India
Spotlight on leading threats to child survival under the age of five - focussing on Pneumonia and Diarrhoea.
Pneumonia and diarrhoea are the world's biggest killers of children. Each claims the lives of more than 2,000 every day. Meanwhile, the COVID-19 crisis is presenting the world with ever-evolving, unprecedented challenges, especially for women and children. It has powerfully highlighted the need for building strong and accessible health systems.
The deadline to deliver on the Sustainable Development Goals (SDGs) is 2030. Now is the time to act. Concerted action is needed to improve policies, to increase innovations that expand coverage and quality of Primary Health Care (PHC) and to scale-up evidence-based interventions that are accessible to all children. Combatting these top killers of children isn't just possible, it's a must– so that every child has the chance to fulfil their right to survive, grow and thrive.
- DOWNLOAD▼DOWNLOAD ▼
children under 5 died per 1,000 live births in 2021.
children from the poorest households died per 1,000 live births compared with
children per 1,000 live births from the richest households in 2021.
Target · 25 deaths of children under 5 per 1,000 live births is the 2030 SDG target.
A child born in a poor household is 3.07 times more likely to die than a child born in a rich one.
Child Mortality Rate
Target · 25 deaths of children under 5 per 1,000 live births is the 2030 SDG target.
Pneumonia
4 children under 5 died from pneumonia per 1,000 live births in 2019.
11% of child deaths were due to pneumonia, the biggest killer of children under 5 in 2019.
Pneumonia killed more than 93163 children under 5 in 2019.
Perin et al. (2021), The Lancet Child & Adolescent Health
Target · 3 deaths of children under 5 from pneumonia per 1,000 births is the 2025 GAPPD target.
Diarrhoea
2 children under 5 died from diarrhoea per 1,000 live births in 2019.
7% of child deaths were due to diarrhoea, the second-biggest killer of children under 5 in 2019.
Diarrhoea killed more than 53395 children under 5 in 2019.
Perin et al. (2021), The Lancet Child & Adolescent Health
Target · 2 deaths of children under 5 from diarrhoea per 1,000 births is the 2025 GAPPD target.
The highest risk factors for child pneumonia deaths in 2019 were:
not having access to hand-washing facilities.
low birth-weight.
ambient particulate matter pollution.
The highest risk factors for child diarrhoea deaths in 2019 were:
using an unsafe water source.
child wasting.
unsafe sanitation.
Note · Many diseases are caused by multiple risk factors. As a result, individual risk factors usually overlap and often add up to more than 100%.
IHME Global Burden of Disease 2019
Trends in Pneumonia and Diarrhoea Mortality
is the average annual rate of reduction in children under 5 dying from pneumonia from 2019.
At this rate, India is expected to reach the 2025 GAPPD target in 2022.
is the average annual rate of reduction in children under 5 dying from diarrhoea from 2019.
Perin et al. (2021), The Lancet Child & Adolescent Health
- DOWNLOAD▼DOWNLOAD ▼
Investment and progress to reduce deaths from pneumonia and diarrhoea are crucial for countries to achieve the SDG target for child survival of less than 25 child deaths per 1,000 live births. Primary Health Care (PHC) is the most efficient and effective way to achieve health for all. Resting on three pillars – integrated health services, multisectoral policy and action, and empowered people and communities – it provides a comprehensive approach to deliver preventive, protective and curative care for high-burden diseases, such as pneumonia and diarrhoea.
This Child Health Spotlight provides key data on all three pillars and show where urgent action is needed to protect, prevent, diagnose, and treat leading causes of child deaths.
Protect
We protect children from the killer diseases of pneumonia and diarrhoea by establishing good health practices and creating a safe and healthy environment from birth. This gives them a better chance of a healthier life, with fewer illnesses – and lower healthcare costs for their families and the health system.
Improving nutrition and breastfeeding have been shown to be highly successful and cost-effective interventions for reducing pneumonia-related mortality and are therefore the focus of the protect pillar. Good nutrition and optimal breastfeeding help infants’ and young children’s bodies fight off infections, respond to treatment, and prevent other underlying causes of pneumonia.
