Public Health Foundation of India, New Delhi, India.
PLoS One. 2013;8(2):e56285. doi: 10.1371/journal.pone.0056285. Epub 2013 Feb 7.
India is unlikely to meet the Millennium Development Goal for child mortality. As public policy impacts child mortality, we assessed the association of social sector expenditure with child mortality in India.
Mixed-effects regression models were used to assess the relationship of state-level overall social sector expenditure and its major components (health, health-related, education, and other) with mortality by sex among infants and children aged 1-4 years from 1997 to 2009, adjusting for potential confounders. Counterfactual models were constructed to estimate deaths averted due to overall social sector increases since 1997. Increases in per capita overall social sector expenditure were slightly higher in less developed than in more developed states from 1997 to 2009 (2.4-fold versus 2-fold), but the level of expenditure remained 36% lower in the former in 2009. Increase in public expenditure on health was not significantly associated with mortality reduction in infants or at ages 1-4 years, but a 10% increase in health-related public expenditure was associated with a 3.6% mortality reduction (95% confidence interval 0.2-6.9%) in 1-4 years old boys. A 10% increase in overall social sector expenditure was associated with a mortality reduction in both boys (6.8%, 3.5-10.0%) and girls (4.1%, 0.8-7.5%) aged 1-4 years. We estimated 119,807 (95% uncertainty interval 53,409-214,662) averted deaths in boys aged 1-4 years and 94,037 (14,725-206,684) in girls in India in 2009 that could be attributed to increases in overall social sector expenditure since 1997.
Further reduction in child mortality in India would be facilitated if policymakers give high priority to the social sector as a whole for resource allocation in the country's 5-year plan for 2012-2017, as public expenditure on health alone has not had major impact on reducing child mortality.
印度不太可能实现儿童死亡率的千年发展目标。由于公共政策会影响儿童死亡率，因此我们评估了印度社会部门支出与儿童死亡率之间的关系。
采用混合效应回归模型，根据潜在混杂因素，评估了 1997 年至 2009 年期间州级整体社会部门支出及其主要组成部分（卫生、与卫生相关、教育和其他）与 1 至 4 岁婴儿和儿童性别死亡率之间的关系。构建了反事实模型，以估计自 1997 年以来整体社会部门增加所避免的死亡人数。与 1997 年相比，2009 年欠发达州的人均整体社会部门支出增长略高于发达州（2.4 倍对 2 倍），但前者的支出水平仍低 36%。公共卫生支出的增加与婴儿或 1 至 4 岁儿童的死亡率降低没有显著关联，但公共卫生相关支出增加 10%与 1 至 4 岁男童的死亡率降低 3.6%（95%置信区间为 0.2-6.9%）相关。整体社会部门支出增加 10%与 1 至 4 岁男孩（6.8%，3.5-10.0%）和女孩（4.1%，0.8-7.5%）的死亡率降低相关。我们估计，2009 年印度 1 至 4 岁男孩可避免 119807 例（95%不确定性区间为 53409-214662）死亡，女孩可避免 94037 例（14725-206684），这归因于自 1997 年以来整体社会部门支出增加。
如果决策者在印度 2012-2017 五年计划中给予社会部门高度优先重视，作为资源分配的一部分，印度的儿童死亡率将进一步降低，因为仅公共卫生支出对降低儿童死亡率没有重大影响。
