India’s Child & Neonatal Mortality Rates Lag World, Disease Prevalence Among World’s Highest

Six million fewer children died in 2016 than in 1990. That’s more than the total number of children in France.

This nugget is from The Stories Behind The Data 2017, a new report on global progress released by the Bill and Melinda Gates Foundation about global effort to fight poverty and disease.

The report tracked 18 data points that were included in the United Nations’ Sustainable Development Goals. We compared India’s performance with the global average on certain health indicators.

India pares maternal deaths, lags world in reducing neonatal, under-five deaths

1. Maternal mortality ratio:

By 2013, India’s maternal mortality ratio was lower than the global average. From 254 deaths per 100,000 live births in 2004-06, the ratio fell to 167 in 2013; the global average in 2016 remains higher at 179. The percentage of institutional deliveries in India rose--from 39% in 2005-06 to 79% in 2015-16, according to NFHS data.

In 1990, the global maternal mortality ratio was 275 deaths per 100,000 live births. For a few years, the ratio remained the same till it declined to 179 in 2016. The fall has been attributed to the increasing number of women giving birth in health facilities, where they have access to skilled obstetric care, instead of at home, according to the report.

At the current rate, the global MMR is projected to reach 138 in 2030, the report projected. The SDGs set a target of less than 70 deaths per 100,000 live births by 2030. India’s National Health Plan 2017 targets a rate of 100 by 2020.

2. Neonatal mortality rate:

In 1990, India’s neonatal mortality rate--infant deaths within 28 days of birth per 1,000 births--was 52, while the global average was 32. India’s rate reduced nearly 50% to 28 in 2013, but is still higher than the global average (17 in 2016). The report projects that the global neonatal mortality rate will fall to 11 in 2030, or by another 50% to 9 if efforts improve.

Poor health infrastructure, poor availability of human resources, anaemic Indian adolescents and excess physical activity in poor women are some of the reasons for the slow decline in neonatal mortalities, IndiaSpend reported in June 2017. India’s National Health Plan 2017 targets a rate of 16 by 2025.

3. Under-five mortality rate:

In 1992-93, India’s under-five mortality rate was 109 deaths per 1,000 live births, according to the National Family Health Survey-1. By 2005-06, this dropped to 74, and by 2015-16 to 50--12 more than the world average. India’s under-five mortality rate is higher than poorer countries such as Nepal, Bangladesh and Rwanda, IndiaSpend reported in March 2017.

In 1990, 11.2 million children died globally before age five, with an under five-mortality rate of 83 deaths per 1,000 live births. By 2016, the number of deaths reduced by more than 50% to 5 million, and the mortality rate to 38, according to the report.

The SDGs have set a target of 25 deaths per 1,000 live births by 2030. India’s National Health Profile sets itself a target of 23 by 2025. At the present rate, global under-five mortality rate will drop to 23 by 2030, and can potentially drop to 19 with better healthcare, the report projected.

4. Immunisation:

Of child deaths estimated next year, about 1.5 million will be from diseases that can be prevented by vaccines, according to the report.

More than 100 million children have been saved since 1990, mainly due to vaccines and better newborn care practices, but there is still a need to build basic infrastructure in countries with weak health care systems, the report said. There are nearly 20 million children in the world who aren’t immunised at all, and 150,000 children die every year from measles, a disease whose vaccine costs less than 20 cents (Rs 13). In India, more than 80% of children aged 12-23 months have received the measles vaccine in 2015-16.

In 2015-16, 62% Indian children aged 12-23 months were fully immunised--up from 43.5% in 2005-06. There are wide variations among the states--from 36% in Nagaland to 89% in Punjab.

Disease control: India has highest TB incidence, third highest malaria cases, third highest HIV cases

The SDGs have set a target to end the epidemic of AIDS, tuberculosis, malaria and neglected diseases by 2030. However, the report has predicted that we will be very far from that goal.

1. Tuberculosis:

India has been declared by the World Health Organization (WHO) as the country with the highest incidence of tuberculosis in the world. In 2015, nearly India reported 2.8 million new cases of tuberculosis--nearly a quarter of the global incidence of 9.6 million cases. This is a 10% increase from 2 million cases reported in 2009.

It is estimated that nearly 40% of the Indian population is living with tuberculosis bacteria.

India had double the number of estimated deaths by tuberculosis in 2015–480,000 deaths, up from 220,000 deaths in 2014–because previous estimates were too low, IndiaSpend reported in this October 2016. India does not implement six of 16 key WHO tuberculosis recommendations, IndiaSpend reported on July 20,2017.

In 1990, the number of new cases of tuberculosis per 100,000 people globally was 187 according to the report. In 2016, it was 140.

2. Malaria:

India has the third highest number of malaria cases globally, and accounts for 70% of cases in the South East Asia region, according to the WHO data. Incidence of malaria in India rose from 0.8 million in 2013 to 1.1 million in 2015, according to this 29th July, 2016 reply given to the Lok Sabha. The number of deaths reduced from 440 to 287 in the same period.

In 1990, there were 31 new cases of malaria reported per 1,000 people globally. Due to a surge in malarial deaths around the world, more cases of malaria were being reported prior to 2000, according to the report. By 2016, the global number of new malaria cases fell only by two points to 29. The report projected that the incidence will almost remain the same in 2030.

3. HIV

India had the third highest number of people living with HIV, according to The Gap Report published in 2014 by UNAIDS.

As of 2015, there were nearly 2.1 million people living with HIV in India; less than 44% of them received the drugs that help prolong their lives and reduce infections, and only 36% children with HIV receive anti-retroviral therapy, IndiaSpend reported in September 2016.

Between 2009-16, 14,474 cases of HIV occurred through blood transfusion. As of 2015-16, less than one-fifth of Indian women and one-third of Indian men had a comprehensive knowledge of HIV/AIDS, according to NFHS data.

An estimated 35 million people have died due to the HIV virus till 2016. In 1990, the global HIV deaths per 1,000 people was 0.05. Till 2005, there was a consistent rise in HIV deaths, peaking at 0.3 in 2005. An increase in the magnitude of providing necessary services and products to HIV patients helped reduce the death rate to 0.14 in 2016, according to the report, though it is still higher than what it was in 1990.

At the present rate, the report projects the death rate to fall further to 0.09 by 2030, although budget cuts to fund treatment can increase the death rate to as high as 0.20.

Less than half the Indian population has access to improved sanitation facilities

In 2015-16, 48% Indians had access to improved sanitation facilities--proper toilets and clean, drinking water--up from 29% in 2005-06, according to NFHS data. This means that less than half the Indian population has access to improved sanitation facilities. Diarrhoea, which can be prevented through improved sanitation facilities, is still one of the leading causes of death among Indian children.

In 2016, 157 million Indians did not have access to toilets. Among the BRICS nations, India has the largest proportion of population living without toilets, at 37.4 %.

As many as 343 healthcare institutions across six Indian states lacked basic hygiene, toilets, clean water and waste disposal, IndiaSpend reported in July 2016.

As of 2016, one-third of the global population had access to unsafe means of sanitation, down from 57% in 1990, according to the report. At the current rate, this figure is projected to fall to 23% by 2030.

(Nair is an intern with IndiaSpend.)

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