Child Mortality Drops as Childhood Disability Rises in South Asia

Over the past few decades, South Asia has witnessed a significant decline in the mortality rate of children under the age of five. However, alongside this positive advancement, a concerning trend has emerged: the number of children living with disabilities is steadily rising.

A recently published study reveals that as child mortality rates decrease, the prevalence of childhood disability increases, presenting a new and dual challenge for regional healthcare systems.

Published in the prestigious journal Developmental Medicine & Child Neurology, the study was conducted by a team of domestic and international researchers led by Dr. Md. Nuruzzaman Khan, an Associate Professor in the Department of Population Science at Jatiya Kabi Kazi Nazrul Islam University.

Dr. Khan also serves as a Senior Research Fellow at the University of Melbourne. The study analyzed data from various South Asian countries spanning from 1985 to 2023.

The research utilized data from six countries: Bangladesh, India, Pakistan, Nepal, Sri Lanka, and Afghanistan. By analyzing data from UNICEF, the World Health Organization (WHO), the World Bank, various surveys, research articles, and international databases, the researchers explored the correlation between declining child mortality and the rise of childhood disability.

Significant Decline in Child Mortality
The study shows that the mortality rate for children under five in South Asia has dropped remarkably over the past three decades. In 1990, the region recorded 126 deaths per 1,000 live births; by 2022, this figure fell to 37. This marks an approximate 70 percent reduction in child mortality during this period.

According to the researchers, improved public healthcare systems, expanded immunization programs, advancements in maternal health, better nutrition, access to clean water, and socioeconomic development played pivotal roles in this success.

The analysis revealed that between 1985 and 2023, the average under-five mortality rate was 62.8 per 1,000 live births. Conversely, an average of 47 out of every 1,000 children under the age of 18 are currently living with a disability.

The Inverse Relationship
The findings indicate that while child mortality fell, the disability rate climbed, with the two trends intersecting between 2005 and 2015.

Since 2010, the population of children with disabilities began rising at a faster rate than the decline in child mortality. This trajectory was observed across Bangladesh, India, Pakistan, Nepal, Sri Lanka, and Afghanistan, with minor variations in timing.

A significant inverse correlation was established between child mortality and childhood disability. Statistical analysis indicates that for every single-unit decrease in the child mortality rate, the prevalence of childhood disability rose by 0.245 units.

Furthermore, increases in healthcare expenditure and preterm birth rates were also linked to rising disability rates.

A single-unit increase in healthcare spending correlated with a 0.87-unit rise in the disability rate, while a rise in preterm births was associated with a 0.182-unit increase.

Researchers note that due to modern medical advancements and improved neonatal care, many infants who previously would have succumbed to premature birth, birth asphyxia, infections, congenital defects, or other complications are now surviving.

However, a portion of these survivors faces long-term physical and developmental challenges. Consequently, while child mortality is decreasing, the number of children with disabilities is growing.

Regional and Global Context
According to the World Health Organization, approximately 240 million children worldwide live with disabilities, a vast majority of whom reside in Asian and African nations.

The study points out that nearly 14 percent of individuals under the age of 18 in South Asia live with some form of disability. Among these, cerebral palsy, intellectual disabilities, hearing and visual impairments, and autism spectrum disorders are the most prevalent.

Key risk factors driving childhood disability in the region include malnutrition, consanguineous marriages (marriage between close relatives), infections, lack of timely prenatal and postnatal care, limited utilization of maternal healthcare services, and the early onset of non-communicable diseases.

The researchers highlighted that while advanced medical care ensures the survival of many preterm babies, these infants remain at a higher risk for developmental complications, including cerebral palsy, intellectual disabilities, and sensory issues. This issue is compounded in South Asian countries by a severe lack of adequate follow-up care, early intervention, and rehabilitation services.

The study also noted that improvements in healthcare infrastructure, advanced diagnostic methods for identifying disabilities, enhanced training for clinicians, and rising public awareness have led to higher detection rates for conditions like autism and intellectual disabilities. This increased diagnostic capacity contributes to the visible rise in statistics.

Malnutrition and Existing Challenges
Malnutrition remains a monumental hurdle in South Asia. Currently, nearly one-third of the children in this region suffer from stunting, which negatively impacts their physical and cognitive development and heightens long-term health risks.

Additionally, financial constraints in low-income families regarding healthcare access, delayed diagnoses, and a lack of treatment options further exacerbate the risk of permanent disability. Genetic factors, environmental influences, and consanguineous marriages remain contributing elements.

However, the researchers urged caution, noting certain limitations in determining the exact scale of childhood disability due to varying data collection methodologies over the decades.

Many developing nations still lack reliable disability surveillance systems. Therefore, the findings should be interpreted as a significant trend rather than a direct cause-and-effect relationship.

Conclusion
The study concludes that the reduction in child mortality is a monumental achievement for South Asia. However, the concurrent rise in childhood disability introduces a fresh public health challenge.

To counter this situation, the researchers have called for integrated policy frameworks that prioritize disability prevention, early detection, timely intervention, rehabilitation, and long-term support services.