title: Neonatal, 1-59 month, and under-5 mortality in 597 Indian districts, 2001 to 2012: estimates from national demographic and mortality surveys.
abstract: BACKGROUND
  India has the largest number of child deaths of any country in the world, and has wide local variation in under-5 mortality. Worldwide achievement of the UN 2015 Millennium Development Goal for under-5 mortality (MDG 4) will depend on progress in the subregions of India. We aimed to estimate neonatal, 1-59 months, and overall under-5 mortality by sex for 597 Indian districts and to assess whether India is on track to achieve MDG 4.
  
  
  METHODS
  We divided the 2012 UN sex-specific birth and mortality totals for India into state totals using relative birth rates and mortality from recent demographic surveys of 24 million people, and divided state totals into totals for the 597 districts using 3 million birth histories. We then split the results into neonatal mortality and 1-59 month mortality using data for 109,000 deaths in children younger than 5 years from six national surveys. We compared results with the 2001 census for each district.
  
  
  RESULTS
  Under-5 mortality fell at a mean rate of 3·7% (IQR 3·2-4·9) per year between 2001 and 2012. 222 (37%) of 597 districts are on track to achieve the MDG 4 of 38 deaths in children younger than 5 years per 1000 livebirths by 2015, but an equal number (222 [37%]) will achieve MDG 4 only after 2020. These 222 lagging districts are home to 41% of India's livebirths and 56% of all deaths in children younger than 5 years. More districts lag behind the relevant goal for neonatal mortality (251 [42%]) than for 1-59 month mortality (197 [33%]). Just 81 (14%) districts account for 37% of deaths in children younger than 5 years nationally. Female mortality at ages 1-59 months exceeded male mortality by 25% in 303 districts in nearly all states of India, totalling about 74,000 excess deaths in girls.
  
  
  CONCLUSIONS
  At current rates of progress, MDG 4 will be met by India around 2020-by the richer states around 2015 and by the poorer states around 2023. Accelerated progress to reduce mortality during the neonatal period and at ages 1-59 months is needed in most Indian districts.
  
  
  BACKGROUND
  Disease Control Priorities 3, Canadian Institutes of Health Research, International Development Research Centre, US National Institutes of Health.
authors.affiliation: Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada; International Institute of Population Science, Mumbai, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Ram
authors.affiliation: Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: prabhat.jha@utoronto.ca.
authors.forename: Prabhat
authors.initials: P
authors.lastname: Jha
authors.affiliation: International Institute of Population Science, Mumbai, India.
authors.forename: Faujdar
authors.initials: F
authors.lastname: Ram
authors.affiliation: International Institute of Population Science, Mumbai, India.
authors.forename: Kaushalendra
authors.initials: K
authors.lastname: Kumar
authors.affiliation: King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Shally
authors.initials: S
authors.lastname: Awasthi
authors.affiliation: St John's Academy of Health Sciences, Bangalore, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Shet
authors.affiliation: Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Joy
authors.initials: J
authors.lastname: Pader
authors.affiliation: Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Stella
authors.initials: S
authors.lastname: Nansukusa
authors.affiliation: School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D017677:Age Distribution; D046688:Child Mortality / Q000639:trends; D002675:Child, Preschool; D003710:Demography; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D017678:Sex Distribution