Infant Mortality In India Research Articles

Cooking Fuel Choice, Indoor Air Quality and Child Mortality in India

Indoor air pollution (IAP)–predominantly from the use of solid fuel for cooking– is a global health threat, particularly for women and young children, and one of the leading causes of infant deaths worldwide in developing countries. We estimate the causal effect of cooking fuel choice on infant mortality in India, focusing on children under five years of age using pooled cross-sectional data from the National Family Health Survey (NFHS) over the period 1992–2016. To address the potential endogeneity in the relationship between fuel choice and mortality, we instrument for cooking fuel choice using a speed of change in forest cover and ownership status of agricultural land, which induce significant variations in fuel type. We find that cooking fuel choice has a statistically significant impact on under-five and neonatal mortality, raising the mortality risk by 4.9 percent. We also find that the past literature has overestimated the association between under-five mortality and polluting fuel use by about 0.6 percentage points or equivalently, 152,000 deaths per year nationally. Our result is robust to a set of alternative specifications with the inclusion of various controls and different estimation strategies.

The Economic Benefits versus Environmental Costs of India's Coal Fired Power Plants

Author(s): Barrows, Geoffrey; Garg, Teevrat; Jha, Akshaya | Abstract: This paper estimates the effect of coal-red power plants on infant mortality in India. We nd that a one GW increase in coal-red capacity corresponds to a 14% increase in infant mortality rates in districts near versus far from the plant site. This effect is 2-3 times larger than estimates from the developed world. Our effects are larger for: (1) older plants, (2) plants located in areas with higher baseline levels of pollution, and (3) plants burning domestic rather than imported coal. The environmental benefits from policy aimed at the power sector are thus likely to be substantially higher if targeted at older plants located in more polluted areas tailored to burn domestic rather than imported coal.

New evidence on the impact of the quality of prenatal care on neonatal and infant mortality in India

Evidence on the impact of the quality of prenatal care on childhood mortality is limited in developing countries, including India. Therefore, using nationally representative data from the latest round of the National Family Health Survey (2015-16), this study examined the impact of the quality of prenatal care on neonatal and infant mortality in India using a multivariable binary logistic regression model. The effect of the essential components of prenatal care services on neonatal and infant mortality were also investigated. The results indicate that improvement in the quality of prenatal care is associated with a decrease in neonatal (OR: 0.93, 95% CI: 0.91-0.97) and infant (OR: 0.94, 95% CI: 0.92-0.96) mortality in India. Tetanus toxoid vaccination, consumption of iron-folic acid tablets during pregnancy and having been weighed during pregnancy were statistically associated with a lower risk of neonatal and infant mortality. Educating women on pregnancy complications was also associated with a lower risk of neonatal mortality. No effect of blood pressure examination, blood test and examination of the abdomen during pregnancy were found on either of the two indicators of childhood mortality. Although the coverage of prenatal care has increased dramatically in India, the quality of prenatal care is still an area of concern. There is therefore a need to ensure high-quality prenatal care in India.

Associations Between Sex Composition of Older Siblings and Infant Mortality in India from 1992 to 2016

BackgroundThis study examines associations between sex composition of older siblings and infant mortality by sex, to guide efforts to address excess female infant mortality in India. MethodsWe conducted a retrospective cross-sectional study of infant mortality in India using four waves of data from the nationally-representative National Family Health Survey, collected between 1992 and 2016 (unweighted N = 338,504 for children aged 1–5). We used sex-stratified multivariable logistic regression models to assess the associations between sex composition of older siblings and risk of infant mortality. FindingsMale infants with two living older sisters and no living older brothers had lower odds of infant mortality relative to those with one living older brother (e.g., 2015–16 AOR 0.62, 95% CI 0.50–0.76); this effect was significant for boys across all waves of data but was not seen for girls in any wave. Exploratory models focused on third order births found that boys were less likely than girls to die in infancy if born subsequent to two older sisters (2015–16 AOR 0.48, 95% CI 0.31–0.74); analysis of crude prevalence data indicated that this converts into a 64% greater risk for infant mortality for girls relative to boys in this third-order group. InterpretationHigher birth order males with older sisters have greater protection against infant mortality, a finding that has persisted for over 25 years. To address ongoing gender inequities in infant survival in India, greater focus is needed to support higher birth order girls and social norm movements against son preference.

