Under-Five Mortality

Under-Five Mortality - Tiny Lives, Big Numbers

• Definitions (per 1000 live births generally, unless specified):
  • U5MR (Under-Five Mortality Rate): Deaths < 5 yrs. $U5MR = \frac{\text{Deaths < 5 yrs/yr}}{\text{Live births/yr}} \times 1000$.
  • IMR (Infant Mortality Rate): Deaths < 1 yr.
  • NMR (Neonatal Mortality Rate): Deaths < 28 days. (Early: <7d; Late: 7-<28d).
  • PMR (Perinatal Mortality Rate): Stillbirths (≥28wk gest.) + Early NMR per 1000 (Live Births + Stillbirths ≥28wk gest.).
  • CMR (Child Mortality Rate): Deaths 1-4 yrs per 1000 children aged 1-4 yrs.
• Current Rates (India SRS 2020 / Global U5MR 2021):
  • U5MR: 32 / 38 (per 1000 live births).
  • IMR (India): 28 (per 1000 live births).
  • NMR (India): 20 (per 1000 live births).
• SDG Target 3.2 (by 2030):
  • U5MR: ≤ 25/1000 live births.
  • NMR: ≤ 12/1000 live births.

⭐ Neonatal period (first 28 days) accounts for the majority of infant deaths and a significant portion of U5MR in India (approx. 71% of IMR & 62.5% of U5MR based on SRS 2020).

Under-Five Mortality - Lethal Culprits

Key global killers of children under five include:

• Prematurity & low birth weight complications
• Birth asphyxia and trauma
• Pneumonia (Acute Respiratory Infections)
• Diarrheal diseases
• Neonatal sepsis and other severe infections
• Congenital anomalies
• Malaria
• Malnutrition (major underlying factor)
• Injuries (especially for older under-fives)

Age-Specific Dominant Causes in India:

⭐ In India, the leading causes of neonatal mortality are prematurity/LBW, birth asphyxia/trauma, and neonatal infections. This accounts for the majority of infant deaths and a significant portion of under-five deaths.

Under-Five Mortality - Vulnerability Web

Key interconnected factors increasing vulnerability:

• Socio-demographic Factors:
  • Maternal education (low)
  • Poverty & low socioeconomic status
  • Early marriage & young maternal age (<20 years)
  • High birth order & short birth spacing (<24 months)
  • Female child (gender discrimination)
• Nutritional Factors:
  • Maternal malnutrition (anemia, undernutrition)
  • Poor infant & young child feeding (IYCF) practices
  • Micronutrient deficiencies
• Environmental Factors:
  • Inadequate sanitation & unsafe water
  • Poor housing & overcrowding
  • Indoor air pollution
• Healthcare-related Factors:
  • Limited access to quality antenatal, natal & postnatal care
  • Poor immunization coverage
  • Delayed care-seeking for childhood illnesses

⭐ Maternal education level is a powerful predictor of under-five mortality; each additional year of maternal schooling can reduce U5MR by 5-10%.

Under-Five Mortality - Saving Futures

• Key Strategies:

  • IMNCI: Manages childhood illnesses. Incl. F-IMNCI.
  • HBNC: ASHA: 6 home visits (Days 0,3,7,14,21,28); extra for LBW (Day 42).
  • RMNCH+A Strategy: Continuum of care.
  • UIP: Vaccine-preventable disease control.
  • IYCF: EBF (0-6 mo), complementary feeding.
  • WASH: Safe water, sanitation, hygiene.

• RMNCH+A Components:

  RMNCH+A	Key Focus
  R	FP, Adol. Health (WIFS)
  M	ANC, Inst. Delivery, PNC
  N	ENBC, SNCU
  C	IMNCI, Immunize, Nutrition (Vit A)
  A	Adolescent Health Services

⭐ JSSK: Free delivery (incl. C-section), drugs, diet, transport for pregnant women in public facilities.

High‑Yield Points - ⚡ Biggest Takeaways

• U5MR: Deaths of children < 5 years per 1000 live births.
• Top causes: Pneumonia, Diarrhea, Prematurity & LBW, Birth Asphyxia.
• Neonatal Mortality (<28 days deaths) significantly contributes to U5MR; main causes: Prematurity, Sepsis, Asphyxia.
• Core interventions: IMNCI, ENC, Immunization, ORS, Exclusive Breastfeeding.
• SDG Target 3.2: Reduce U5MR to ≤ 25/1000 live births by 2030.
• India's U5MR (NFHS-5): 35.5/1000 live births; focus on reducing disparities.