Although the protect pillar focusses on tackling malnutrition through improved nutrition and breastfeeding, it is important to note that pneumonia and diarrhoea are first and foremost diseases of poverty (which exacerbates malnutrition and other risk factors). Consequently, a sustainable approach to protecting children would both support better nutrition and breastfeeding while also investing in interventions aimed at improving children’s livelihoods and communities’ resilience to shocks.
At the core of all these strategies, communities’ engagement and empowerment is crucial. This encourages families to take responsibility for their health, drives community ownership and suitability of interventions, and builds local and national accountability.
Nutrition
Wasting rate for under 5 children
of children under 5 suffered wasting in 2017, including 5% of children who were severely wasted.
UNICEF/WHO/World Bank Joint Malnutrition Estimates Expanded Databases May 202221% of children suffered wasting in the poorest households compared with 13% of children in the richest households.
UNICEF/WHO/World Bank Joint Malnutrition Estimates Expanded Databases May 2022A child born in a poor household is 62% more likely to suffer wasting than a child born in a rich one.
18% was the wasting rate in rural areas compared with 16% in urban areas.
UNICEF/WHO/World Bank Joint Malnutrition Estimates Expanded Databases May 2022A child born in a rural area is 13% more likely to suffer wasting than a child born in an urban area.
Stunting rate among under 5 children
of children under 5 were stunted in 2017.
UNICEF/WHO/World Bank Joint Malnutrition Estimates Expanded Databases May 202249% of children under 5 in the poorest households were stunted compared with 19% of children in the richest households.
UNICEF/WHO/World Bank Joint Malnutrition Estimates Expanded Databases May 2022A child born in a poor household is 2.58 times more likely to suffer stunting than a child born in a rich one.
37% of children under 5 in rural areas were stunted compared with 27% of children in urban areas.
UNICEF/WHO/World Bank Joint Malnutrition Estimates Expanded Databases May 2022A child born in a rural area is 37% more likely to suffer stunting than a child born in an urban area.
Breastfeeding
Target
50% is the rate of exclusive breastfeeding during the first 6 months of life recommended by the 2025 objectives of the World Health Assembly Resolution.
was the exclusive breastfeeding rate in 2017.
Engagement
of women participated in household decision-making in 2020.
- DOWNLOAD▼DOWNLOAD ▼
Prevent
Prevent pneumonia and diarrhoea in children by addressing underlying causes and risk factors as an essential component of a strategy to increase overall child survival.
Despite the existence of low-cost and effective interventions, pneumonia and diarrhoea remain leading causes of death in children with most of the disease burden finding its roots in the poverty relate factors, such as poor indoor air pollution, lack of access to proper sanitation and health education and poor access to healthcare. To this end, the Prevent pillar is structured around three key interventions: 1) scaling up immunisation across the whole population and reaching the hardest to reach children 2) ensuring adequate water, hygiene and sanitation in all communities paying special attention to the needs of women, girls and those in vulnerable situations, and 3) addressing environmental factors especially improving air quality and improving access to affordable, reliable, sustainable and modern energy for all.
The fight against pneumonia and diarrhoea is a multifaceted problem which is directly linked to a large pool of socio-economic, geographical, cultural and environmental factors that all impact children’ health. The prevent pillar highlights the need to consolidate and extend preventative efforts against pneumonia and diarrhoea across key social determinants of health and requires effective coordination and action across multiple sectors. Pneumonia and diarrhoea in children are prevented by addressing underlying causes and risk factors. This is an essential component of a strategy to increase overall child survival.
Despite the existence of low-cost and effective interventions, pneumonia and diarrhoea remain leading causes of death in children. Most of the disease burden has its roots in poverty-related factors, such as indoor air pollution and lack of access to safe sanitation, health education and healthcare. The prevent pillar is therefore structured around three key interventions:
- scaling up immunisation across the whole population and getting to the hardest-to-reach children
- ensuring adequate water, hygiene and sanitation in all communities, paying special attention to the needs of women, girls and those who are most vulnerable
- addressing environmental factors, especially improving air quality and access to affordable, reliable, sustainable and modern energy.
Immunization
Penta3 vaccine coverage among 1-year-old
Target
90% national coverage for vaccination by 2030, as recommended by the Immunization Agenda 2030.
Penta3 vaccine coverage among 1-year-old children in 2021.
