Burden of infectious and associated diseases reducing in India, but still high in northeastern states

Even though burdern of most infectious and associated diseases reduced in India from 1990 to 2016, this burden continues to be higher in eight northeastern states of Assam, Arunachal Pradesh, Meghalaya, Manipur, Tripura, Nagaland, Mizoram and Sikkim and eight north Indian states of Bihar Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh, Uttarakhand [ clubbed as Empowered Action Group ( EAG) states] than in other states of the country. This has been revealed in the “India: Health of the Nation’s States Report 2017” released last month.

The report states that the burden of most infectious and associated diseases reduced in India from 1990 to 2016, but five of the ten individual leading causes of disease burden in India in 2016 still belonged to this group: diarrhoeal diseases, lower respiratory infections, iron-deficiency anaemia, preterm birth complications, and tuberculosis.

"The death rate due to NCDs (Non-Communicable Disease) was over two times that due to CMNNDs (Communicable, maternal, neonatal and nutritional diseases) in India in 2016. The proportion of deaths and the death rates due to CMNNDs were higher in EAG and North-East states group as compared with the Other states group, whereas the proportion of deaths and the death rates due to NCDs were highest in the Other states group. CMNNDs caused the predominant proportion of deaths in the age group 0-14 years in all the states groups. Injuries caused 34%–40% of the deaths in the age group 15-39 years across the three states groups. NCDs were the dominant cause of death in those 40 years or older. The proportion of deaths in the different age groups differed widely across the individual states of India: 3%–19% of total deaths in the 0-14 years age group, 7%–16% in the 15-39 years age group, 35%–44% in the 40-69 years age group, and 30%–52% in those 70 or more years old," adds the report.

Distribution of deaths from major disease groups by age in the state groups, 2016

Unacceptably high risk of child and maternal malnutrition While the disease burden due to child and maternal malnutrition has dropped in India substantially since 1990, this is still the single largest risk factor, responsible for 15% of the total disease burden in India in 2016. This burden is highest in the major EAG states and Assam, and is higher in females than in males. Child and maternal malnutrition contributes to disease burden mainly through increasing the risk of neonatal disorders, nutritional deficiencies, diarrhoeal diseases, lower respiratory infections, and other common infections. As a stark contrast, the disease burden due to child and maternal malnutrition in India was 12 times higher per person than in China in 2016. Kerala had the lowest burden due to this risk among the Indian states, but even this was 2.7 times higher per person than in China. This situation after decades of nutritional interventions in the country must be rectified as one of the highest priorities for health improvement in India.

The report also states that "Unsafe water and sanitation was the second leading risk responsible for disease burden in India in 1990, but dropped to the seventh leading risk in 2016, contributing 5% of the total disease burden, mainly through diarrhoeal diseases and other infections. The burden due to this risk is also highest in several EAG states and Assam, and higher in females than in males. The improvement in exposure to this risk from 1990 to 2016 was least in the EAG states, indicating that higher focus is needed in these states for more rapid improvements. Remarkably, the per person disease burden due to unsafe water and sanitation was 40 times higher in India than in China in 2016. The massive effort of the ongoing Swachh Bharat Abhiyan in India has the potential to improve this situation."

Health status improving, but major inequalities between states Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males. There were, however, continuing inequalities between states, with a range of 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and from 63.6 years in Assam to 73.8 years in Kerala for males in 2016. The per person disease burden measured as DALYs (Disability asociated Life Years)rate dropped by 36% from 1990 to 2016 in India, after adjusting for the changes in the population age structure during this period. But there was an almost two-fold difference in this disease burden rate between the states in 2016, with Assam, Uttar Pradesh, and Chhattisgarh having the highest rates, and Kerala and Goa the lowest rates. While the disease burden rate in India has improved since 1990, it was 72% higher per person than in Sri Lanka or China in 2016. The under-5 mortality rate has reduced substantially from 1990 in all states, but there was a four-fold difference in this rate between the highest in Assam and Uttar Pradesh as compared with the lowest in Kerala in 2016, highlighting the vast health inequalities between the states.

Distribution of deaths from major disease groups by age in the state groups, 2016

( Source : India: Health of the Nation’s States Report, 2017. This report provides the first comprehensive set of findings for the distribution of diseases and risk factors across all states of the country from 1990 to 2016. These findings have been produced by the India State-level Disease Burden Initiative as part of the Global Burden of Disease Study collaboration, utilising all available data identified through an extensive effort involving over 200 leading health scientists and policymakers in India from about 100 institutions.

The India State-level Disease Burden Initiative is a collaboration between the Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation at the University of Washington, and experts and stakeholders currently from close to 100 institutions across India. The goal of this Initiative, which was launched in October 2015, is to produce the best possible state-level disease burden and risk factors trends from 1990 onward as part of the Global Burden of Disease study, utilising all identifiable epidemiological data from India and in close engagement with the leading health scientists of India. The work of this Initiative is approved by the Health Ministry Screening Committee of the Indian Council of Medical Research.)