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Background

In India, an estimated 26 millions of children are born every year. As per Census 2011, the share of children (0-6 years) accounts 13% of the total population in the Country. An estimated 12.7 lakh children die every year before completing 5 years of age. However, 81% of under-five child morality takes place within one year of the birth which accounts nearly 10.5 lakh infant deaths whereas 57% of under-five deaths take place within first one month of life accounts 7.3 lakh neo-natal deaths every year in the Country.

In 2000, 189 nations made a promise to free people from extreme poverty and multiple deprivations. This pledge became the eight Millennium Development Goals (MDGs) to be achieved by 2015.

Goal 4: Reduce Child Mortality: The target is to reduce Under-Five Mortality Rate (U5MR) by two-thirds, between 1990 and 2015. In case of India, it translates into a goal of reducing U5MR to 42 per 1000 live births by 2015 and assessed by the following three targets:

4.1 Under five mortality rate

4.2 Infant mortality rate

4.3 Proportion of 1 year old children immunised against measles.

Progress of achievements against MDG 4 targets are as follows:

1. India set a target of bringing down under five mortality to 42/1000 live birth by 2015. Under 5 mortality rate has declined to 49/1000 live births in 2013 (SRS). 11 States have achieved MDG4 ( <42 per 1000 live births) namely Andhra Pradesh, Delhi, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Maharashtra, Punjab, Tamil Nadu, Telangana and West Bengal.

2. Infant Mortality Rate currently stands at 40 /1000 live births (SRS 2013), against the MDG target of 29 /1000 live births by 2015. 15 States/UTs have already achieved MDG 4 ( <29 per 1000 live births) namely Kerala, Tamil Nadu, Goa, Andman & Nicobar Islands, Chandigarh, Daman & Diu, Delhi, Lakshadweep, Puducherry, Manipur, Maharashtra, Nagaland, Tripura, Sikkim, Punjab. Further, 13 States/UTs are near to achieving MDG4 namely West Bengal, Gujarat, Karnataka, Jharkhand, Uttarakhand, Himachal Pradesh, Jammu & Kashmir, Dadar & Nagar Haveli, Arunachal Pradesh, Mizoram, Bihar, Haryana, Andhra Pradesh.

3. Children (12-23 months) immunised against measles has reached a coverage of 74% in 2009 (CES 2009) against a target of universal immunization against measles. Measles immunisation in rural areas improved from 61.8% to 72.4% over a period of four years (2005 to 2009), while urban measles immunisation coverage in this period declined from 79.4 from 78.3%.

Child Health Goal under RCH II/NHM

The Reproductive and Child Health programme (RCH) II under the National Rural Health Mission (NRHM) comprehensively integrates interventions that improve child health and addresses factors contributing to Infant and under-five mortality. Reduction of infant and child mortality has been an important tenet of the health policy of the Government of India and it has tried to address the issue right from the early stages of planned development. The National Population Policy (NPP) 2000, the National Health Policy 2002 and the Eleventh Five Year Plan (2007-12) and National Rural Health Mission (NRHM - 2005 – 2012) have laid down the goals for child health. Further, Twelfth Five Year plan (2012-2017) and National Health Mission (NHM) laid down the Goal to Reduce Infant Mortality Rate (IMR) to 25 per 1000 live births by 2017.

Child Health IndicatorCurrent statusRCH II/NHM 2010/2012MDG 2015NHM (By 2017)
IMR (Infant Mortality Rate) 40 (SRS 2013) <30 <28  25
Neonatal Mortality rate 28 (SRS 2013) -- -- --
Under 5Mortality Rate 49 ( SRS 2013) --  <42 -- 

Source: Sample Registration System (SRS) 2013

Causes of Child Mortality in India

As per WHO 2012 estimates, the causes of Child Mortality in the age group 0-5 years in India are (a) Neonatal causes (53%), (b) Pneumonia (15%), (c) Diarrhoeal disease (12%), (d) Measles (3%), (e) Injuries (3%) and (f) others (14%)

Causes of Infant Mortality

The prominent causes of death among infants are perinatal conditions (46%), respiratory infections (22%), diarrhoeal disease (10%), other infectious and parasitic diseases (8%), and congenital anomalies (3.1%).

Causes of Neo-natal Mortality

The major causes of neonatal deaths are Infections (33%) such as Pneumonia, Septicemia and Umbilical Cord infection; Prematurity (35%) i.e birth of newborn before 37 weeks of gestation and Asphyxia (20%) i.e. inability to breathe immediately after birth and leads to lack of oxygen.

Thrust area under Child Health programme

Thrust Area 1 : Neonatal Health

  • Essential new born care (at every ‘delivery’ point at time of birth)
  • Facility based sick newborn care (at FRUs & District Hospitals)
  • Home Based Newborn Care

Thrust Area 2 : Nutrition

  • Promotion of optimal Infant and Young Child Feeding Practices
  • Micronutrient supplementation (Vitamin A, Iron Folic Acid)
  • Management of children with severe acute malnutrition

Thrust Area 3: Management of Common Child hood illnesses

  • Management of Childhood Diarrhoeal Diseases & Acute Respiratory Infections

Thrust Area 4: Immunisation

  • Intensification of Routine Immunisation
  • Eliminating Measles and Japanese Encephalitis related deaths
  • Polio Eradication

The strategies for child health intervention focus on improving skills of the health care workers, strengthening the health care infrastructure and involvement of the community through behaviour change communication.