Death clustering in India: Levels, trends, and differentials, 1992–2016

Abstract

Background: India and many of its bigger states could not achieve the national goal related with child health based on 4th UN Millennium Development Goal. There is a need to look for different approaches which deal with infant mortality. Literature emphasizes clustering of infant deaths in families has implications on infant mortality. Objective: The present study attempts to examine the levels, trends, and differentials of clustering of infant deaths in families in India using National Family Health Survey (NFHS) dataset and how they changed over the years. Materials and Methods: Study used bivariate analysis and multilevel random effects logit model based intraclass correlation coefficient and median odds ratio to examine the clustering of deaths in families, in India. Results: There has been a consistent decline in both infant mortality rate (IMR) and clustering of infant deaths in families in India between 1992 and 2016. However, the pace of decline was faster after 2005. States such as Uttar Pradesh, Madhya Pradesh, and Bihar are the major contributors in clustering of infant deaths in families. In Kerala, clustering of infant deaths has been disappeared in families while among relatively more developed states such as Maharashtra and Tamil Nadu have experienced a reduction in clustering of infant deaths in families by an amount of <1%. Conclusion: Between NFHS-3 and NFHS-4 there has been an increase in clustering of infant deaths among mothers with age at first birth >30 years and for mothers who have received higher education. IMR can be reduced to a greater extent if government policies and health resources are directed toward the families experiencing the clustering of infant deaths.