84% of children in the poorest households get Penta3 vaccine compared with 90% in the richest ones.
Save the Children estimates based on DHSA child born in a poor household is 11% less likely to get vaccinated than a child born in a rich one.
88% of children in rural areas get Penta3 vaccine compared with 87% in urban areas.
Save the Children estimates based on DHSA child born in a rural area is 1% more likely to get vaccinated than a child born in an urban area.
PCV3 vaccine coverage among 1-year-old
Target
90% national coverage for vaccination by 2030, as recommended by the Immunization Agenda 2030.
PCV3 vaccine coverage among 1-year-olds in 2021.
Rota vaccine coverage among 1-year-old
Rota vaccine coverage among 1-year-olds in 2021.
Air Quality
People with Primary Reliance on Clean Fuels and Technologies
Target
All people should have access to affordable, reliable, sustainable and modern energy by 2030 according to SDG 7.
of people relied on clean fuels and technologies in 2020.
WHO Global Health Observatory54% of people in rural areas relied on clean fuels and technologies compared with 91% in urban areas.
WHO Global Health ObservatoryA person in a rural area is 67% less likely to rely on clean fuels and technologies than a person in an urban area.
PM2.5 pollution / Mean Annual Exposure Concentrations of fine particulate
Target
10 micrograms per cubic metre of air (μg/m3) should be the mean annual exposure to fine particulate matter (PM2.5), according to WHO Air Quality Guidelines.
micrograms per cubic metre of air was the average mean annual exposure to PM2.5 pollution in 2019.
WHO Global Health Observatory46 micrograms per cubic metre of air was the mean annual exposure to PM2.5 pollution in rural areas compared with 53 in urban areas.
WHO Global Health ObservatoryA person in a rural area is 11% less likely to be exposed to PM2.5 than a person in an urban area.
Water & Sanitation
People Using Basic Drinking Water Services
All people should have access to a safe and affordable drinking water by 2030 according to SDG 6.
of people were using safely managed drinking water in 2020.
WHO/UNICEF Joint Monitoring Programme (2021)Encuesta Demografica y de Salud Familiar 2020There is no information on People using basic drinking water services in rural areas or People using basic drinking water services in urban areas.
People using at least basic sanitation services
Target
All people should have access to adequate and equitable sanitation and hygiene by 2030 according to SDG 6.
of people were using basic sanitation in 2020.
WHO/UNICEF Joint Monitoring Programme (2021)67% of people were using basic sanitation in rural areas compared with 79% in urban areas.
WHO/UNICEF Joint Monitoring Programme (2021)A person in a rural area is 25% less likely to have access to basic sanitation than a person in an urban area.
People practicing open defecation
Target
Open defecation should end by 2030 according to SDG 6.
of people were practicing open defecation in 2020.
People with basic hand washing facilities at home
of people had basic hand-washing facilities at home in 2020.
- DOWNLOAD▼DOWNLOAD ▼
Diagnose & Treat
To limit the harm caused by pneumonia and diarrhoea and create the conditions for optimal recovery, it’s critical to diagnose and treat children who become ill with these diseases as early as possible.
This can be done by enhancing the capacity for early and accurate diagnosis, and by increasing the delivery of cost-effective treatment at the community level, at first-level facilities, and – if the disease is severe – at referral-level facilities. The diagnose and prevent pillar focusses on four essential aspects:
- access to oxygen as a life-saving, essential and effective treatment for acute pneumonia cases
- provision of integrated, good-quality services to ensure all children can access high impact interventions that prevent, diagnose and treat pneumonia and diarrhoea
- key factors that influence care-seeking behaviours, such as availability and access to services, community awareness and engagement, education and other socioeconomic, geographical and cultural factors
- a well-paid, well-trained and well-supplied healthcare workforce, including community health workers, which is trusted by communities and able to deliver comprehensive coverage of good-quality services for all children.
To diagnose and treat childhood pneumonia and diarrhoea, it is vital to prioritise building resilient health systems with robust primary healthcare. This needs to be free at point of use, decentralised and easy to access by all communities. It also needs to be well-prepared, well-resourced and flexible enough to absorb the impact of disruptive events.
Health Workers
doctors per 10,000 people in 2020.
WHO Global Health Observatorynurses and midwives per 10,000 people in 2020.
