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Most child deaths in India avoidable

An article published online by The Lancet shows that five avoidable causes accounted for nearly 1.5 million child deaths in India throughout the year

More children under the age of 5 die in India than in any other country in the world, and from five main causes -- pneumonia, premature and low birth weight, diarrhoeal diseases, neo-natal infections and birth asphyxia, and birth trauma -- that are avoidable, says a paper published in The Lancet on November 13, 2010.

“Each of the major causes… can be prevented or treated with known, highly effective and widely practicable interventions such as improvements in pre-natal care,” wrote the researchers, led by the Registrar General of India.

Expanded neo-natal and obstetric care, proper management of diarrhoea and pneumonia, and adding new vaccines to immunisation programmes could substantially reduce child deaths in the country, they added.

Some 2.35 million children under the age of 5 died in India in 2005, making up more than 20% of all child deaths in that age-group worldwide. Three-fifths, or 62%, of the deaths were caused by those five reasons, the researchers said.

Most deaths in India occur at home and without medical intervention. In this survey, field workers investigated the causes of death of 24,841 children, through interviews with their families, using a standard questionnaire. Two of 130 physicians then independently assigned a cause to each death.

The survey found the number of girls who died between 1 to 59 months was 36% higher than boys; the difference was even more stark in certain places in India. “Girls in central India had a five-times-higher mortality rate from pneumonia than did boys in south India, and had a four-times-higher mortality rate from diarrhoeal diseases than boys in the west,” they wrote.

They believe the greater number of deaths in girls is due to Indian society’s preference for boys which results in more boys using healthcare facilities than girls. “Fewer girls than boys are vaccinated in health facilities. However, outreach programmes that visit households immunise a greater proportion of girls than do facility-based vaccination programmes,” the researchers wrote.

To address this problem, they recommended that vaccines against pneumonia and childhood diarrhoea be added to immunisation programmes that deliver vaccines directly to people’s homes.

The study, led by the Registrar General of India, is co-authored by Professor Prabhat Jha, Centre for Global Health Research (CGHR), Li Ka Shing Knowledge Institute, St Michael’s Hospital and Dalla Lana School of Public Health, University of Toronto, Canada, and Professor Rajesh Kumar, Head of the School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh.

The authors present the causes of child deaths in India separately for the neo-natal period and at ages 1-59 months, for boys and girls, and for each of six major regions in India. There were 10,892 deaths in neo-nates and 12,260 deaths in children aged 1-59 months in the study. When these numbers were projected nationally, three causes accounted for 78% (0.79 million) of all 1.01 million neo-natal deaths: premature and low birth weight, neo-natal infections, and birth asphyxia and birth trauma. Two causes -- pneumonia and diarrhoeal diseases -- accounted for 50% (0.67 million) of all child deaths at ages 1-59 months.

Among child deaths aged 1-59 months, girls in central India had a roughly five-times-higher mortality rate (per 1,000 live births) from pneumonia (21) than did boys in south India (4) and around four-times-higher mortality rate from diarrhoeal diseases (18) than did boys in west India (4).

Source: http://www.reuters.com, November 2010
             http://www.medicalnewstoday.com, November 2010