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A comprehensive index for longitudinal monitoring of child health status
L Satyanarayana1, A Indrayan, H P Sachdev
1Division of Biostatistics and Epidemiology, Institute of Cytology and Preventive Oncology, Maulana Azad Medical College Campus, New Delhi.
Insights
A new comprehensive child mortality index was developed using factor analysis. This index effectively tracks child health status over time, showing improvements in states like Kerala and Maharashtra.
Area of Science:
- Public Health
- Biostatistics
- Demography
Background:
- Conflicting trends in child mortality indicators necessitate a unified assessment tool.
- Existing indicators do not provide a holistic view of child health status.
- Longitudinal monitoring of child health in India requires a comprehensive index.
Purpose of the Study:
- To develop a single, comprehensive index for longitudinal assessment of child mortality.
- To create a reliable measure reflecting multiple child mortality indicators.
- To enable effective monitoring of child health trends across Indian states.
Main Methods:
- Utilized data from the Sample Registration System (SRS) reports (1972-1988).
- Included five key child mortality indicators: under-five mortality rate (U5MR), infant, neonatal, perinatal, and stillbirth rates.
- Applied a modified factor analysis method to identify underlying mortality factors.
Main Results:
- Factor analysis revealed two primary factors explaining 78%-93% of variation: post-natal and pre/peri-natal mortality.
- A comprehensive index was derived as a linear combination of these factors.
- The index demonstrated significant improvements in child health in Kerala, Punjab, Andhra Pradesh, Gujarat, and Maharashtra.
Conclusions:
- The developed comprehensive index accurately represents child mortality trends.
- This index is suitable for longitudinal monitoring of child health status in India.
- Lower index values correlate with better child health outcomes.
Abstract:
The aim of this study was to develop a single comprehensive index of child mortality for longitudinal assessment of health status of children. The need for such a comprehensive index arose from conflicting trends in different child mortality indicators. The data for the study was taken from the Sample Registration System (SRS) reports of the Registrar General of India. SRS is known to provide reliable estimates of births and deaths at the State and the National level. The study included five child mortality indicators, namely, under five mortality rate (U5MR), infant mortality rate, neonatal mortality rate, perinatal mortality rate and still birth rate. These were available for fifteen states of India over the years 1972-1988. To develop this index we modified an earlier method based on factor analysis. Factor analysis of data on various indicators of child mortality revealed two factors which together explained 78% to 93% of the total variation in different years. The first factor was identified as representing mortality after birth and the second as before and during birth. The comprehensive index was obtained as a linear combination of these two factors. The resultant index thus fairly represented all five mortality indicators and provided a comprehensive and reasonably correct picture of child mortality. The lower the magnitude of this index, the better was the child health status. Trends in the index showed that the highest decline in the magnitude was in the state of Kerala followed by Punjab, Andhra Pradesh, Gujarat and Maharashtra in that order. This indicates steady improvement of the child health status over years in these states. In the State of Jammu and Kashmir, the index remained more or less constant over the years though the magnitude was low in the cross-sectional comparison with other states. Thus the comprehensive index developed by using factor analysis of the various mortality indicators can be used for the longitudinal monitoring of child health status in the states of India.