Child Survival In India Research Articles

Explaining the diminishing of Muslim advantage in child survival in India

AbstractReligion is one of the key instrumental social institutions in determining child health and mortality. Muslim advantage in child survival in India has been widely reported. Recent India’s National Family Health Survey (NFHS) shows that the gap between Hindu–Muslim childhood mortality rates is shrinking—reversing decades of child survival advantage for Muslims. This study examines the factors linked to the diminishing of Muslim advantage in childhood survival and attempts to uncover the mechanisms accounting for the convergence using the characteristics hypothesis of Goldscheider (Population, modernization, and social structure Little, Brown & Co; 1971) and the analytical framework of Guillot and Allendorf (Genus 66(2), 2010). We have analyzed a pooled sample of 23,47,245 all live births and 428,541 of last live births from four rounds of NFHS (1992–2016). Kaplan–Meier survival plots over time by religion confirm convergence in Hindu–Muslim child survival probabilities. The Pyatt decomposition model reveals that the gap in Hindu–Muslim childhood mortality is diminishing due to a decline in within-Hindu inequality. Cox proportional hazard regression model shows that improvement in household and maternal socioeconomic factors has contributed to Hindu children catching up with Muslims—leading to a convergence in Hindu–Muslim childhood survival probabilities. Conditional β-convergence regression model also suggests the convergence in socio-economic status and maternal health care is driving the convergence in child survival of Hindus and Muslims across Indian states.

Prevalence and predictors of exclusive breastfeeding in urban slums, Bihar.

Objective:Various socio-cultural factors influence infant feeding practices and thus early childhood nutrition and child survival in India. This study aimed to examine the prevalence of exclusive breastfeeding, its promoters and barriers in urban slums of Bihar, India.Methods:We conducted a community based cross-sectional survey involving 297 mothers living in slum settlements in Bihar. Data were collected using structured questionnaire on exclusive breastfeeding practices, and the factors that could influence this. Descriptive analysis was done to estimate the prevalence of exclusive breastfeeding and regression model was performed to identify the predictors of exclusive breastfeeding.Results:Only 23% of mothers initiate breastfeeding within 1 hour of delivery and 27.6% mothers practise exclusive breastfeeding up to six months. Mother's education was found to be associated with duration of exclusive breastfeeding (OR 11, 95% CI 2-59). Term babies were more likely to be breastfed exclusively for six months than pre-term babies (OR 8.6, 95% CI 1.6-47.6). Antenatal care visits and completing immunization were significantly associated with duration of exclusive breastfeeding (P < 0.001). The majority of mothers acquire exclusive breastfeeding knowledge through television/radio (OR 68, 95% CI 5.5-832.5) and newspaper advertisements (OR 14, 95% CI 2.6-76).Conclusion:Prevalence of exclusive breastfeeding up to six months of age and early initiation of breastfeeding remains low in slums of Bihar. Exclusive breastfeeding and early initiation of breastfeeding rates could be improved by educating and counselling mothers during health facility contacts by primary care providers.

The Impact of Maternal Health Care Utilization on Probability of Child Survival in India

Maternal and child health programmes plays a key role in reducing infant and child mortality in any population. The Government of India started maternal and child health care services in the first five year plan (1951-56). This study uses data from the fourth round of the National Family Health Survey (NFHS, 2015-16). We are interested to examine the effect of child delivery at a healthcare facility, on child survival. We are followed by Mosley and Chen’s framework (1884), according to the framework, several socioeconomic determinants are grouped into some categories, namely, maternal, environmental contamination, nutrient deficiency, and personal illness control. Consequently, we reduced the number of independent variables to women’s age at birth and education, birth order, low child birth weight, household wealth, and healthcare.

Factors explaining regional variation in under-five mortality in India: An evidence from NFHS-4.

