Neonatal encephalopathy in India: spatiotemporal variations in declining mortality.

BACKGROUND

United Nations Sustainable Development Goals (SDGs) target reduction of global neonatal and infant mortality. We examined trends in both neonatal/overall infant mortality (NMR/IMR) and those related to neonatal encephalopathy (NE) for India.

METHODS

NE mortality data (1990-2019), stratified by age (0-6 days, 7-27 days) and location, were sourced from the Global Health Data Exchange. Birth cohort data were obtained from the UN Population Prospects. NE-NMR trends were analyzed using joinpoint regression to estimate annual percent change (APC) and average APC (AAPC). Pearson correlation assessed relationships between NE-NMR and sociodemographic index (SDI) or composite coverage index (CCI).

RESULTS

Of 811 million live births (1990-2019), 4.3 million deaths (uncertainty interval [UI]: 3.6-5.3 million) were NE-related. NE-NMR declined from 6.7 to 3.5 (47.5%, AAPC: -2.2%)], while all-cause NMR and IMR declined from 57.3 to 21.6 (62.6%; AAPC: -3.3%) and from 83.2 to 29.9 (64.1%, AAPC: -3.5%) per 1000 livebirths, respectively. NE-NMR correlated inversely with SDI (R² = 0.57, p < 0.01) but not with CCI (R² = 0.08, p = 0.13). Regional disparities persisted.

CONCLUSIONS

NE-related neonatal mortality declines, though significant, lags overall neonatal and infant mortality improvements. Sustained, focused and community-oriented efforts are critical to closing these disparities to meet India's SDG targets.

IMPACT

India has achieved significant reductions in neonatal encephalopathy (NE) and all-cause neonatal mortality over the past three decades. From 1990 to 2019, infant mortality rate (IMR) declined from 83 to 29 per 1000 livebirths though NE's share of IMR increased from 8% to 11.8%. Significant interstate variations in NE mortality persist, highlighting the need for targeted state-specific healthcare strategies. NE mortality strongly correlates with sociodemographic development, reflecting the critical role of broad social and economic progress. Strategic and sustained investments in healthcare systems are vital to closing data gaps, reducing disparities, and achieving single-digit neonatal mortality rates by 2030.