Infant and Child Mortality in India in the Last Two Decades: A Geospatial Analysis

Abhishek Singh,Rajesh Kumar Chauhan,Praveen Kumar Pathak,William Pan,Zulfiqar A Bhutta

doi:10.1371/journal.pone.0026856

Abhishek Singh, Rajesh Kumar Chauhan + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0026856

Copy DOI

Abstract

BackgroundStudies 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.MethodologyThe 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/ConclusionsThis 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.

Highlights

Classical demographic and epidemiological studies examining the level and determinants of infant and child mortality in developing countries have largely focused on the proximate determinants of child survival [1], and ignored the important dimension of geographic space as an independent factor governing the risks of infant and child deaths [2,3,4,5,6,7,8,9]
To understand this important research gap in demographic and epidemiological literature, we attempt to examine whether the geographic regions which are underprivileged in terms of wealth, female literacy, child nutrition, or safe delivery were grappling with the elevated risk of child mortality; whether there are any spatial outliers; whether these relationships have undergone any significant change over historical time periods
We use bivariate models to address a closely related and pertinent question- whether the geographic regions which were underprivileged in terms of wealth or child nutrition or female literacy or safe delivery were disadvantaged in terms of infant and child survival

Summary

Introduction

Classical demographic and epidemiological studies examining the level and determinants of infant and child mortality in developing countries have largely focused on the proximate determinants of child survival [1], and ignored the important dimension of geographic space as an independent factor governing the risks of infant and child deaths [2,3,4,5,6,7,8,9]. Most of the previous studies have looked at the issue of infant and child mortality using only a broad-set of individual, household level and community level socioeconomic and environmental risk factors ignoring the important effect of geographic space Such analysis assumes that the relationship between deprivation and mortality is homogenous and uniform over space. Our literature search could not yield any study that takes into account spatial patterns/clustering while analyzing infant and child mortality in India To understand this important research gap in demographic and epidemiological literature, we attempt to examine whether the geographic regions which are underprivileged in terms of wealth, female literacy, child nutrition, or safe delivery were grappling with the elevated risk of child mortality; whether there are any spatial outliers; whether these relationships have undergone any significant change over historical time periods. These regions are homogeneous regional clusters in terms of natural topography, agro-climatic conditions and similar cultural attributes

Methods

Results

Discussion