Although child mortality has declined in India, pronounced regional and socioeconomic inequality exists. The study examines the effects of individual- and community-level characteristics on under-five mortality and investigates the extent to which they affect regional variation. The study is based on Indian National Family and Health Survey 4, 2015-16 data. A two-level logistic regression model was performed to examine the effects of the socio-economic characteristics, and multivariate decomposition analysis was done to assess the contribution of factors in the inter-regional under-five mortality differentials. Regional variation in the selected variables is observed. For instance, the percentage of children with small childbirth size varied from 9.7% in the southern to 21.6% in the northeastern region. The percentage of poor households, low educated mothers, and childbirths delivered at home facility were higher in the central and eastern region compared to the southern region. The multilevel analysis shows that the region of residence explained 15.8% variance, and community-level characteristics alone could explain 25.3% variation in the risk of under-five deaths. The decomposition analysis indicates that the average number of excess deaths in the central and eastern regions is higher compared to the other regions. The compositional differences account for 50.9% of the under-five mortality gaps between the south and north region, 80.9% of the gap between the south and east, and 42.9% of the gap between the south and central region of India. Special attention and targeted action are needed to address the underlying causes of low birth weight of children in all the regions of India. Region-specific interventions might be priorities; for example, north, and central regions, need an economic and educational uplift, while infrastructural and economic policies should be prioritized for the northeastern region. Also, region-specific community-level interventions are needed to improve child survival in India.

Impact of Maternal Employment On Child Survival in India in The Era of Sustainable Development Goals

Impact of Maternal Employment On Child Survival in India in The Era of Sustainable Development Goals

The association between maternal employment and child survival in India, 1998–99 and 2005–06

ABSTRACTWhile many studies contend that a mother's economic activity may generate positive outcomes for both mother and children, empirical results from less developed countries actually indicate higher mortality rates among children of working mothers. This article examines the association between maternal employment and child survival using India's National Family Health Survey. Using propensity score matching, the study compares working with matched nonworking mothers in child's risk of death. To address the heterogeneous nature of working mothers, the employment-survival relationship is analysed across various occupational categories. A supplementary analysis examines gaps between children of working and nonworking mothers in nutritional status and low birth weight (LBW). Our results show that high risk of mortality and low nutritional status are more pronounced among children of mothers working in low-status occupations. The results indicate insignificant differences in LBW, a finding that favours the explanation that the mortality disadvantage of children of working mothers emerges primarily after birth most likely because of inadequate childcare. The article discusses these findings in relation to various potential mechanisms mediating the negative association between maternal employment and child survival.

Tackling inequities in child survival in India: Let’s meet at the horizon of pediatrics and public health

I write this president’s page with great pride, honour and humility towards all fellow IAPians for giving me opportunity to serve this prestigious association in the golden jubilee year of Indian Academy of Pediatrics. It has been a great honour and privilege indeed and I profusely thank each and every one of you, not only for electing me president of IAP but supporting the efforts, which I initiated during my tenure, i.e. Mission Uday and Mission Kishore Uday, IAP TOUCH, BLS Awareness Program, Child India (our new e-bulletin), Advisory Committee on Vaccination and Immunization Practices (ACVIP), and Indian College of Pediatrics.

Understanding the Linkages of Household Environmental Deprivation, Asset Index and Child Survival in India

Often the household environmental factors are combined with the household assets in explaining the economic differentials in population and health parameters of developing countries. Though the utility of wealth index (that combines household environment with assets) in explaining health and health care utilization is established, its utility as a proxy of economic measures is contested. In this paper we attempted to differentiate the role of household environmental factors and the household assets in explaining the infant mortality (IMR) and the under-five mortality (U5MR) in India. We hypothesize that there are no significant differences in IMR and U5MR among those households residing in poor household environmental condition and those who are poor in asset in India. We have used the data from the National Family Health Survey (NFHS-3), 2005-06, India, a population based large scale representative survey. Bi-variate analyses, principal component analysis, life-table technique and hazard model are used in the analyses. Two composite indices namely, an asset index based on consumer durables of the households and household environmental deprivation index based on the household environmental factors are constructed. The indices are categorized as poor and non-poor based on the 50% of the median composite score. Result shows that the correlation coefficient of asset index and household environmental deprivation index is weak. Further, there are no significant differences of IMR and U5MR among households living in poor household environment and those are poor in asset cutting across the states. Results of cox-proportional hazard model indicate that the household environmental factors have significant impact on child survival. It calls for improving the household environmental conditions of the household in promoting child survival in India.

