The number of children who died before their fifth birthday has dropped to 2.9 million in 2022, reaching a historic low, according to the latest estimates of under-5 mortality released today by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).  And since 2000, the global under-five mortality rate has declined by more than half.  Under-5 deaths have fallen by half since 1990.

Yet the annual death toll among children, adolescents and youth remains unacceptably high, states the report, published by UNICEF in collaboration with WHO and the World Bank, among others. Of the 4.9 million under-five deaths in 2022, 2.3 million occurred during the first month of life and 2.6 million children died between the ages of 1 and 59 months. There are also broad disparities in rates of child survival by region, with children under-5 facing the greatest risks in sub-Saharan Africa.

A child born in sub-Saharan Africa is on average 18 times more likely to die before turning 5 than one born in the region of Australia and New Zealand, the report found.  The risk of death amongst those younger than 5 in the highest-mortality country is 80 times that of the lowest-mortality country.

Worldwide, children born into the poorest households are twice as likely to die before the age of 5 compared to the wealthiest households, while children living in fragile or conflict-affected settings are almost three times more likely to die before their fifth birthday than children elsewhere.

“The new estimates show that strengthening access to high-quality health care, especially around the time of birth, helps to reduce mortality among children under age 5,” said Li Junhua, United Nations Under-Secretary-General for Economic and Social Affairs in a press release issued jointly by WHO, UNICEF and other UN agencies. “While the milestones in the reduction of child mortality are important to track progress, they should also remind us that further efforts and investments are needed to reduce inequities and end preventable deaths among newborns, children and youth worldwide.”

Studies show that child deaths in the highest-risk countries could drop substantially more if a basic package of interventions is delivered in communities at need.  These include: immunization, clean drinking water, hygiene and sanitation, healthy nutrition, and integrated management of childhood illnesses close to home – including for acute respiratory infections, diarrhoea, and malaria.

At current rates, 59 countries will miss the SDG under-5 mortality target, and 64 countries will fall short of the newborn mortality goal. That means an estimated 35 million children will die before reaching their fifth birthday by 2030—a death toll that will largely be borne by families in sub-Saharan Africa and Southern Asia or in low- and lower-middle-income countries.

Progress slowed between 2015-2022 although some countries outperformed

Additionally, progress in reducing under-five and neonatal mortality slowed between 2015–2022, during the era of the Sustainable Development Goals (SDGs) in comparison to 2000–2015 – the era of the Millennium Development Goals (MDGs). Economic instability, new and protracted conflicts, the intensifying impact of climate change, and the fallout of COVID-19, pose threats that could lead to stagnation or even reversal of gains, the report warns.

On the brighter side, six low-income countries, and 13 lower-middle income countries outperformed their neighbours – reducing under-5 mortality by two-thirds or more.  Among these, Malawi, Rwanda and DPR Korea, reduced under-5 mortality by 75% since 2000, along with four lower middle-income countries, Cambodia, Mongolia, Sao Tome and Principe, and Uzbekistan.

In addition, the low-income countries of Burundi, Ethiopia and Uganda, as well as and nine lower-middle-income countries – Angola, Bhutan, Bolivia, India, Iran, Morocco, Nicaragua, Senegal and the United Republic of Tanzania – have reduced their under-5 mortality rate by more than two thirds since 2000. This reflects the possibility for greater gains at any income level, the report’s authors stressed.

The report, however, also notes large gaps in data, particularly in sub-Saharan Africa and Southern Asia, where the mortality burden remains particularly high. Data and statistical systems must be improved to better track and monitor child survival and health, including indicators on mortality and health via household surveys, birth and death registration through Health Management Information Systems (HMIS), and Civil Registration and Vital Statistics (CRVS), it underlines.

The United Nations Inter-agency Group for Child Mortality Estimation or UN IGME is led by UNICEF and includes the World Health Organization, the World Bank Group and the Population Division of the United Nations Department of Economic and Social Affairs.

Image Credits: UNICEF 2024 , UNICEF , UNICEF 2024.