In 2023, the crude birth rate in live births per 1,000 inhabitants in India stood at 16.15. Between 1960 and 2023, the figure dropped by 26.75, though the decline followed an uneven course rather than a steady trajectory.

Objective: Retrospective analysis of routinely collected data using verbal and social autopsy tools to identify the medical causes of death and contribution of non-biological factors towards infant mortality Setting: The study site was Health and Demographic Surveillance System (HDSS), Ballabgarh, North India Participants: All infant deaths during year 2008 to 2012 were included for verbal autopsy whereas infant deaths from July 2012 to December 2012 were included for social autopsy. Outcome measures: Cause of death ascertained by validated verbal autopsy tool and level of delay based on three delay model using INDEPTH social autopsy tool were the main outcome measures. Results: Infant mortality rate during study period was 46.5/100 live births. Neonatal deaths contributed to 54.3% of infant deaths and 39% occurred on first day of life. Birth asphyxia (31.5%) followed by Low Birth Weight (LBW)/prematurity (26.5%) were the most common causes of neonatal death. While infective cause (57.8) was the most common cause of post-neonatal death. Care-seeking was delayed among 50% of neonatal deaths and 41.2% of post-neonatal deaths. Delay at level 1 was most common, observed in 32.4% of neonatal deaths and 29.4% of post-neonatal deaths. Deaths due to LBW/prematurity were mostly followed by delay at level 1. Conclusion: High proportion of preventable infant mortality still exists in an area which is under continuous health and demographic surveillance. There is need to enhance home based preventive care to enable the mother to identify and respond to danger signs. Verbal autopsy and social autopsy could be routinely done to guide policy interventions aimed at reduction of infant mortality.

Goal 3: Ensure healthy lives and promote well-being for all at all agesChild health17,000 fewer children die each day than in 1990, but more than six million children still die before their fifth birthday each year.Since 2000, measles vaccines have averted nearly 15.6 million deaths.Despite global progress, an increasing proportion of child deaths are in sub-Saharan Africa and Southern Asia. Four out of every five deaths of children under age five occur in these regions.India’s Under Five Mortality (U5MR) declined from 125 per 1,000 live births in 1990 to 49 per 1,000 live births in 2013.Maternal healthGlobally, maternal mortality has fallen by almost 50% since 1990.In Eastern Asia, Northern Africa and Southern Asia, maternal mortality has declined by around two-thirds. But, the maternal mortality ratio – the proportion of mothers that do not survive childbirth compared to those who do – in developing regions is still 14 times higher than in the developed regions.Only half of women in developing regions receive the recommended amount of health care.From a Maternal Mortality Rate (MMR) of 437 per 100,000 live births in 1990-91, India came down to 167 in 2009. Delivery in institutional facilities has risen from 26% in 1992-93 to 72% in 2009.HIV/AIDSBy 2014, there were 13.6 million people accessing antiretroviral therapy, an increase from just 800,000 in 2003.New HIV infections in 2013 were estimated at 2.1 million, which was 38% lower than in 2001.At the end of 2013, there were an estimated 35 million people living with HIV.At the end of 2013, 240,000 children were newly infected with HIV.India has made significant strides in reducing the prevalence of HIV and AIDS across different types of high-risk categories. Adult prevalence has come down from 0.45 percent in 2002 to 0.27 in 2011.This map layer is offered by Esri India, for ArcGIS Online subscribers, If you have any questions or comments, please let us know via content@esri.in.

