Nepal may be in line to achieve the Sustainable Development Goal on reducing child mortality rate, but the likelihood of child reaching the age of five still varies about three-fold in some districts and provinces, according to a new study.

The detailed study carried out for mapping child deaths from 2000 to 2017 by the Institute for Health Metrics and Evaluation (IHME) suggests that tackling inequality of source distribution could save millions of lives. The institute is an independent global health research organisation at the University Of Washington School Of Medicine.

The study, published on Thursday, shows that 18,698 children died before their fifth birthday in 2017. In 2000, the number was 58,633. The highest mortality rate in 2017 was 57.2 in the districts of Karnali Province, whereas the lowest was 21.3 in the districts of Province 3.

"Study shows hundreds of child deaths can be averted if all districts and provinces rose to the level of best performing districts," Dr Megnath Dhimal, co-author of the study, told the Post. "Without tackling the unequal distribution of the sources, we cannot make further progress to meet health targets."

Along with Nepal, the study was carried out in 99 low and middle-income countries, in which 90 percent of child deaths occurred in 2017.

Nepal has to bring down child mortality to 25 per 1,000 live births to meet the United Nation's Sustainable Development Goal target. The country’s current neonatal mortality rate is 21 per 1,000 live births, and the infant mortality rate is 32 per 1,000 live births. The numbers have remained stagnant for the last several years. Moreover, under-five mortality rate of 39 per 1,000 live births has remained constant since 2016.

Dhimal said that the government and concerned agencies should bring intervention measures to lift social, economic status of remote and backward places.

"Such studies help the government and policymakers to bring targeted intervention measures and change the policies, which are not working properly," Dhimal added.

The report says Nepal significantly decreased inequalities among its districts over the study period.

Child health experts say the country has to do a lot to bring under-five mortality rate down and achieve the United Nations’ health targets.

“Under-five mortality rate and neonatal deaths are still high and disparity among different communities and geographical areas are very high," Dr Atul Upadhyay, senior project manager at Helen Keller International, told the Post. "All concerned agencies should work in a uniformed way to address such disparities."

Costly nutritious foods, poor hygiene conditions, lack of awareness about health, declining breastfeeding practices, and high prevalence of junk and processed foods are among the challenges that should be overcome to reduce the existing child death rate, according to him.

The districts where the child mortality rate was found to have been high are also struggling to find malnutrition, one of the causes of deaths of children.

Malnutrition is a silent crisis in Nepal. The Nepal Demographic Health Survey-2016, shows 60 percent of children under-five in the Karnali region and Solukhumbu district are stunted, which is an indicator of chronic undernutrition. Karnali and Solukhumbu are also the poorest and most food insecure compared to the national average, according to the survey.

The survey states that 36 percent of children under five years of age in the country suffer from chronic malnutrition (stunting or low height-for-weight) and 10 percent suffer from acute malnutrition (wasting or low weight-for-height).

Another 27 percent of children are underweight and one percent are overweight.

According to a UNICEF report published earlier this week, 43 percent of children under the five years of age are either stunted or wasted or overweight and that one in every two Nepali children are eating a poor diet.

Doctors say nutrition deficiency in mothers during pregnancy increases the risk of complications during childbirth and increases the likelihood of maternal and neonatal deaths as well as chances of low birth weight.

Report of the Global Burden of Disease study published recently also shows neonatal disorders were the biggest cause of deaths before the age of five both in 2000 and 2017.

Dr Shyam Raj Upreti, a child health expert, said that the country could have done a lot more in the child health sector.

According to Upreti, the focus of the government and other stakeholders has diverted towards political transition and implementation of three tiers of government.

"Countries like Vietnam and Cambodia have made enormous progress and achieved SDG target in 2017," said Upreti. "We could also have done far better, but the fact is we have been struggling to follow SDG targets."