Factors Associated with Under-Five Mortality: A Comparison between Empowered Action Group (EAG) and Non-EAG States of India

Background: In India under-five mortality (U5MR) has declined by 71% from 126 to 37 deaths per 1000 live births between 1990 and 2018. The Empowered Action Group (EAG) states accounts for 74% of the under-five deaths as compared to 26% among Non-EAG states. Method: National Family Health Survey round fourth (NFHS-4), 2015-16 was used for this study. A life table method and Cox Proportional Hazard (PH) model was used to examine the various factors associated with U5MR in EAG and Non-EAG states of India. Result: Overall, it was observed that U5MR is much higher in EAG compared to Non-EAG states. Absolute difference varies according to background characteristics. The highest difference was among mothers who had never breastfed (316 vs 150 U5MR per 1000 live births in EAG & Non-EAG states respectively). Factors—total children ever born to mother, household members, children never breastfed and size of the baby were found to be statistically significantly associated with under-five mortality after controlling for other factors in both EAG and Non-EAG states. Hazard of U5MR was two and half-times higher among birth order 4+ (AHR = 2.5, 95% CI = 1.8 - 3.3) compared to birth order ≤2 after controlling for other factors in EAG states. The risk of under-five mortality was found three times higher among mother having up to primary or no education (AHR = 2.9, 95% CI = 1.4 - 5.9) compared to mother having higher education in non-EAG states. Conclusion: The study revealed that both groups of states need health program interventions focused on high risk mothers, TT immunization and promoting basic health services and breastfeeding practices for the reduction U5MR.