Patterns and determinants of child mortality in India: a multistate analysis using National Family Health Survey data

Background: This paper, utilizing data from several rounds of the National Family Health Survey, investigated long-term differentials in child mortality rates across caste groups and seeked to identify the principal determinants of child survival. Methods: Trends in child mortality rates were analyzed by using all five rounds of NFHS. Survival analysis and regression analysis were performed by using NFHS-5 (2019-2021). The study included children aged 1-59 months born in the five years preceding the survey, excluding infant deaths. Kaplan-Meier survival analysis, log-rank tests, and binary logistic regression models were used, taking into account the survey design. State-level analysis was performed for Uttar Pradesh, Madhya Pradesh, and Maharashtra. Results: At the national level, the rate of child mortality was highest among Scheduled Tribes (9.03 per 1,000), followed by Scheduled Castes (8.58 per 1,000), compared with non-SC/ST children (6.04 per 1,000). The survival analysis revealed significant caste differentials in child survival (χ2=28.47, p<0.001), with the gap increasing at older ages of childhood. In unadjusted regression models, Scheduled Castes (OR=1.38; 95% CI: 1.16-1.65) and Scheduled Tribes (OR=1.56; 95% CI: 1.32-1.85) had significantly higher odds of child mortality. These associations were reduced and rendered non-significant after adjusting for proximate determinants, indicating mediation by maternal and health-related variables. Maternal education had a strong protective effect, with higher education being associated with significantly lower odds of child mortality (OR=0.27). Conclusions: Although there has been a steady decline in child mortality rates across NFHS cycles, caste and geographic inequities in India.