Infant Mortality in India and its Contributing Risk Factors: A Systematic Analysis

Infant mortality rate (IMR) data can be used as a statistical measure to identify the changing dynamics of children health, which can be an indicator of the welfare and progress of a society. However, these data are usually collected by authorized bodies or Government organizations on a large scale, with very little local stratification. For implementing correct policies for medical intervention, the knowledge about patterns of the cause-specific mortality is necessary. Studies included in this article were identified through a systematic analysis search of the scientific literature published between 2018 & 2019. Secondary data was extracted from vital records, sample Registration system 2019, database from “UN inter-agency” group of infant mortality estimates. The data between 2009–2019 (on or before June 2019) were collected. The infant mortality rate was calculated based for every death per 1000 live birth in the year. The data for each year was evaluated based on the information collected from secondary records. Further, the IMR data from the “Indian Sample Registration System (ISRS)”. Estimated NMR for 2019 was based on assumption and data collected on or before May 2019. For the purpose analysis all publicly available data on infant mortality was used.

On the Structure of Infant Mortality using Accelerated Failure Time (AFT) Model: A Comparative Study based on National Family Health Survey (NFHS) Data in India

This paper analyzes the effect of socioeconomic and demographic factors on infant mortality in India. The Paper also examines reasonable comparison of the three National Family Health Survey (NFHS), the largest sample survey of India from the 1993–1994, 1998–1999 and 2005–06 with respect to different determinants of infant mortality. Accelerated Failure Time (AFT) model is used to measure the direct effect of the above factors on the survival of infants. On the basis of Akaikes Information Criterion (AIC), the Weibull AFT model fits better to other selected models. In all the three NFHS, Weibull AFT model shows the significant effect of the factors on infant survival.

The Health Costs of Coal-Fired Power Plants in India

This paper estimates the effect of coal-fired power plants on infant mortality in India. We find that a one GW increase in coal-fired capacity corresponds to a 14% increase in infant mortality rates in districts near versus far from the plant site. This effect is 2-3 times larger than estimates from the developed world. Our effects are larger for: (1) older plants, (2) plants located in areas with higher baseline levels of pollution, and (3) plants burning domestic rather than imported coal. The environmental benefits from policy aimed at the power sector are thus likely to be substantially higher if targeted at older plants located in more polluted areas tailored to burn domestic rather than imported coal.

The role of national rural health mission in reducing infant mortality rate in India

PurposeThe purpose of this paper is to assess the role of National Rural Health Mission (NRHM) in reducing Infant Mortality in India. The study will help the government in deciding its future course of action regarding the infant mortality rate (IMR) reduction in India.Design/methodology/approachThis paper adopts the interrupted time series analysis (ITSA) approach with a control group to study the role of NRHM in reducing the IMR in India. The authors examined infant mortality in rural areas of India for the level and trend change before and after the implementation of NRHM. The authors then applied a suitable ARMA model to estimate the coefficients of the regression model. From the estimated results, the study predicts the counterfactuals for both the rural IMR and urban IMR and plots the results.FindingsThe study found the evidence supporting the hypotheses that the NRHM has led to a reduction in the difference between urban IMR and rural IMR. The research shows that the rural IMR declined at steeper rates in the post-NRHM period (2005–2015).Originality/valueNone of the existing studies analyses the impact of a social scheme like NRHM on the reduction of IMR in India by applying the ITSA. The study is unique as it estimates the counterfactuals and plots the results which show the impact of NRHM on reducing IMR.

Infant mortality rate in India: mediating causes

PurposeThe purpose of this paper is to develop a new approach to health service quality assurance.Design/methodology/approachData were collected using a structured, eight-section questionnaire. Stratified random samples were drawn from four villages based in four Indian regions.FindingsPsychological discomfort is an infant mortality rate (IMR) mediating factor. The root mean square error of approximation fit statistic for the model was 0.08, which was considered the best fit.Practical implicationsAddressing mediating causes can reduce IMR in developing countries.Originality/valueThe model that the authors described helps health institution managers to map quality assurance health management and economics.

Reducing early infant mortality in India: results of a prospective cohort of pregnant women using emergency medical services

ObjectivesTo describe the demographic characteristics and clinical outcomes of neonates born within 7 days of public ambulance transport to hospitals across five states in India.DesignProspective observational study.SettingFive Indian states using...

Spatio-temporal assessment of infant mortality rate in India.

