More children under the age of five die in India than in any other country in the world, and from five main causes that are avoidable, a study in India has found.

In a paper published in The Lancet Saturday, the authors named the five causes as pneumonia, prematurity and low birthweight, diarrhoeal diseases, neonatal infections and birth asphyxia, and birth trauma.

“Each of the major causes ... can be prevented or treated with known, highly effective and widely practicable interventions such as improvements in prenatal care,” wrote the researchers, led by the Registrar General of India.

Expanded neonatal and obstetric care, proper management of diarrhoea and pneumonia, and adding new vaccines to immunization programs could substantially reduce child deaths in the country, they added.

Some 2.35 million children under the age of five died in India in 2005, making up more than 20 percent of all deaths in children within that age group worldwide.

Three-fifths, or 62 percent, of the deaths were caused by those five reasons, the researchers said.

Most deaths in India occur at home and without medical attention. In this survey, field workers investigated causes for the deaths of 24,841 children through interviews with their families using a standard questionnaire.

Two of 130 physicians then independently assigned a cause to each death.

The survey found the number of girls who died between one to 59 months was 36 percent higher than boys, and the difference was even more stark in certain places in India.

“Girls in central India had a five-times higher mortality rate from pneumonia than did boys in south India, and had a four-times higher mortality rate from diarrhoeal disease than boys in the west,” they wrote.

They believe the higher number of deaths in girls is due to Indian society’s preference for boys which results in more boys using healthcare facilities than girls.

“Fewer girls than boys are vaccinated in health facilities. However, outreach programs that visit households immunize a greater proportion of girls than do facility-based vaccination programs,” the researchers wrote.

To address this problem, they recommended that vaccines against pneumonia and childhood diarrhoea be added to immunization programs that deliver vaccines directly to peoples’ homes.

(Reporting by Tan Ee Lyn; Editing by Sugita Katyal)