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 1,000 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-five deaths in 2019, while they only account for 52 per cent of the global under-five population. Half of all under-five deaths in 2019 occurred in just five 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 1,000 children aged 5 years. As for children under five, 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.