Neonatal encephalopathy in India: spatiotemporal variations in declining mortality

Area of Science:

• Global Health
• Public Health
• Neonatal Medicine

Background:

• The United Nations Sustainable Development Goals (SDGs) aim to reduce global neonatal and infant mortality.
• India has made progress in reducing neonatal mortality, but disparities persist, particularly for deaths related to neonatal encephalopathy (NE).

Purpose of the Study:

• To examine trends in neonatal/overall infant mortality (NMR/IMR) and deaths related to neonatal encephalopathy (NE) in India from 1990 to 2019.
• To analyze the correlation between NE mortality and sociodemographic factors.

Main Methods:

• Utilized NE mortality data (1990-2019) stratified by age and location from the Global Health Data Exchange.
• Analyzed birth cohort data from UN Population Prospects.
• Employed joinpoint regression for NE-NMR trend analysis and Pearson correlation to assess relationships with sociodemographic index (SDI) and composite coverage index (CCI).

Main Results:

• NE-related neonatal mortality (NE-NMR) declined by 47.5% (AAPC: -2.2%), while all-cause NMR and IMR decreased by 62.6% and 64.1%, respectively.
• NE-NMR showed an inverse correlation with SDI (R²=0.57, p<0.01) but not with CCI (R²=0.08, p=0.13).
• Regional disparities in NE mortality persisted, with NE's share of IMR increasing from 8% to 11.8%.

Conclusions:

• While India has significantly reduced NE-related neonatal mortality, the decline lags behind overall infant mortality improvements.
• Persistent interstate variations and the strong correlation with sociodemographic development underscore the need for targeted, state-specific healthcare strategies.
• Sustained, focused, and community-oriented efforts are essential to close disparities and achieve SDG targets for neonatal mortality reduction.