Causes and Predictors of Neonatal, Post-neonatal and Maternal Deaths in India: Analysis of a Nationwide District-Level Household Survey-4 (DLHS-4), 2012-13.
BACKGROUND
There is lack of reliable mortality estimates in India about maternal, neonatal and infant deaths. As we move towards achieving the targets under Sustainable Development Goals, information on cause of death is essential to prioritize our resources and planning. Therefore, the present study describes the causes and characteristics of neonatal, post-neonatal and maternal deaths in India.


METHODS
The study analysed nationwide District-Level Household Survey-4 conducted by the Ministry of Health and Family Welfare, Government of India, in 2014. The household questionnaire collected information on the socio-economic characteristics of the household and deaths within the household, including neonatal, post-neonatal, maternal and adult deaths.


RESULTS
Of 1324 neonatal deaths, 46% occurred at home and 73% in the first week of life. Among 2032 post-neonatal deaths reported, 70% occurred at home. Birth injuries, low birth weight and neonatal infections were the leading causes of neonatal deaths. Acute respiratory infection was the most common cause of post-neonatal deaths, whereas excessive bleeding and pregnancy-induced hypertension were the common causes of maternal deaths. Nearly 39% of neonatal and 50% of post-neonatal deaths were either classified as others or could not be ascertained. Household characteristics such as use of unclean fuel, poor sanitation, poor drinking water source, type of house (kachha) and below poverty line family are associated with mortality.


CONCLUSIONS
A high proportion of avoidable deaths still occur at home. These findings indicate the need for an efficient ambulance transport system, promoting health-seeking behaviour, better knowledge of danger signs and strengthening community-facility linkages. A more accurate verbal autopsy tool and proper administration of the tool are required to accurately ascertain cause of death and reduce the number of deaths that are assigned an ill-defined cause.
The Union South East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi 110016, India.
Jaya P
JP
Tripathy
Independent Public Health Consultant, New Delhi 110070, India.
Sanskruti
S
Mishra
DLHS; maternal death; neonatal death; verbal autopsy