BackgroundIn India, although the proportion of institutional births is increasing, there are concerns regarding quality of care. We assessed the effectiveness of a nurse-led onsite mentoring program in improving quality of care of institutional births in 24/7 primary health centres (PHCs that are open 24 hours a day, 7 days a week) of two high priority districts in Karnataka state, South India. Primary outcomes were improved facility readiness and provider preparedness in managing institutional births and associated complications during child birth.MethodsAll functional 24/7 PHCs in the two districts were included in the study. We used a parallel, cluster randomized trial design in which 54 of 108 facilities received six onsite mentoring visits, along with an initial training update and specially designed case sheets for providers; the control arm received just the initial training update and the case sheets. Pre- and post-intervention surveys were administered in April-2012 and August-2013 using facility audits, provider interviews and case sheet audits. The provider interviews were administered to all staff nurses available at the PHCs and audits were done of all the filled case sheets during the month prior to data collection. In addition, a cost analysis of the intervention was undertaken.ResultsBetween the surveys, we achieved coverage of 100% of facilities and 91.2% of staff nurse interviews. Since the case sheets were newly designed, case-sheet audit data were available only from the end line survey for about 80.2% of all women in the intervention facilities and 57.3% in the control facilities. A higher number of facilities in the intervention arm had all appropriate drugs, equipment and supplies to deal with gestational hypertension (19 vs.3, OR (odds ratio) 9.2, 95% C.I 2.5 to33.6), postpartum haemorrhage (29 vs. 12, OR 3.7, 95% C.I 1.6 to8.3); and obstructed labour (25 vs.9, OR 3.4, 95% CI 1.6 to8.3). The providers in the intervention arm had better knowledge of active management of the third stage of labour (82.4% vs.35.8%, AOR (adjusted odds ratio) 10, 95% C.I 5.5 to 18.2); management of maternal sepsis (73.5% vs. 10.9%, AOR 36.1, 95% C.I 13.6 to 95.9); neonatal resuscitation (48.5% vs.11.7%, AOR 10.7, 95% C.I 4.6 to 25.0) and low birth weight newborn care (58.1% vs. 40.9%, AOR 2.4, 95% C.I 1.2 to 4.7). The case sheet audits revealed that providers in the intervention arm showed greater compliance with the protocols during labour monitoring (77.3% vs. 32.1%, AOR 25.8, 95% C.I 9.6 to 69.4); delivery and immediate post-partum care for mothers (78.6% vs. 31.8%, AOR 22.1, 95% C.I 8.0 to 61.4) and for newborns (73.9% vs. 32.8%, AOR 24.1, 95% C.I 8.1 to 72.0). The cost analysis showed that the intervention cost an additional $5.60 overall per delivery.ConclusionsThe mentoring program successfully improved provider preparedness and facility readiness to deal with institutional births and associated complications. It is feasible to improve the quality of institutional births at a large operational scale, without substantial incremental costs.Trial RegistrationClinicalTrials.gov NCT02004912

IntroductionRates of primary school enrolment have improved in India, but levels of learning achievement remain low. In the Support To Rural India’s Public Education System (STRIPES) trial, a para-instructor intervention improved numeracy and literacy levels in Telangana, India (2008−10). The STRIPES2 trial was designed to assess whether a similar intervention in a younger cohort of children would have similar effects in Satna and Maihar districts of Madhya Pradesh, India, and be cost-effective.MethodsIn this Madhya Pradesh cluster-randomized controlled trial, 196 villages (clusters) were randomized to receive either a health (CHAMPION2: community health promotion and medical provision and impact on neonates) or education (STRIPES2) intervention. Villages receiving the health intervention were controls for the education intervention and vice versa. For children newly enrolled in primary school, the STRIPES2 intervention comprised before/after-school classes (2 hours per day, 6 days a week) given by trained para-instructors from the local community, frequent monitoring, and engagement with caregivers to motivate children, delivered by the Pratham Education Foundation. STRIPES2 activities had to be suspended twice for around ten and a half months, and some components of the intervention modified due to the COVID-19 pandemic. The period of the trial was extended with the primary outcome (a composite literacy and numeracy score of Early Grade Reading and Mathematics Assessments) assessed around 30 months after classes started.ResultsComposite test scores were significantly higher in the intervention arm (98 villages; 3054 children) than in the control arm (98 villages; 3275 children) at the end of the trial. The mean difference on a percentage point scale was 14.17; 95% CI 11.36 to 16.97; p