地域医療と健康教育

抽象的な

Reducing Under-Five Mortality in India - A Review of Major Encumbrances and Suggestions for Progress

Niyi Awofesoand Anu Rammohan

About 128 million of India’s 1.2 billion populations are aged less than 5 years. India’s under-five mortality rate fell from 2.2 million (123/1000 live births) in 1990 to 1.726 million (63/1000 live birth) in 2010. Based on current trends, India is unlikely to meet the 67% reduction in under-five mortality rate by 2015, compared with 1990 baseline (i.e. less than 41/1000 live births), as stipulated in Millennium Development Goal (MDG) 4, Target 4A. This article examines six major factors encumbering efforts to reduce India’s under-five mortality: poorly delivered antenatal and obstetric care; inadequacy of well-resourced birthing resources; weak immunisation programs, particularly for measles and pneumonia, inadequate prevention and treatment of pneumococcal infections, and; chronic childhood undernutrition. Initiatives to address these obstacles are suggested. The authors posit that a well-resourced and efficiently managed continuum of care approach operated within a strong Indian health system, extending from Pre-pregnancy, Pregnancy, Birth, Postnatal, and Childhood is more likely to accelerate progress towards sustainable reductions in India’s under- five mortality compared with the status quo. Particular emphasis should be focussed on improving child care during the neonatal period, given the rising proportion of under-five deaths as percentage of total deaths prior to age 5 years.