Increased childhood disability and reduced overall child mortality in South Asia

AIM: This study examines temporal trends in childhood disability and under-5 mortality and assesses their association in South Asian countries from 1985 to 2023. METHOD: We conducted an ecological panel study using secondary data from UNICEF, the World Health Organization, and other sources in South Asian countries. The primary outcome was the prevalence trends of childhood disability, mapped against the under-5 mortality rate as the explanatory variable. Temporal patterns were examined using descriptive and trend-based approaches, and associations were assessed using panel regression adjusted for covariates. RESULTS: The mean under-5 mortality rate was 62.8 per 1000 live births and the disability rate was 47.0 per 1000 population. While under-5 mortality declined, childhood disability rates increased across countries, intersecting during 2005 to 2015. Trend analysis showed a significant inverse association between under-5 mortality and childhood disability, which remained in the regression model (coefficient = -0.245, 95% confidence interval = -0.392 to -0.098). Higher disability rates were also associated with increased health expenditure (coefficient = 0.87) and preterm birth rates (coefficient = 0.182). INTERPRETATION: The decline in under-5 mortality in South Asia has been accompanied by increased childhood disability, posing a dual challenge for health care. This underscores the need for integrated policies emphasizing early intervention and support for newborn infants with birth complications.