Under-five mortality and associated factors in India: an analysis at the district level

Abstract

Introduction: Under-five mortality refers to the death of a child before reaching the age of five. It is a critical indicator of child health and overall development within a country. In this study, we use data from the 2015–16 National Family Health Survey (NFHS) to estimate under-five mortality at the district level in India, considering a range of socioeconomic and demographic variables.

Methods: We examined the association between these variables and under-five mortality using a Bayesian hierarchical model for 677 districts, employing the Integrated Nested Laplace Approximation (INLA) approach.

Results: Our findings indicate that excess under-five mortality is more prevalent in the northern and northeastern states of India. Additionally, Hindu children and those with literate mothers are less likely to die before reaching their fifth birthday. In contrast, higher risks of under-five mortality were observed among children from socially disadvantaged groups, those who were not exclusively breastfed, and those born through non-institutional deliveries.

Conclusions: The results of this study underscore the urgent need for targeted strategies to address under-five mortality in India. A variety of factors, such as biophysical conditions, socio-demographic disparities, and limited access to healthcare, must be addressed not only to strengthen the health infrastructure but also to promote maternal education and reduce socioeconomic inequalities. Prioritizing the implementation of effective health policies and programs is essential for India to achieve the Sustainable Development Goal (SDG) target of reducing under-five mortality and safeguarding the health of its youngest population across regions and demographic groups.