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Background

In India, an estimated 24.7 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.

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 Proportion of 1 year old children immunised against measles.

Progress of achievements against MDG 4 targets are as follows:

1. As per latest Sample Registration System, 2016 Report; The Under Five Mortality Rate in India is 39/1000 live births. 15 states have achieved MDG-4 namely Andhra Pradesh, Haryana, Telangana, Gujarat, Jharkhand, Karnataka, Himachal Pradesh, West Bengal, Jammu & Kashmir, Punjab, Delhi, Maharashtra, Tamil Nadu, Kerala and Uttarakhand

2. As per latest Sample Registration System, 2016 Report; Infant Mortality Rate is 34/1000 live births.

3. The U5MR has declined at a faster pace in the period 2008-2016, registering a compound annual decline of 6.7% per year, compared to 3.3% compound annual decline observed over 1990-2007.

4. Four states together contribute to 56% of all child deaths in the country, namely-Uttar Pradesh , Bihar, Madhya Pradesh and Rajasthan.

5. About 46% of under-five deaths take place within the first 7 days of birth, 61% within first one month of birth.

6. 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 National Health Policy (2017)

The Child Health programme under the Reproductive, Maternal, Newborn, Child and Adolescent (RMNCH+A) Strategy of the National Health Mission (NHM) comprehensively integrates interventions that improve child health and nutrition status and addresses factors contributing to neonatal, infant, under-five mortality and malnutrition. The National Population Policy (NPP) 2000, the National Health Policy 2002, Twelfth Five Year Plan (2007-12), National Health Mission (NRHM - 2005 – 2017), Sustainable Development Goals (2016-2030) and New National Health Policy, 2017 have laid down the goals for child health.

Child Health IndicatorCurrent statusNHP Target
IMR (Infant Mortality Rate) 34 (SRS 2016) 28 by 2019
Neonatal Mortality rate 24 (SRS 2016) 16 by 2025
Under 5 Mortality Rate 39 ( SRS 2016) 23 by 2025

Causes of Child Mortality in India

The major causes of child mortality in India as per the SRS reports (2010-13) are: Prematurity & low birth weight (29.8%), Pneumonia (17.1%), Diarrheal diseases (8.6%), Other non-communicable diseases (8.3%), Birth asphyxia & birth trauma (8.2%), Injuries (4.6%), Congenital anomalies (4.4%), Ill-defined or cause unknown (4.4%), Acute bacterial sepsis and severe infections (3.6%), Fever of unknown origin (2.5%), and all other remaining causes (8.4%).

Causes of Infant Mortality

• The major causes of infant mortality in India as per the SRS reports (2010-13) are: Prematurity & low birth weight (35.9%), Pneumonia (16.9%), Birth asphyxia & birth trauma (9.9%), Other noncommunicable diseases (7.9%), Diarrhoeal diseases (6.7%), Ill defined or cause unknown (4.6%), Congenital anomalies (4.6%), Acute bacterial sepsis and severe infections (4.2%), Injuries (2.1%), Fever of unknown origin (1.7%), and all other remaining causes (5.4%).

Causes of Neo-natal Mortality

The major causes of neonatal deaths as per Sample Registeration System Report (2010-13) are Prematurity & low birth weight (48.1%), Birth asphyxia & birth trauma (12.9%), Neonatal Pneumonia (12.0%), Other noncommunicable diseases (7.1%), Sepsis (5.4%), Ill defined or cause unknown (5.0%), Congenital anomalies(4.0%), Diarrhoeal diseases (3.1%), Injuries (0.9%), Tetanus (0.5%) and all other remaining causes (0.9%).

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 and Home Based Young Care (HBYC) Programme

Thrust Area 2 : Nutrition

  • Promotion of optimal Infant and Young Child Feeding Practices under Mother’s Absolute Affection (MAA) Programme
  • Micronutrient supplementation (Vitamin A, Iron Folic Acid)
  • Management of children with severe acute malnutrition
  • National Deworming Day

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.