Assessment of Implementation of Integrated Management of Neonatal and Childhood Illness in India

At the current rate of decline in infant mortality, India is unlikely to achieve the Millennium Development Goal on child survival. Integrated Management of Neonatal and Childhood Illness (IMNCI), adapted from the global Integrated Management of Childhood Illness to enhance the focus on newborns and on community health workers, is the central strategy within the National Reproductive and Child Health Programme to address high infant mortality. This paper assessed the progress of IMNCI in India, identified the programme bottlenecks, and also assessed the effect on coverage of key newborn and childcare practices. Programme data were analyzed to ascertain the implementation status; rapid programme assessment was conducted for identifying the programme bottlenecks; and results of analysis of two rounds of district-level household surveys were used for comparing the change in the coverage of child-health interventions in IMNCI and control districts. More than 200,000 community health workers and first-level healthcare providers were trained during 2005-2009 at a variable pace across 223 districts. Of the reported births (n = 1,102,573), 65.5% were visited by a trained worker within 24 hours, and 63.1% were visited three times within 10 days. Poor supervision and inadequate essential supplies affected the performance of trained workers. During 2004-2008, 12 early-implementing districts had covered most key newborn and child practice indicators compared to the control districts; however, the difference was significant only for care-seeking for acute respiratory infection (net difference: 17.8%; 95% confidence interval 2.3-33.2, p < 0.026). Based on the early experience of IMNCI implementation in different states of India, measures need to be taken to improve supportive supervision, availability of essential supplies, and monitoring of the programme if the strategy has to translate into improved child survival in India.

Multidimensional poverty and child survival in India.

BackgroundThough the concept of multidimensional poverty has been acknowledged cutting across the disciplines (among economists, public health professionals, development thinkers, social scientists, policy makers and international organizations) and included in the development agenda, its measurement and application are still limited.Objectives and MethodologyUsing unit data from the National Family and Health Survey 3, India, this paper measures poverty in multidimensional space and examine the linkages of multidimensional poverty with child survival. The multidimensional poverty is measured in the dimension of knowledge, health and wealth and the child survival is measured with respect to infant mortality and under-five mortality. Descriptive statistics, principal component analyses and the life table methods are used in the analyses.ResultsThe estimates of multidimensional poverty are robust and the inter-state differentials are large. While infant mortality rate and under-five mortality rate are disproportionately higher among the abject poor compared to the non-poor, there are no significant differences in child survival among educationally, economically and health poor at the national level. State pattern in child survival among the education, economical and health poor are mixed.ConclusionUse of multidimensional poverty measures help to identify abject poor who are unlikely to come out of poverty trap. The child survival is significantly lower among abject poor compared to moderate poor and non-poor. We urge to popularize the concept of multiple deprivations in research and program so as to reduce poverty and inequality in the population.

Indians can do better at improving child survival

The author chose the word ‘Indians’ over ‘India’ because every citizen has a role in improving child survival in India and should not leave it to the government alone. Government initiatives such as the National Rural Health Mission (NRHM) are laudable but will not be adequate without mobilizing other important stake holders. These stakeholders include all Indians from parents who want to the best for their children to the academicians who need to take responsibility of guiding program managers policy makers and grass root level functionaries. The government programs need to clearly identify the role of each of these stakeholders with inbuilt accountabilities and help them in performing their identified role. In India around 1.7 million children every year which equals 4730 every day and 3 every minute. Most of these deaths occur because many simple interventions which have been available for many decades have still not reached a large proportion of children. Today we live in the “knowledge age.” We can access a large amount of information through the internet and share it easily with others. There has also been tremendous improvement in the availability of modern technology to improve health care. Despite these advances there is a huge gap in converting this advantage to benefit the poor and disadvantaged. There is an unacceptable inequity in health between countries and populations in both access to and capacity to use new technologies. For example skilled attendance at birth is available to only 19% among the poorest quintile as compared to 89% among the wealthiest quintile. Launched on April 12 2005 the NRHM is a commendable effort to address many of the problems in health care delivery in rural areas through ‘communalization’ flexible financing improved management through capacity building monitoring progress against standards and innovations in human resource management.

