India second highest contributor of children under-five deaths worldwide in 2023: Study

About one million children worldwide died before turning five in 2023 due to factors affecting growth, including being underweight, stunted or wasted, with India reporting over 100,000 of these deaths, according to a new study.

Nigeria recorded the highest number of under-five deaths linked to ‘child growth failure’ at 188,000, while the Democratic Republic of Congo ranked third, a step below India, with more than 50,000 deaths, the findings published in The Lancet Child and Adolescent Health journal show.

‘Child growth failure’ increases the risks of death and disability from several diseases, including lower respiratory infections, diarrhoeal diseases, malaria and measles.

The analysis used data from the Global Burden of Disease Study 2023, the latest in the series of assessments that measures health lost due to diseases, injuries and risk factors across 204 countries and territories.

Globally, deaths due to factors affecting child growth have declined from 2.75 million in 2000 to 0.8 million in 2023. However, sub-Saharan Africa and South Asia continue to see substantial and concentrated adverse health effects with more than 600,000 and 165,000 deaths among under-fives, respectively, the researchers estimated.

“The drivers behind child growth failure are complex and cumulative due to feeding issues, food insecurity, climate change, lack of sanitation, or war,” said co-author Bobby Reiner, professor at the University of Washington’s Institute for Health Metrics and Evaluation in the US, which coordinates the Global Burden of Disease study.

“Therefore, no single strategy will improve their health across all regions,” he added.

The authors estimated that “in children younger than five years in 2023, CGF (child growth failure) was associated with 79.4 million DALYs lost (disability-adjusted life years lost) and 880,000 deaths.”

Being underweight accounted for 12 per cent of deaths in this age group, the highest share, followed by wasting (a form of malnutrition) at nine per cent and stunting at eight per cent.

79 per cent of diarrhoeal disease deaths and 53 per cent of lower respiratory infection deaths among under-fives in South Asia were linked to child growth failure. The high-income region in South Asia, which recorded the lowest number of deaths related to growth failure, also saw the lowest fraction of deaths from both causes at about 33 per cent and 35 per cent, respectively.

Most stunted infants show signs of growth failure within the first three months of life, which underscores the importance of interventions before and during pregnancy, the researchers said.

Wasting and stunting can create a destructive loop because stunting increases the risk of future wasting and vice versa, and this cycle worsens as children grow older, they said.

Growth failure in the first few months of life often indicates newborns born too small or too early. In older infancy and early childhood, it might point to other drivers of poor growth like inadequate nutrition, repeated infection or other causes, the team said.