Infant mortality rate (IMR) is globally identified by the policymakers as the marker of health of a population. This study aimed to detect the change in hotspots of IMR in Indian states from the year 2000 to 2012, identify hotspots of IMR at district level in selected states from each of the six regions of India and determine the potential predictors of IMR after accounting for spatial autocorrelation. Ecological study design was used to analyze state and district level data on IMR of India. For the first objective, the data were obtained from Sample Registration System. For the second objective, we classified India into six regions and selected a state in each region that had the highest IMR. The district level data on IMR and potential predictors were obtained from surveys, namely, Annual Health Survey, District Level Household and Facility Survey and Census. Spatio-temporal hotspots of IMR were examined using local indicators of spatial association statistic. Spatial regression was used to identify the potential predictors of IMR after accounting for spatial autocorrelation. Temporal hotspots of IMR were found in the central part of India. Spatial hotspots were identified in districts of Uttar Pradesh. A negative association of IMR existed with female literacy rate, mothers receiving antenatal checkup (%), and people living in urban areas (%). IMR continues to be a problem in the states that have previously shown to be poor performing. Certain districts within these states need emphasis for focused activities.

Economic growth, public expenditure on health and IMR in India

Purpose The purpose of this paper is to employ a two-step approach to investigate the bi-directional causal linkage between: economic growth (measured by GDP) and public expenditure on health; public expenditure on health and infant mortality rate (IMR); and economic growth and IMR in the Indian context. Design/methodology/approach The present study uses econometric analysis, namely, panel cointegration and Granger causality on 20-year panel data on 16 major Indian states to investigate the causality. Findings The results suggest GDP to Granger cause public expenditure on health both in the short run and in the long run, but public expenditure on health to Granger cause GDP only in the long run. Further, public expenditure on health and economic growth were found to Granger cause IMR in the long run. However, the reverse linkage from IMR to public expenditure on health and/or economic growth was not significant. Research limitations/implications The present study provides support to the existing literature on the effects of economic growth on health expenditure and health outcomes but also raises a question on the time required to realize the same. Practical implications The findings have implications for policy makers on the time frame and application of health expenditure to achieve better results. Originality/value The present study is one of the first to test the tripartite linkage between economic growth, public health expenditure and health outcomes at a state-level analysis.

Socio-cultural determinants of breast feeding practices in Dharwad district of Karnataka

WHO recommends mothers worldwide to exclusively breastfeed infants for the child's first six months to achieve optimal growth, development and health. The infant mortality rate in India is 40/1000 live births and 31/1000 live births in Karnataka according to NFHS-4 report released in 2013. In India, breastfeeding is culturally well accepted but inadequately practiced, partly due to ignorance. Lack of knowledge, prevailing misconceptions and cultural taboos significantly contribute to undesirable breastfeeding practices such as delayed initiation and discarding of colostrum. In this context the present study was conducted to study the knowledge, attitude and breast feeding practices among the lactating mothers in Dharwad district of Northern Karnataka. A cross-sectional study was conducted in rural and urban areas of Dharwad district, Karnataka. The population of the study consisted of mother -infant dyads, where the infants were in the age group of 3 months to 24 months and their mothers from rural as well as urban area of the district. The sample comprised of 300 women of whom 200 were from rural area and 100 from urban area in the age range of 17-45 years. The tools used for the study were Socio - economic status scale developed by Aggarwal et al. (2005) and a self structured questionnaire to document the mother and child health characters, demographic profile, feeding practices, patterns and knowledge of mothers towards breast feeding. Iowa Infant Feeding Attitude Scale (1999) was used to assess maternal attitude towards infant feeding and information regarding feeding choice. The results indicated that 56.33 per cent breastfed the baby within 1hr and 26 per cent fed after 3 days. Majority of the mothers fed colostrum (71.67%) and 28.33 per cent discarded the colostrum. 51.33 per cent mothers gave prelacteal feeds. 48.7 per cent mothers practiced exclusive breast feeding. Majority of mothers both in urban and rural area had medium level knowledge and attitude towards breast feeding. Breast feeding knowledge had significant association with feeding practices while SES had no impact.

Infant mortality in Russian Federation and influence on its dynamic factors

Minimizing infant mortality (IM) is the primary national objective of the Russian Federation.
 Aim: This study aimed to analyze IM indicators in the Russian Federation and identify factors that influence the dynamics of IM. The level of leading regional indicators of socioeconomic development and provision by doctors and hospital beds in the Russian Federation was studied and compared with the similar factors in foreign countries.
 Materials: Official and operative reports of Rosstat for 2011-2016 were assessed.
 Results. The coefficient of IM was 6.0 per 1000 live births in the Russian Federation, and varied from 4.8-9.2 in federal districts. The indicator increased in 2012 in connection with the transition to a new system of newborn registration. The indicator witnessed a permanent decline in 2016 and revealed a negative correlation between the regional bulk products and the coefficient of IM and a positive correlation with the overall IM. However, the relationship among the indicators of IM and the size of the region, the number of highways, the number of patients per one hospital bed or assigned to one doctor could not be established.
 Conclusion. In the Russian Federation, IM is higher than that indeveloped countries; has permanent tendency to decline; correlates with regional bulk products; does not depend on transport availability, provision with doctors, and hospital beds; and is determined by the organization and the quality of medical care.

