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Original article Geospatial analysis of neonatal mortality in North-eastern India: a multilevel Bayesian approach
Vidhi Jain1orcid , Kh. Jitenkumar Singh2orcid , Deboshree Das3orcid , Shefali Gupta4orcid , Gunjan Singh5orcid
Epidemiol Health 2025;e2025021
DOI: https://doi.org/10.4178/epih.e2025021 [Accepted]
Published online: April 27, 2025
1Amity School of Applied Sciences, Amity University, Lucknow, Uttar Pradesh, India, Lucknow, India
2Scientist E, Indian Council of Medical Research New Delhi, India, New Delhi, India
3Indian Council of Medical Research- NIRDHDS, New Delhi, India, New Delhi, India
4Indian Council of Medical Research- NIRDHDS, New Delhi, India, New Delhi, India
5Assistant Professor, Amity School of Applied Sciences, Amity University, Lucknow, Uttar Pradesh, India, Lucknow, India
Corresponding author:  Vidhi Jain,
Email: vidhijain2320@gmail.com
Received: 6 January 2025   • Revised: 9 April 2025   • Accepted: 11 April 2025
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Abstract

OBJECTIVES
Neonatal mortality remains a significant public health issue in India. This study investigates spatial patterns and contributing factors to neonatal mortality in the north-eastern states, identifying hotspot regions and spatial variations.
METHODS
A sample of 34,222 mothers from NFHS-5 (2019–21) in the north-eastern states was analysed. Descriptive and bivariate analyses were conducted alongside Bayesian multilevel logistic regression using Integrated Nested Laplace Approximation (INLA) to model neonatal mortality. Spatial hotspot analysis using Getis-Ord Gi* statistics identified clusters of high neonatal mortality, while geographically weighted regression (GWR) was used to examine spatial variations in the relationships between neonatal mortality and contributing factors.
RESULTS
The neonatal mortality rate in the north-eastern states declined from 45 to 21 per 1,000 live births (NFHS-1 to NFHS-5) but remains higher than the national average. Assam reported the highest mortality (42.16%), whereas Sikkim had the lowest (0.87%). Higher mortality was observed among male infants, mothers with advanced age, low maternal education, and mothers who attended less than 5 antenatal care (ANC) visits. Spatial analysis identified hotspots in Assam, Meghalaya, and Tripura. GWR indicated that areas with less than 5 ANC visits had the strongest association with neonatal mortality. Bayesian multilevel analysis highlighted spatial variations of up to 51% across districts in northeast India.
CONCLUSIONS
This study underscores spatial disparities in neonatal mortality across north-eastern India. Addressing childcare practices and healthcare access in hotspot regions is essential for improving new-born health outcomes. The findings provide critical insights for policymakers to develop targeted interventions aimed at reducing neonatal mortality in these underserved areas.

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