The highest number of under-five and neonatal deaths in 2017 were reported in Uttar Pradesh followed by Bihar, according to findings of the India state-level Disease Burden Initiative released on Tuesday.
According to the first comprehensive estimate of district-level trends of child mortality and child growth failure in India between 2000-2017, child growth failure, measured as stunting, wasting and underweight has improved in India since 2000, but their rates vary 4-5 fold between the districts.
The highest number of under-five deaths in 2017 were reported in Uttar Pradesh at 312,800, which included 165,800 neonatal deaths. The second highest deaths were reported in Bihar at 141,500 which included 75,300 neonatal deaths, the study showed.
In Uttar Pradesh, 48 per cent of the districts fell in the highest priority category of high neonatal mortality rate (NMR) and under-5 mortality rate (U5MR) and low annual rate of reduction included a cluster of eight districts of Bahraich, Balrampur, Barabanki, Gonda, Hardoi, Kheri, Shravasti, and Sitapur in the north-central part.
Three districts in the south UP -- Allahabad, Banda and Chitrakoot and Lalitpur district in the south-west corner of the state -- were the highest priority category of high NMR and U5MR and low annual rate of reduction, the study said.
In Bihar, the highest priority was scattered in the north-east -- Kishanganj and Purnia -- and the south-west of the state -- Aurangabad and Kaimur.
In Assam, which the study said, had the second highest child mortality rate in 2017, the highest priority category of high U5MR and NMR and low annual rate of reduction was concentrated in the southern handle of the state (Cachar, Dima Hasao, Hallakandi, Karbi Anglong, Karimganj, and West Karbi Anglong).
Based on the nationwide district-level distribution of child mortality rate, two-thirds of the districts in the less developed low socio-demographic Index (SDI) states fell in the high category of U5MR and NMR.
SDI is a summary measure that identifies where states, countries or other geographic areas fall on the spectrum of socio-demographic development.
According to the study, the U5MR and NMR was lower with the increasing level of development of the states.
In 2017, there was 5.7 fold variation in U5MR ranging from 10 per 1000 live births in the more developed (high SDI) state of Kerala to 60 in the less developed (low SDI) state of Uttar Pradesh, and 4.5 fold variation for NMR ranging from 7 per 1000 live births in Kerala to 32 in Uttar Pradesh.
The annual rate of reduction from 2010 to 2017 for U5MR ranged among the states from 2.7 per cent in Nagaland to 6.5 per cent in Telangana, and for NMR from 1.8 per cent in Nagaland to 5.5 per cent in the high SDI state of Tamil Nadu.
The annual rate of reduction of NMR was lower than that of U5MR in all states during 2010-2017, but this varied considerably between the states, the study stated.
Inequality between the districts within the states, measured as coefficient of variation (CV), varied extensively in 2017, ranging 7-fold for stunting, 12-fold for wasting, and 9-fold for underweight among the states.
The magnitude of inequality in stunting, wasting and underweight varied widely even between states at similar levels of socio-demographic development, the study said.
"For example, the CV for stunting in 2017 varied from 4 per cent in Bihar to 21 in Odisha among the less developed (low SDI) states, and from 3 per cent in Delhi to 19 per cent in Kerala among the more developed (high SDI) states," the study said.
Despite the decrease in stunting, wasting and underweight in most of the districts from 2000 to 2017, the inequality in these indicators increased in 90 per cent of the states for stunting, in 52 per cent states for wasting, and in 65 per cent states for underweight.
"For stunting, the highest increase in inequality between districts within states was in Odisha among the low SDI states, in Telangana and Haryana in the middle SDI states, and in Nagaland and Delhi in the high SDI states," the study said.
"For underweight and wasting, the inequality between the districts within the states increased from 2000 to 2017 in some of the states, while it decreased for the others, spread across the low, middle and high SDI states," it said.
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