Socio-economic inequalities in child survival in India: A decomposition analysis

This paper provides a first time assessment of the decomposed contributions of socio-economic determinants of under2 child mortality in India and its states using the recent National Family Health Survey (NFHS-3, 2005-06) data. In the first stage analysis, concentration indices of under2 mortality were generated as measures of socio-economic inequalities. The concentration indices were then decomposed into their determining factors. Decomposition results reveal that poor household economic status (46%), mother's illiteracy (35%) and rural residence (15%) contribute to 96% of total socio-economic inequalities in child survival at the national level. The contribution of economic status is relatively smaller in 5 states that are advanced in health transition. The varying pattern of evidence across the states from decomposition analysis suggests the need for unique health intervention strategies for different states in accordance with the evidence of major contributions to total child health inequalities arising from poverty, illiteracy and rural residence.

Insecticide treated nets, antimalarials and child survival in India

Malaria has been a complex public health problem affecting mainly the poor and the rural communities in India. Insecticide treated nets (ITN) and antimalarials are the two proven interventions for prevention and control of malaria. ITN has been amply demonstrated to be an effective intervention to protect children from malaria, and in preventing deaths due to falciparum malaria. Antimalarials are a therapeutic intervention for management of malaria, and prevention of complications due to Plasmodium falciparum infection. However, implementation of these interventions is fraught with problems of complex and multidimensional nature at the periphery. These can be addressed by optimizing the use of the 2 interventions, the insecticide treated nets and antimalarials, for area specific application and country specific needs, determined by the eco-epidemiological diversity of malaria in India. This article reviews the significant role of ITN in reducing child mortality, and the judicious use of antimalarials in the management of malaria patient, and the problems associated with the use of these interventions in protecting children against malaria in India.

Breastfeeding and complementary feeding as a public health intervention for child survival in India

The relevance of breastfeeding and complementary feeding as proven child survival interventions, is well documented by the scientific research. These two preventive interventions can save as many as 19% of all child deaths. However, despite the volume of evidence favouring mainstreaming of these interventions, many countries, including India are yet to achieve universal appropriate infant and young child feeding practices. This article attempts to explore the evidenced based role of these interventions in the crusade to save children, and looks into the present scenario of infant and young child feeding in India, along with a possible road map to achieve high rates of early and exclusive breastfeeding and appropriate complementary feeding in the country.

Micronutrient supplementation and child survival in India

India contributes to a large number and proportion of child deaths, both due to higher under five mortality rate and large child population cohort in the country. The micronutrient malnutrition is an ignored area as it is not a direct cause of child mortality but a contributory factor in many deaths. The repeated surveys and studies have noted that iron deficiency anemia, vitamin A deficiency, iodine deficiency are highly prevalent amongst the children in the country and the preventive interventions are reaching only small proportion of 10-50% of the targeted populations. The contribution of these micronutrients (Iron, Vitamin A, Iodine and Zinc) towards child survival depends upon number of factors that are responsible for child mortality, and these situations vary from region to region, time to time and depend upon number of other socio demographic characteristics of the population. This paper discusses that although there may be debate on the role of some micronutrients in reducing childhood mortality, there is no doubt that these micronutrients are needed in small amount for overall child development. These micronutrients, both directly and indirectly, contribute to the child survival and should reach to each and every child in the country and the strategy is proven cost effective.

Health research strengthening and operational research needs for improving child survival in India

Health research can be utilized to improve the policies, interventions and outputs of the health systems, and ultimately the health of individuals and population. This requires systematic evaluation of evidence and its integration into national policies and programs after suitable adoption at the local level. It has been noted that there has been limited focus upon strengthening health research in India, due to weak research systems or institutional mechanisms, lack of trained human resources and enabling environment, absence of well defined priorities, perceived low quality of research, and inadequate funding. Though various vertical and integrated health programs for improving child survival in the country have been introduced, the decline in child mortality has been excessively slow. Operational research, a sub theme of health research, which uses systematic research techniques to provide evidence to the policymakers and program managers, can be used to assess programmatic issues and improve their effectiveness. This article analyzes the current situation of health research in India, describes briefly the process of operational research, and summarizes the areas of programmatic concern and priority topics for future research in five key fields of child health (Newborn health, Immunization, Malnutrition, Disease prevention and control, health systems strengthening). Finally, it outlines the immediate need of strengthening health research system in the country for improving child survival through increased funding, development of institutional mechanisms, building pool of talented researchers and provision of an enabling environment, to facilitate health and operational research in a scientifically credible manner and to ensure wider dissemination of results.

