Dr Akansha Singh akansha.singh@durham.ac.uk
Assistant Professor
Continuities and changes in spatial patterns of under-five mortality at the district level in India (1991–2011)
Singh, Akansha; Masquelier, Bruno
Authors
Bruno Masquelier
Abstract
Background India has the largest number of under-five deaths globally, and large variations in under-five mortality persist between states and districts. Relationships between under-five mortality and numerous socioeconomic, development and environmental health factors have been explored at the national and state levels, but the possible spatial heterogeneity in these relationships has seldom been investigated at the district level. This study seeks to unravel local variation in key determinants of under-five mortality based on the 1991 and 2011 censuses. Methods Using geocoded district-level data from the last two census rounds (1991 and 2011) and ordinary least squares and geographically weighted regressions, we identify district-specific relationships between under-five mortality rate and a series of determinants for two periods separated by 20 years (1986–1987 and 2006–2007). To identify spatial groupings of coefficients, we perform a cluster analysis based on t-values of the geographically weighted regression. Results The geographically weighted regression analysis shows that relationships between the under-five mortality rate and factors for socioeconomic, development, and environmental health factors vary spatially in terms of direction, strength, and extent when considering: female literacy and labor force participation; share of scheduled castes and scheduled tribes; access to electricity; safe water and sanitation; road infrastructure; and medical facilities. This spatial heterogeneity is accompanied by significant changes over time in the roles that these factors play in under-five mortality. Important local determinants of under-five mortality in 2011 were female literacy, female labor force participation, access to sanitation facilities and electricity; while the key local determinants in 1991 were road infrastructure, safe water, and medical facilities. We identify six different clusters based on geographically weighted regression coefficients that broadly encompass the same districts in both periods; but these clusters do not follow the regional boundaries suggested by the previous studies. In particular, the high mortality states of India that are often typically classified as high focus states were classified into three different clusters based on the relationship of the factors associated with under-five mortality. Conclusion This study demonstrates the utility of combining geographically weighted regression and cluster analyses as a methodological approach to study local-level variation in public health indicators, and it could be applied in any country using aggregate-level information from census or survey data. Identifying local predictors of under-five mortality is important for designing interventions in specific districts. Additional reduction in under-five mortality will only be possible with intervention programs designed at the local level, which take into consideration local level determinants of under-five mortality.
Citation
Singh, A., & Masquelier, B. (2018). Continuities and changes in spatial patterns of under-five mortality at the district level in India (1991–2011). International Journal of Health Geographics, 17(1), https://doi.org/10.1186/s12942-018-0159-3
Journal Article Type | Article |
---|---|
Acceptance Date | Nov 9, 2018 |
Online Publication Date | Nov 15, 2018 |
Publication Date | 2018 |
Deposit Date | Oct 11, 2019 |
Publicly Available Date | Jan 8, 2021 |
Journal | International Journal of Health Geographics |
Electronic ISSN | 1476-072X |
Publisher | BioMed Central |
Peer Reviewed | Peer Reviewed |
Volume | 17 |
Issue | 1 |
DOI | https://doi.org/10.1186/s12942-018-0159-3 |
Public URL | https://durham-repository.worktribe.com/output/1318112 |
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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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