Seasonality of pneumonia mortality among infants in India from 2018 - 2020: a joinpoint analysis.

BACKGROUND

Infant mortality is often considered a key indicator of a country’s overall progress and health development. Pneumonia, the second leading cause of infant deaths, accounts for 16.2% of mortality in this age group. The Sample Registration System (SRS) 2023 reported that India’s Infant Mortality Rate (IMR) declined from 40 per 1,000 live births in 2013 to 25 per 1,000 live births in 2023, reflecting substantial progress. However, further reduction is still required to achieve Sustainable Development Goal 3, which targets a reduction in infant and child mortality. We examined the seasonality of pneumonia mortality among infants during the period 2018 to 2020 in India and in two of its states, namely Himachal Pradesh and Kerala, using the Health Management Information System (HMIS) dataset.

METHODS

We calculated the Pneumonia-Specific Infant Mortality Rate (PSIMR) as the ratio of infant deaths due to pneumonia reported in HMIS to the total number of births reported in HMIS. We carried out joinpoint regression analysis to examine the seasonality of pneumonia mortality.

RESULTS

India’s national mean monthly PSIMRs are considerably higher than Kerala’s, ranging from 36.4 (July) to 66.7 (January), placing it in an intermediate position. Himachal Pradesh experiences the highest mortality rates, with mean monthly PSIMRs ranging from 12.4 (August) to an alarming 107.7 (November). At the national level, the PSIMR declines from January through August and then rises from September to December. In Himachal Pradesh, mortality peaks from December to March, drops from April to August, and then rises again from September to November. At the national level, joinpoint regression showed one joinpoint for each year—2018, 2019, and 2020. The Monthly Percent Change in 2018, from January to June and from June to December, was − 7.23* (CI: −17.52, − 2.77) and 2.49 (CI: −1.08, 15.49), respectively.

CONCLUSIONS

The joinpoint results showed that seasonality exists in India and Himachal Pradesh. Kerala showed some seasonal fluctuation in deaths, but not significantly. These findings offer the government valuable evidence for designing health strategies aligned with the Sustainable Development Goals (SDGs), particularly those aimed at reducing infant and child mortality. CLINICAL TRIAL NUMBER: Not applicable.