WHO Global Health ObservatoryIs there a national guideline for community health workers to dispense antibiotics?
Yes
National Pneumonia Guidelines 2019; Home Based Newborn Care Operational Guidelines Revised 2014Care Seeking Behaviour for Pneumonia
Target
90% of children with pneumonia symptoms to be taken to a health facility by 2025 is the GAPPD target.
of children with pneumonia symptoms were taken to a health facility in 2021.
National Family Health Survey 2019-2021 (Final report)58% of children with pneumonia symptoms in the poorest households were taken to a health facility compared with 52% of children in the richest ones.
A child with pneumonia symptoms born in a poor household is 12% more likely to be taken to a health facility than a child born in a rich one.
57% of children with pneumonia symptoms in rural areas were taken to a health facility compared with 56% in urban areas.
National Family Health Survey 2019-2021 (Final report)A child with pneumonia symptoms born in a rural area is 2% more likely to be taken to a health facility than a child born in an urban area.
Oxygen
Is it mandatory for all health centres to have medical oxygen?
Yes
Indian Public Health Standards Revised Guidelines 2012; Operational Guidelines for Facility Based Integrated Management of Neonatal and Childhood Illness (F-IMNCI) 2009Is it mandatory for community health workers to use pulse oximeters?
No
Indian Public Health Standards Revised Guidelines 2012; Operational Guidelines for Facility Based Integrated Management of Neonatal and Childhood Illness (F-IMNCI) 2009Care Seeking Behaviour for Diarrhoea
Target
90% of children with diarrhoea symptoms to be taken to a health facility by 2025 is the GAPPD target.
of children with diarrhoea symptoms were taken to a health facility in 2021.
National Family Health Survey 2019-2021 (Final report)75% of children with diarrhoea symptoms in the poorest households were taken to a health facility compared with 80% in the richest ones.
A child with diarrhoea symptoms born in a poor household is 11% less likely to be taken to a health facility than a child born in a rich one.
76% of children with diarrhoea symptoms in rural areas were taken to a health facility compared with 78% in urban areas.
National Family Health Survey 2019-2021 (Final report)A child with diarrhoea symptoms born in a rural area is equally likely to be taken to a health facility than a child born in an urban area.
ICCM
Is there a policy/guideline of integrated community case managment?
No
WHO Reproductive, Maternal, Newborn, Child, and Adolescent Health Policy Survey 2018Does the national Essential Drugs List include Amoxicillin dispersible tablet (250 mg) for management of childhood illness?
No
WHO Reproductive, Maternal, Newborn, Child, and Adolescent Health Policy Survey 2018- DOWNLOAD▼DOWNLOAD ▼
Health financing
To achieve significant and sustainable impact on child survival, health financing strategies need to focus on how money is spent as well as how much.
If countries are to deliver on eradicate pneumonia and diarrhoeal disease and achieve their commitments towards UHC, the needs of the poorest children and most marginalized communities must be put at the heart of countries’ health financial strategies. To achieve the global target of 90% coverage of maternal and child health services, limit out-of-pocket payments for essential health services and prevent catastrophic health expenditure, especially among the poorest households, national governments must allocate at least 5% of GDP to health.
Most importantly, national governments need to develop effective structuring and management of their health financing. In order to ensure equitable distribution of resources across all priorities of their health strategy – including essential elements like PHC and community health services – governments will need to reprioritise budgets and improve technical efficiency.
In addition to strengthening domestic resource mobilisation for health, it is essential that national and global actors commit to harmonising financing mechanisms and ensure alignment of complementary financing streams with national policies and the needs of children and local communities. This includes global funding mechanisms (such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Financing Facility for Women, Children and Adolescents, and Gavi, the Vaccine Alliance) as well as other institutional and private donors.
Government spent per person in USD
Target · USD 86 is the minimum recommended government spend per person and year to provide essential health services.
Government spent per person in USD
Government budget on health
Target · 5% of GDP is the minimum recommended government spend on health.
Government budget on health
Target · 57% of government health expenditure should be on primary-level healthcare services.
Target · Out-of-pocket expenditure on health should not be more than 10% of total household expenditure or income.
- DOWNLOAD▼DOWNLOAD ▼