Mortality in children under five years is a critical population health indicator in Low- and Middle-Income Countries including India. Over the years, India has implemented several policies to target maternal and child mortality to promote safe motherhood and to improve nutritional outcomes for pregnant women, lactating mothers, and children. Using the disaggregated data from the fourth National Family Health Survey (NFHS 2015-16) and the estimated annual births from the WorldPop Project, we calculated the probability and headcount of neonatal, postneonatal, and child mortality for 640 districts in India. The geo-visualisations as following are presented with a motivation to help various stakeholders prioritise indicators and districts for interventions.
Neonatal, Postneonatal and Childhood Mortality in India
Geographic Visualization
Explore Data
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Citation: Akhil Kumar, Weiyu Wang, Julie Kim, Weixing Zhang, Rockli Kim, S V Subramanian. Neonatal, Postneonatal, and Childhood Mortality in India. https://doi.org/10.7910/DVN/07TG5Q Apr 2021. Geographic Insights Lab at the Harvard Center for Population and Development Studies; Center for Geographic Analysis at Harvard University, Cambridge, MA.
Methodology
Prevalence-Headcount Metric
Blank areas represent unavailable data. We estimated the burden for each mortality indicator in children under five years by two dimensions of Prevalence (P) and Headcount (H), and combined them to derive a Prevalence-Headcount Metric (PHM) which the legend and rank both show.
Prevalence
We used the predicted estimates in probability of death multiplied by 1000 which gives us the number of deaths per 1000 live births. For details on the estimation of the district specific probability of neonatal, post-neonatal and child mortality, see Kim et al. (2020).
The P metric quantifies the risk of child mortality in a district. For example, in the Sitapur district of Uttar Pradesh, the prevalence of neonatal mortality is 5.7%. Thus, the P metric helps identify districts where the probability of a child dying within the first 28 days since birth remains high and should be reduced.
However, the P metric does not contain any information on the absolute number of new births who are at risk because it does not take into account the total population of new births in a district. For example, consider the districts of Uttar Bastar Kanker (5.24%) in Chhattisgarh and Mahrajganj (5.26%) in Uttar Pradesh; both have similar P metric but differ with regards to the estimated number of new births of 15,261 and 68,410, respectively, translating to different levels of absolute burden.
Headcount
The metric H is given as the product of P and the estimates of annual births by district (from the WorldPop Project) N for each district.
Hj = Pj × Nj
Returning to the above example, the number (H) of Neonatal mortality is substantially large in Maharajganj (3598) than Uttar Bastar Kanker (800) despite both districts having almost the same prevalence because the total population of new births burden by Neonatal mortality in Maharajganj is substantially larger.
The headcount estimates are the expected number of deaths by a particular age if all births are exposed to the estimated mortality probabilities in that age in a given year. Using the annual death count, we also estimated the average number of death count per day by dividing annual death count by 365.
These estimates for death counts follow a hypothetical-cohort approach. They estimate what would happen to live-births in 2015 if they experienced the mortality probabilities observed in NFHS-4. This is the same approach taken in calculating period life tables and period life expectancies. As with period life expectancies, the limitation of this approach is that as these children age, mortality probabilities may change. The death counts calculated here assume that the mortality probabilities will remain the same till this cohort of new-borns in 2015 turns 5.
Prevalence-Headcount Metric
We developed a combined Prevalence-Headcount metric (PHM) that takes into account the features of both the risk (P) as well as the headcount (H) to provide a comprehensive picture of the burden of child mortality in a district. Step-by-step instructions can be found in the "PHM Methodology" section.
Types of Under-5 Child Mortality
Indicator |
Age Group |
Definition |
---|---|---|
Neonatal Mortality (NM) |
0-28 days |
The probability of dying within the first 28 days since birth |
Postneonatal Mortality (PNM) |
28 days-12 months |
The probability of dying between the 28 days since birth and the first birthday |
Childhood Mortality (CM) |
12-48 months |
The probability of dying between the first and fifth birthdays |