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 sarizwan1986@outlook.com