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Child mortality indicators:Child death rate &
Under-5 mortality rate
Dr. S. A. Rizwan, M.D.,Asst. Professor,
Dept. of Community Medicine,VMCHRI, Madurai
Learning objectives• At the 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
Revision• What is an indicator?• What is a health indicator?• Name some health indicators from previous classes• How do health indictors help you?
Indicator
1-4 year mortality
rate
0-5 year mortality
rate
Age-specific mortality rates in India
Deaths in each age group - 1986
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+0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
20.9
1.7 1.0 1.7 2.1 2.3 2.4 3.3 4.07.3
11.818.0
27.2
38.2
88.1
Mortality rates in 1986 in India
Deaths in each age group - 2013
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+0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
6.40.4 0.4 0.9 1.2 1.4 1.4 2.6 3.1 4.1 6.7
10.015.0
25.6
67.8
Mortality rates in 2013 in India
Child death rate(mortality in 1-4 years age group)
Definition of 1-4 year MR •Child death rate =
x 1000
Description of 1-4 year 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
How much 1-4 year MR in India?• 2.8% of all deaths that occurred in 2012
Statewise variation in 1-4 year MR
Kerala
Andhra Pradesh
Tamil N
adu
Maharashtra
Punjab
Karnataka
West Bengal
Himachal Pradesh
Haryana
Chhattisgarh
Gujarat
India
Orissa
Rajasthan
Jharkhand
Uttar Pradesh
Madhya Pradesh
Assam
Bihar
0
1
2
3
4
5
6
0.2 0.4 0.6 0.71.3 1.3
1.6 1.7 1.92.2
2.8 2.83.4 3.5
44.4 4.6
5.2 5.3
1-4 year mortality (% of all deaths)
Top causes of 1-4 year MRNo. Developing countries Developed countries
1 Diarrhoel diseases Accidents
2 Respiratory infections Congenital anomalies
3 Malnutrition Malignancy
4 Infections Influenza
Type of accidents responsible• Falls from stairs• Suffocation• Burns• Poisoning
Top causes of 1-4 year MR in India
Pneumonia18.2%
Diarrhoeal diseases17.9%
Injuries16.9%
Other noncommunicable diseases
10.6%
Malaria7.0%
Fever of unknown origin6.3%
Other infectious and parasitic diseases
4.0%
Congenital anomalies3.5%
Meningitis/encephalitis3.5%
Ill defined or cause unknown
3.2% All Other Remaining Causes8.9%
Top Ten Causes of Death Age 1 - 4 Years: 2010-2013
Pneumonia 18.2%
Diarrhoea 17.8%
Injuries 16.9%
Under-5 mortality rate(mortality in 0-5 years age group)
Definition of U5MR • Child mortality rate =
x 1000
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
Global picture of U5MR in 2015
How much U5MR in India?• 49 per 1000 Live Births in 2013
Statewise variation in U5MR in India
Kerala
Tamil N
adu
Delhi
Maharashtra
Punjab
Karnataka
West Bengal
Jamm
u & Kashm
ir
Andhra Pradesh
Himachal Pradesh
Gujarat
Haryana
Jharkhand
India
Chhattisgarh
Bihar
Rajasthan
Uttar Pradesh
Orissa
Madhya Pradesh
Assam
01020304050607080
12
23 26 2631
35 3540 41 41
45 45 48 4953 54 57
64 66 6973
U5MR in India in 2013
Trends in U5MR in India
Top causes of U5MR in 2012 - Global
Top causes of U5MR in 2013 - IndiaRank 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%
Child Survival Index
Child survival index= • Percentage of live born who survive to the
age of 5 years
How much?
Recap of causes of child mortality in India
Top causes of child deaths India - 2013Rank 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%
0-27 days1-59 m
onths
How to reduce U5MR?
