Missing the trees for the forest: A survey of sub-district-level mortality pattern in North Bihar, India

Background and Objective: The paucity of knowledge on mortality patterns in a state such as Bihar with its population of 200 million contributes to misdirected planning and prioritization of health expenditure. This study aims to estimate the regional differences in mortality rates between a region in North Bihar and the rest of state and country. Methodology: Using a multi-stage cluster design, 4159 households were interviewed across six Community Development blocks in North Bihar, identifying deaths between the Chhath festivals of 2014 and 2015. The cause of death was assessed by verbal autopsy and coded using the International Classification of Disease 10. Proportionate and specific mortality rates were calculated. Results: Of 229 deaths, only 7% were registered. The epidemiological transition level for the region was 1.12 with an infant mortality rate of 72 per 1000 live births (95% confidence interval [CI] 55.7–88.4) and under-five mortality rate of 93.2 per 1000 live births (95% CI 74.6–111.7). These rates were double that of the state estimates. Among infant deaths, infections predominated over prematurity while in adult deaths diseases of the respiratory system exceed diseases of the circulatory system as seen in the state and country mortality rates. Conclusions: This study indicates that regional mortality patterns widely differ from state and national average estimates. Deaths due to maternal and neonatal conditions along with communicable diseases still predominate over other causes. Obtaining disaggregated information on causes of death by strengthening the vital registration system will bring these variations into focus.