Who is most at risk?
Children under the age of 5
Substantial global progress has been made in reducing child deaths since 1990. The total number of under-5 deaths worldwide has declined from 12.6 million in 1990 to 5.2 million in 2019. Since 1990, the global under-5 mortality rate has dropped by 59%, from 93 deaths per 1000 live births in 1990 to 38 in 2019. This is equivalent to 1 in 11 children dying before reaching age 5 in 1990, compared to 1 in 27 in 2019.
Although the world as a whole has been accelerating progress in reducing the under-5 mortality rate, difference exist in under-5 mortality across regions and countries. Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, with 1 child in 13 dying before his or her fifth birthday, 20 years behind the world average which achieved a 1 in 13 rate in 1999. Two regions, sub-Saharan Africa and central and southern Asia, account for more than 80 per cent of the 5.2 million under-5 deaths in 2019, while they only account for 52 per cent of the global under-5 population. Half of all under-5 deaths in 2019 occurred in just 5 countries: Nigeria, India, Pakistan, the Democratic Republic of the Congo and Ethiopia. Nigeria and India alone account for almost a third of all deaths.
At the country level, mortality rates for older children ranged from 0.2 to 16.8 deaths per 1000 children aged 5 years. As for children under 5, higher mortality countries are concentrated in sub-Saharan Africa. Countries with the highest number of deaths for 5-to-9-year-olds include India, Nigeria, Democratic Republic of the Congo, Pakistan and China.
Top 10 countries with the highest numbers of deaths (thousands) for children under-5 years, 2019
| Country | Under-five deaths | Lower bound | Upper bound |
| Nigeria | 858 | 675 | 1118 |
| India | 824 | 738 | 913 |
| Pakistan | 399 | 343 | 465 |
| Democratic Republic of the Congo | 291 | 187 | 440 |
| Ethiopia | 178 | 146 | 216 |
| China | 132 | 116 | 152 |
| Indonesia | 115 | 97 | 139 |
| United Republic of Tanzania | 103 | 78 | 172 |
| Angola | 93 | 43 | 172 |
| Bangladesh | 90 | 82 | 99 |
Globally, infectious diseases, including pneumonia, diarrhoea and malaria, along with pre-term birth, birth asphyxia and trauma, and congenital anomalies remain the leading causes of death for children under five. Access to basic lifesaving interventions such as skilled delivery at birth, postnatal care, breastfeeding and adequate nutrition, vaccinations, and treatment for common childhood diseases can save many young lives. Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illness such as diarrhoea, pneumonia, and malaria. Nutrition-related factors contribute to about 45% of deaths in children under-5 years of age.
The patterns of death in older children reflect the underlying risk profiles of this age group, with a shift away from infectious diseases of childhood and towards accidents and injuries, notably drowning and road traffic injuries. The rise of injury deaths changes the nature of interventions to improve older child survival. There is a shift from health sector actions to prevent and treat the infectious diseases of early childhood towards other government sectors including education, transportation and road infrastructure, water and sanitation and law enforcement. All of these need to work together to prevent premature mortality in older children.
Global response: Sustainable Development Goal 3.2.1
The Sustainable Development Goals (SDGs) adopted by the United Nations in 2015 were developed to promote healthy lives and well-being for all children. The SDG Goal 3.2.1 is to end preventable deaths of newborns and under-5 children by 2030. There are two targets:
- Reduce newborn mortality to at least as low as 12 per 1000 live births in every country; and
- Reduce under-5 mortality to at least as low as 25 per 1000 live births in every country.
Target 3.2.1 is closely linked with target 3.1.1, to reduce the global maternal mortality ratio to less than 70 deaths per 100 000 live births, and target 2.2.1 on ending all forms of malnutrition, as malnutrition is a frequent cause of death for under-5 children. These have been translated into the new Global Strategy for Women’s, Children’s and Adolescent’s Health (Global Strategy), which calls for ending preventable child deaths while addressing emerging child health priorities. Member States need to set their own targets and develop specific strategies to reduce child mortality and monitor their progress towards the reduction.
In 2019, 122 countries have met the SDG target for under-5 mortality and a further 20 countries are expected to meet the target by 2030 if current trends continue. However, accelerated progress will be needed in 53 countries, which will not achieve the target by 2030 on current trends. Thirty of these countries will need to double their current rate of reduction and 23 will need to triple their current rate of reduction. Meeting the SDG target would reduce the number of under-5 deaths by 11 million between 2019 and 2030. Focused efforts are still needed in sub-Saharan Africa and South-East Asia to prevent 80 per cent of these deaths.
WHO response
WHO calls on Member States to address health equity through universal health coverage so that all children are able to access essential health services without undue financial hardship. Moving from business as usual to innovative, multiple, and tailored approaches to increase access, coverage, and quality of child health services will require strategic direction and an optimal mix of community and facility-based care. Health sector and multisectoral efforts are also needed to overcome the inequalities and the social determinants of health.