • The neonatal mortality rate (NMR) reduced by 38% during this period, from 38 deaths per 1,000 live births to 23 deaths in 2017
  • There were 1.04 million under-five deaths in India in 2017, down from 2.24 million in 2000
  • There were 570,000 neonatal deaths in 2017, down from 1.02 million deaths in 2000
  • The highest number of under-five deaths in 2017 were in the states of Uttar Pradesh (312,800, including 165,800 neonatal deaths) and Bihar (141,500, including 75,300 neonatal deaths)

Preterm birth was one of the biggest causes of death in children, leading to 15.6% of under-five deaths and 28% of neonatal deaths. Nearly 83% of neonatal deaths were due to low birth weight and short gestation, while 11% of the under-five deaths could be attributed to unsafe water and sanitation and 9% due to air pollution, said the report.

If these trends continue, India will meet its Sustainable Development Goal (SDG) 2030 on under-five mortality--to reduce the rate to 25 per 1,000 live births by 2030.

But it will not meet the SDG 2030 for neonatal mortality--12 per 1,000 live births.

Some 34% of the districts in India would need to improve their U5MR and 60% districts would need to improve their NMR to individually meet these targets.

“Child malnutrition is a major determinant along with maternal malnutrition for these deaths and should be accorded highest priority for corrective action,” said K Srinath Reddy, President, PHFI.

With malnutrition being a leading risk factor for child death, focus on maternal nutrition during pregnancy needs to be a priority and “the health system needs to track every pregnant woman and every newborn effectively to substantially reduce child deaths in India”, said Rakhi Dandona, professor at PHFI.

Amid the ongoing COVID-19 lockdown, access to food is a challenge for most families. “Our preoccupation with COVID-19 should not let these development imperatives slip into the shadows,” said Reddy from PHFI.

(Tiwari is a principal correspondent with IndiaSpend.)