UPSC MainsMEDICAL-SCIENCE-PAPER-II20172 Marks
Q7.

Mention the important causes of mortality in children under 5 years of age.

How to Approach

This question requires a comprehensive understanding of pediatric health and public health challenges. The answer should be structured around the major causes of under-5 mortality, categorized for clarity (e.g., neonatal, post-neonatal). Include specific diseases, risk factors, and geographical variations. Data from recent reports (UNICEF, WHO, NFHS) should be incorporated to demonstrate awareness of current trends. A focus on preventable causes is crucial.

Model Answer

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Introduction

Under-five mortality (U5MR) remains a significant global health indicator, reflecting the socio-economic conditions and healthcare access within a country. According to UNICEF data (2023), approximately 4.9 million children died before reaching their fifth birthday in 2022. While substantial progress has been made in reducing U5MR over the past decades, disparities persist, particularly in low- and middle-income countries. Understanding the leading causes of these deaths is crucial for designing effective interventions and achieving Sustainable Development Goal 3 (Good Health and Well-being). This answer will detail the important causes of mortality in children under 5 years of age, categorized for clarity.

Neonatal Period (0-28 days)

The neonatal period accounts for a substantial proportion of under-five deaths. Key causes include:

  • Preterm birth complications: Prematurity is a leading cause, contributing to respiratory distress syndrome, infections, and intraventricular hemorrhage.
  • Birth asphyxia and trauma: Lack of oxygen during birth can cause brain damage and death.
  • Neonatal infections: Sepsis, pneumonia, and tetanus are major threats, particularly in settings with poor hygiene and limited access to healthcare.
  • Congenital anomalies: Birth defects affecting the heart, brain, or other organs contribute significantly to neonatal mortality.

Post-Neonatal Period (29 days – 1 year)

After the neonatal period, the causes of mortality shift. Important factors include:

  • Pneumonia: Remains a leading killer, especially in resource-limited settings.
  • Diarrheal diseases: Caused by infections, leading to dehydration and malnutrition. Rotavirus is a common culprit.
  • Malaria: A significant cause of mortality in endemic regions, particularly sub-Saharan Africa.
  • Measles: Despite vaccination efforts, outbreaks still occur, leading to severe complications and death.
  • Malnutrition: Undernutrition weakens the immune system, increasing susceptibility to infections.

1-5 Years

Mortality in this age group is often linked to preventable diseases and injuries:

  • Pneumonia: Continues to be a major cause.
  • Diarrheal diseases: Remain a significant threat.
  • Malaria: Persistent risk in endemic areas.
  • Injuries: Accidents, drowning, burns, and falls are common causes of death.
  • HIV/AIDS: Although declining, remains a concern in certain regions.

Geographical Variations and Risk Factors

The causes of under-five mortality vary significantly by region:

Region Major Causes Specific Risk Factors
Sub-Saharan Africa Malaria, Pneumonia, Diarrhea, HIV/AIDS, Malnutrition Poverty, Limited access to healthcare, Poor sanitation, Conflict
South Asia Pneumonia, Diarrhea, Malnutrition, Neonatal conditions Poverty, Overcrowding, Poor hygiene, Lack of access to clean water
Developed Countries Congenital anomalies, Injuries, Sudden Infant Death Syndrome (SIDS) Socioeconomic disparities, Access to specialized care

Socioeconomic factors play a crucial role. Children from poorer families are more likely to die from preventable causes due to limited access to healthcare, nutrition, and safe living conditions. Maternal health is also a critical determinant; mothers who are malnourished or lack access to antenatal care are more likely to have low-birth-weight babies, increasing the risk of neonatal mortality.

Addressing the Challenges

Effective interventions include:

  • Improving access to quality healthcare: Strengthening primary healthcare systems, training healthcare workers, and ensuring availability of essential medicines.
  • Promoting immunization: Expanding vaccination coverage for preventable diseases like measles, polio, and pneumococcal disease.
  • Improving nutrition: Promoting breastfeeding, providing micronutrient supplementation, and addressing food insecurity.
  • Improving water, sanitation, and hygiene (WASH): Reducing the risk of diarrheal diseases and infections.
  • Strengthening maternal health services: Providing antenatal care, skilled birth attendance, and postnatal care.

Conclusion

Reducing under-five mortality requires a multi-faceted approach addressing both immediate causes of death and underlying socioeconomic determinants. Continued investment in healthcare infrastructure, improved access to essential services, and targeted interventions to address regional disparities are crucial. Furthermore, empowering communities and promoting health education are essential for sustainable improvements in child survival rates. The progress made in recent decades demonstrates that achieving further reductions in U5MR is possible with sustained commitment and effective strategies.

Answer Length

This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.

Additional Resources

Key Definitions

Under-Five Mortality Rate (U5MR)
The number of deaths of children under five years of age per 1,000 live births in a given year.
Sepsis
A life-threatening condition that arises when the body’s response to an infection spirals out of control, leading to tissue damage, organ failure, and death.

Key Statistics

In 2022, an estimated 4.9 million children under the age of five died globally.

Source: UNICEF, 2023

Approximately 70% of all under-five deaths occur in the first year of life.

Source: WHO, 2021 (Knowledge Cutoff)

Examples

The ASHA program in India

The Accredited Social Health Activist (ASHA) program in India utilizes community health workers to provide essential healthcare services, including antenatal care, immunization, and nutrition counseling, contributing to reductions in U5MR.

Frequently Asked Questions

What is the role of breastfeeding in reducing child mortality?

Breastfeeding provides infants with essential nutrients and antibodies, protecting them from infections and reducing the risk of diarrheal diseases and pneumonia. Exclusive breastfeeding for the first six months of life is recommended by WHO and UNICEF.

Topics Covered

MedicinePediatricsPublic HealthChild MortalityInfectious DiseasesPublic Health