Making the continuum of care work for mothers and infants: Does gender equity matter? Findings from a quasi-experimental study in Bihar, India.

BackgroundImprovements in continuum of care (CoC) utilization are needed to address inadequate reductions in neonatal and infant mortality in India and elsewhere. This study examines the effect of Ananya, a health system training and community outreach intervention, on reproductive, maternal and newborn health continuum of care (RMNH CoC) utilization in Bihar, India, and explores whether that effect is moderated by gender equity factors (child marriage, restricted mobility and low decision-making control).MethodsA two-armed quasi-experimental design compared districts in Bihar that did/did not implement Ananya. Cross-sections of married women aged 15–49 with a 0–5 month old child were surveyed at baseline and two year follow-up (baseline n = 7191 and follow-up n = 6143; response rates 88.9% and 90.7%, respectively). Difference-in-difference analyses assessed program impact on RMNH CoC co-coverage, defined by 9 health services/behaviors for the index pregnancy (e.g., antenatal care, skin-to-skin care). Three-way interactions assessed gender equity as a moderator of Ananya’s impact.FindingsParticipants reported low RMNH CoC co-coverage at baseline (on average 3.2 and 3.0 of the 9 RMNH services/behaviors for Ananya and control groups, respectively). The Ananya group showed a significantly greater increase in RMNH CoC co-coverage (.41 services) compared with the control group over time (p<0.001), with the primary drivers being increases in clean cord care, skin-to-skin care and postpartum contraceptive use. Gender equity interaction analyses revealed diminished intervention effects on antenatal care, skilled birth attendance and exclusive breastfeeding for women married as minors.ConclusionAnanya improved RMNH CoC co-coverage among these recent mothers, largely through positive health behavior changes. Child marriage attenuated Ananya’s impact on utilization of key health services and behaviors. Supporting the health system with training and community outreach can be beneficial to RMNH CoC utilization; additional support is needed to adequately address the unique issues faced by women married as minors.

District-Level wealth-inequality in infant mortality in India

Using data from population based surveys; it has been tried to examine the extent of district-level wealth inequality in infant mortality in India, considering the districts as the units of analysis. Analysis shows that there was significant variation in infant mortality among districts of India. About one-fifth of the districts had IMR of above 65 of which more than 65% districts are economically backward. The degree of wealth inequality in infant mortality was higher among economically backward districts than that of economically well-off districts. Results from regression analysis suggest that the factors such as female literacy, proportion of households having toilet facility and female workforce participation rate are the most significant predictors of district level variation in infant mortality. The proportion of households having toilet facility has strong bearing on infant mortality, indicating that availability of basic sanitation would help in reducing infant mortality. The female literacy and female workforce participation rate have strong and negative effects on infant mortality. The magnitude of the coefficients for female literacy, proportion of households having toilet facility and female workforce participation indicates that the level of IMR would decline by 7%, 5% and 4% for every 10% increase in female literacy rate, proportion of households having toilet facility and female workforce participation rate, respectively. It has been found that the level of IMR is likely to be higher in northern region and Uttar Pradesh and lower in southern region of India.

Targetting early neonatal mortality key to reduce infant mortality rate in India (Beyond Mayurbhanj Model)

Targetting early neonatal mortality key to reduce infant mortality rate in India (Beyond Mayurbhanj Model)

Sex-selective Abortions and Infant Mortality in India: The Role of Parents’ Stated Son Preference

In India, millions of female foetuses have been aborted since the 1980s alongside an abnormally high infant girl mortality rate; this has generated a vast literature exploring the root causes of son preference. The literature is sparse, however, on how the decisions to abort or neglect girls are made. This paper examines mothers’ and fathers’ respective roles behind those decisions. Using the third National Family and Health Survey (NFHS-3) data, we show that sex-selective abortions are most commonly used if both spouses or if only the fathers prefer sons, while sex-selective neglect is used if only the mothers prefer sons.

Screening for Group B streptococcal carriage in antenatal cases in a tertiary care hospital

Sepsis is an important cause of infant mortality in India with bacterial infections being the most common causative agent. However studies related to group B streptococcus have been limited and hence a study was taken up to look for antenatal carriage of Streptococcus agalactiae in the Indian population this study revealed a carriage rate of 14.81% implying that we now need to look at group B streptococcus as a possible etiology in neonatal sepsis more actively.

Current status of neonatal intensive care in India

Globally, newborn health is now considered as high-level national priority. The current neonatal and infant mortality rate in India is 29 per 1000 live births and 42 per 1000 live...