Measures to reduce U5MR• 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
Measures to reduce U5MR• 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
3 delays model of child deaths
Main programme strategies in India related to child health• NRHM, NUHM or NHM• RMNCH + A• ASHA• HBPNC• IYCF• BFHI• IMNCI
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
Interventions, neonatal - infections
Exposure to infections
Severe bacterial infection
SurviveDie
Breastfeeding
Antibiotics for sepsis
Prevention Treatment
Clean delivery
Antibiotics for premature rupture of membranes
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
Interventions by cause - diarrhoea
Exposure to diarrhoea
Diarrhoea
SurviveDie
Breastfeeding
Complementary feeding
Treatment
Zinc
Future: rotavirus vaccine
Vitamin AAntibiotics for dysentry
Oral rehydration therapy
Zinc
Water/San/Hygiene
Prevention
Cause based strategies: post-neonatal childrenCause of death Risk factors Prevention Treatment
Pneumonia, or other acute respiratory infections
Low birth weightMalnutritionNon-breastfed childrenOvercrowding
VaccinationAdequate nutritionExclusive breastfeedingReduction of IAP
Appropriate care by trained providerAntibioticsOxygen for severe illness
Childhood diarrhoea
Non-breastfed childrenUnsafe drinking water and foodPoor hygiene practicesMalnutrition
Exclusive breastfeedingSafe water and foodAdequate sanitation and hygieneAdequate nutritionVaccination
Low-osmolarity oral rehydration salts (ORS)Zinc supplements
Every Newborn Action Plan
% of deaths preventable by each interventionin India
Review
Review 1• Which one of the following is the leading cause of
death in the under 5 age group in developing countries?
a) Malariab) Acute Respiratory Infectionsc) Hepatitisd) Prematurity
Review 2• All are true about child mortality rate in India
EXCEPTa) Almost half of IMR occurs in neonatal periodb) Almost 3/4th of U5MR occurs in first yearc) 1 in 13 children die before the age of 5d) NMR is higher in females
Review 3• Child survival index is calculated from a) MMRb) IMRc) NMRd) U5MR
Review 4• All are important causes of PNMR EXCEPTa) Diarrheab) ARIc) Malnutritiond) Tetanus
Review 5• Child Death Rate isa) Child Mortality Rateb) 1-5 years mortalityc) 0-4 years mortalityd) 13-48 months mortality
Review 6• Child Death Rate is reflective ofa) Quality of perinatal care b) Availability of world class ICUsc) Environmental factors of child healthd) All the above
Review 7• Single largest age category of mortality isa) 1st yearb) 2nd yearc) 5th yeard) 80th year
Review 8• What proportion of deaths occurred in the 1-4 year
age group in India in 2012a) <3% b) 1%c) 50%d) 4%
Review 9• All the following states have a proportion of child
deaths that is higher than the national average EXCEPT
a) Biharb) Orissac) Madhya Pradeshd) Gujarat
Review 10• MDG goals for the U5MR in India has been
achieveda) True b) False
Review 11• Top causes of child deaths are all EXCEPTa) Prematurityb) Birth Asyphxiac) Pneumoniad) Diarrhoeae) Congenital anomaliesf) None of the above
Review 12• Top neonatal causes of child deaths are all EXCEPTa) Prematurityb) Birth Asyphxiac) Pneumoniad) Diarrhoeae) Congenital anomaliesf) None of the above
Review 13• Top post-neonatal causes of child deaths are all
EXCEPTa) Pneumoniab) Diarrhoeac) Injuriesd) Measlese) None of the above
Review 13• Top post-neonatal causes of child deaths are all
EXCEPTa) Pneumoniab) Diarrhoeac) Injuriesd) Measlese) None of the above
Review 14• Priority strategies for reduction of child mortality in
India include (PGI type Q)a) Skilled birth attendantb) Promotion of IYCF practicesc) Immunizationd) IMNCIe) Injury prevention
Review 15Rank the strategies in order of highest to lowest impact on reduction of U5MR1. Skilled birth attendant2. Measles vaccine3. Promotion of IYCF (BF and CF)4. Sanitation & hygiene
a) 1, 2, 3, 4b) 2, 3, 4, 5c) 4, 1, 2, 3d) 3, 1, 4, 2
Review 16• What is the current U5MR in India?a) 50 per 1000 Birthsb) 49 per 1000 Live Birthsc) 52 per 1000 Live Birthsd) 37 per 1000 Live Births
Thank youSend your queries to [email protected]