Primary health care and child survival in India

The Primary Health Care (PHC) has been globally promoted as a comprehensive approach to achieve optimal health status and 'Health for all'. The PHC approach, although, initially received the attention but failed to meet the expectations of the people in India. The child health programs in India had been started for long as verticals programs, which later on integrated and had been planned in a way to deliver the services through the PHC systems. Nevertheless, the last decade has witnessed many new initiatives for improving child health, specially; a number of strategies under National Rural Health Mission have been implemented to improve child survival--Skilled Birth Attendant and Emergency Obstetric Care, Home Based Newborn Care, Sick newborn care units, Integrated Management of Neonatal and Childhood Illnesses, strengthening Immunization services, setting up Nutritional rehabilitation centers etc. However, for a large proportion of rural population, an effective and efficient PHC system is the only way for service delivery, which still needs more attention. The authors note that although there have been improvements in infrastructure, community level health workers, and availability of the funding etc., the areas like community participation, district level health planning, data for action, inter-sectoral coordination, political commitment, public private partnership, accountability, and the improving health work force and need immediate attention, to strengthen the PHC system in the country, making it more child friendly and contributory in child survival, in India.

Nutrition and child survival in India

India recognized the importance of improving the health and nutritional status of children, and initiated steps to improve access to nutrition and health services soon after independence. Over the years, the infrastructure and human resources for manning the health and nutrition services have been built up and currently cover the entire country. However these are inadequacies in terms of content and quality of services and undernutrition rates and under five morality rates continue to be high. Undernutrition begins in utero, and with low birthweight, effective antenatal care can help in reducing low birth weight. The poor infant and young child feeding (IYCF) practices, repeated morbidity due to infections and poor utilization of health and nutrition services are other causes of undernutrition in children in India. The key intervention to prevent undernutrition is nutritional and health education through all modes of communication, to bring about is a behavioral change towards appropriate IYCF and utilization of health care. Appropriate convergence and synergy between health and nutrition functionaries can play a major role in early detection and effective management of both undernutrition and infections, accelerate the pace of reduction in both undernutrition and under five mortality and enable India to reach Millennium Development Goals.

The puzzle of Muslim advantage in child survival in India

The socioeconomic status of Indian Muslims is, on average, considerably lower than that of upper-caste Hindus. Muslims nevertheless exhibit substantially higher child survival rates, and have done for decades. This paper analyses this seeming puzzle. A decomposition of the survival differential confirms that some compositional effects favour Muslims but that, overall, differences in characteristics and especially the Muslim deficit in parental education predict a Muslim disadvantage. The results of this study contribute to a recent literature that debates the importance of socioeconomic status (SES) in determining health and survival. They augment a growing literature on the role of religion or culture as encapsulating important unobservable behaviours or endowments that influence health, indeed, enough to reverse the SES gradient that is commonly observed.

Proximate sources of population sex imbalance in India.

There is a population sex imbalance in India. Despite a consensus that this imbalance is due to excess female mortality, the specific source of this excess mortality remains poorly understood. I use microdata on child survival in India to analyze the proximate sources of the sex imbalance. I address two questions: when in life does the sex imbalance arise, and what health or nutritional investments are specifically responsible for its appearance? I present a new methodology that uses microdata on child survival. This methodology explicitly takes into account both the possibility of naturally occurring sex differences in survival and possible differences between investments in their importance for survival. Consistent with existing literature, I find significant excess female mortality in childhood, particularly between the ages of 1 and 5, and argue that the sex imbalance that exists by age 5 is large enough to explain virtually the entire imbalance in the population. Within this age group, sex differences in vaccinations explain between 20% and 30% of excess female mortality, malnutrition explains an additional 20%, and differences in treatment for illness play a smaller role. Together, these investments account for approximately 50% of the sex imbalance in mortality in India.