Over 3.6 lakh children under age five die from pre-term birth complications each year in India, according to a new study which found premature birth kills more under-fives globally than anything else.
Of the estimated 6.3 million deaths of children under the age of five in 2013, complications from preterm births accounted for nearly 1.1 million deaths, the findings show.
Specifically, direct complications from preterm births accounted for 965,000 deaths during the first 28 days of life, with an additional 125,000 deaths between the ages of one month and five years, according to the findings published in The Lancet journal by a research team coordinated by Robert Black, of the Johns Hopkins Bloomberg School of Public Health.
Other main causes for young child deaths include pneumonia, which killed 935,000 children under-five, and childbirth complications, which caused 720,000 deaths.
"This marks a turning of the tide, a transition from infections to neonatal conditions, especially those related to premature births, and this will require entirely different medical and public health approaches," said Joy Lawn of the London School of Hygiene and Tropical Medicine.
"The success we've seen in the ongoing fight against infectious diseases demonstrates that we can also be successful if we invest in prevention and care for preterm birth," said Lawn.
The countries with the highest numbers of children under-five dying from preterm birth complications each year are: India (361,600), Nigeria (98,300), Pakistan (75,000), Democratic Republic of the Congo (40,600), China (37,200), Bangladesh (26,100), Indonesia (25,800), Ethiopia (24,400), Angola (15,900) and Kenya (13,300).
Some of the highest rates of preterm deaths are in West Africa, particularly in the countries currently being decimated by Ebola, where the risk will now be even higher given the challenges faced in those countries, notably Sierra Leone and Liberia, researchers said.
The 10 countries with the highest%age of under-five deaths directly resulting from preterm birth complications are: Macedonia, 51.0%; Slovenia, 47.5%; Denmark, 43.0%; Serbia, 39.8%; the UK, 38.7%; Hungary, 37.4%; Slovakia, 34.9%; Poland, 34.8%; Republic of Korea and Switzerland, 32.7%.
All of these exceed the global average of 17.4% of under-five deaths, partly because of success in reducing infectious diseases.
"Some 7,600 newborns die daily," said Andres de Francisco, of the Partnership for Maternal, Newborn and Child Health (PMNCH), a coalition of more than 600 partners.
"We have an epidemic of preterm and newborn deaths that represents one of the greatest health challenges of the 21st century. Two-thirds of these deaths could be prevented without intensive care," said Francisco.
