Results on Causes of Deaths regarding children – A report from Government of India

A Special Survey of Deaths (SSD), undertaken in 2001-2003, has been carried out under the domain of Sample Registration System (SRS), which covered over 6,645 small areas (sample units) in all the States and Union Territories. The causes of death have been determined using an advanced form of Verbal Autopsy called the “RHIME” or Representative, Re-sampled, Routine Household Interview of Mortality with Medical Evaluation method. The SRS field staff that have been trained extensively for collection of the symptoms, signs and key circumstances leading to death using a two-page structured form with a brief narrative in local language, have undertaken the survey. A random sample of about 5-10% of the units has been reported on Causes of Death:2001-03, Office of Registrar General, India Page 2 surveyed by an independent team to ensure the quality of fieldwork, completeness and accuracy. The assignment of causes of death has been done through a medical evaluation by two independent trained physicians who have examined the field reports using a web-based system developed specifically for the study. The cases resulting into continuing disagreements were referred to a third physician to adjudicate the final ICD-10 code. 

The following are a few results from this survey in respect of children:

1. Among children aged 0 to 4 years, the top 10 causes of death are:

Peri-natal conditions (33%), Respiratory infections (22%), Diarrheal diseases (14%), Other infectious and parasitic diseases (11%), Symptoms, signs and ill-defined conditions (3.4%), Unintentional injuries: other (3.2%), Nutritional deficiencies (2.8%), Malaria (2.7%), congenital anomalies (2.7%), and Fever of unknown origin (1.5%).

Deaths due to peri-natal conditions constitute a higher proportion among males with vast majority of these deaths concentrated in the first month of life. However, deaths on account of most of the other causes are higher in proportion among females.

2. Among infants, the top 10 causes of death are:

Peri-natal conditions (46%), Respiratory infections (22%), Diarrheal diseases (10%), Other infectious and parasitic diseases (8%), Congenital anomalies (3.1%), Symptoms, signs and ill-defined conditions (3%), Nutritional deficiencies (2%), Unintentional injuries: other (1.4%), Malaria (1.1%), and Fever of unknown origin (0.9%).

Deaths due to peri-natal conditions are in a higher proportion among males whereas deaths due to most of the other causes are higher in proportion among females as is observed in the case of children aged 0 to 4 years.

3. Among children aged 1 to 4 years, the top 10 causes of death are:

Diarrheal diseases (24%), Respiratory infections (23%), Other infectious and parasitic diseases (16%), Unintentional injuries: other (8%),  Malaria (7%), Nutritional deficiencies (4.8%), Symptoms, signs and ill-defined conditions (4.5%), Fever of unknown origin (3%), Digestive Diseases (1.7% ), and Congenital anomalies (1.5%).

The proportion of deaths from the top10 causes except for unintentional injuries: other; symptoms, signs and ill-defined conditions; and congenital anomalies are higher among the females.

4. Ages 5-14 is generally a period of lower mortality than at ages 0-4 years. The ten leading causes of death at ages 5-14 are:

Diarrheal diseases (17%), Unintentional injuries: other (16%), Other infectious and parasitic diseases (15%), Respiratory infections (10%), Malaria (9%), Ill-defined conditions (5%), Motor vehicle accidents (4%), Cancers (2.9%), Digestive diseases (2.9%), and Fever of unknown origin (2.9%).

  The report concludes that large number of deaths in the country have been occurring in early ages as well as in middle ages, which is suggestive that proper medical attention and health care facilities can certainly help alleviate this situation. The findings of the Report highlight specifically the need for augmenting interventionist strategies and programs for reducing the mortality resulting from health problems in childhood. There is, however, a need for a word of caution. The mortality results presented in the Report should be interpreted carefully as the chance of misclassification of causes is not completely ruled out. However, despite this limitation, the study brings out findings which should definitely help enrich understanding of the mortality situation and challenges thereof in the country.