Under-five deaths have fallen globally by more than half since the year 2000. However, since 2015, the pace of reduction in early childhood mortality has slowed by more than 60%, a new UN report shows. 

The report, co-authored by UNIICEF, WHO and the World Bank, also shows that while great gains have made globally, the overwhelming burden of under-five deaths has now shifted to Sub-Saharan Africa.

The report provides the clearest and most detailed picture to date of how many children, adolescents and youth are dying, and where, said WHO’s Dr Tedros Adhanom Ghebreyesus in a Geneva press briefing on Wednesday.

The report also fully integrates estimates on the causes of death for the first time ever. It found, for instance, that more than 100 000 children aged 1-59 months – or 5% – died from acute severe malnutrition in 2024. 

That is but one reflection of how children in fragile states and conflict zones are far more at risk, and their relative mortality rates far higher. 

Newborn deaths account for nearly half of all under-five deaths, reflecting slower progress in preventing deaths around the time of birth and in the first month thereafter, Tedros said. 

Some 36% of those deaths are due to complications arising from preterm birth, while 21% is due to complications related to labour and delivery.  Infections, including neonatal sepsis and congenital anomalies, were also important causes, the report found.

Based on trends from 2020-2024 the data reflects trends during the pandemic period – but not the more recent impacts of sharp cuts in global health aid seen last year. 

Diarrhoeal and pneumonia remain big killers despite sharp declines   

Beyond the first month, infectious diseases and particularly malaria, diarrhoea, and pneumonia remain the leading killers, the report found. 

This is despite the fact that diarrhoeal deaths have decreased by 75% since the year 2000 – largely as a result of safe drinking water access and better awareness about early interventions. Pneumonia deaths, meanwhile, have declined by 63% due to higher vaccination rates against the most serious bacterial pathogens as well as falling rates of exposures to household air pollution from biomass stoves. These represent the two biggest achievements in terms of early childhood mortality reductions.  

Rates of malaria death have declined by only 41% and malaria is now the single largest killer of under-fives (17%)  – with most deaths occurring in endemic areas of sub-Saharan Africa. Progress in reducing malaria mortality has also slowed significantly after big gains up to 2015. 

Malaria deaths remain concentrated in a handful of endemic countries – such as Chad, the Democratic Republic of the Congo, Niger, and Nigeria – where conflict, climate shocks, invasive mosquitos, drug resistance, and other biological threats continue to affect access to prevention and treatment.

Child deaths heavily concentrated in a small number of regions

In 2024, sub-Saharan Africa accounted for 58% of all under-five deaths and 54% of all deaths of children, adolescents and youths up to age 24. 

That, as compared to representing 38% of those deaths in the year 2000.  

Leading infectious diseases are still responsible for 54% of all under-five deaths in the African Region, as compared to only 9% in Europe and Northern America, and 6% in n Australia and New Zealand. 

“These stark disparities reflect unequal access to proven, life-saving interventions,” states the WHO report. 

Progress in even the poorest states — with political will  

Even so, progress in countries in many of the world’s low- and middle income regions demonstrates what is possible when there is political will, stressed Tedros in his remarks. 

“For example, in 2022 Sierra Leone declared child mortality a national emergency. Since then, almost 1 million children have been screened for malnutrition, and the number of children who have not received any vaccines has been reduced from 15,000 in 2024 to 9000 last year. 

“Likewise, North Macedonia has achieved one of the fastest recent declines globally, cutting neonatal mortality by 87% since 2015 through improvements in emergency obstetric and newborn care.”

“One of the main reasons for the decline in child mortality is immunization. In 1974 only 5% of the world’s children were vaccinated against killer diseases, including measles. Today, that number stands at 85%.” 

He credited the WHO Essential Programme on Immunization (EPI), founded iin 1974, for playing a signifiicant role in that transformation. Building on the momentum of the global smallpox eradication effort, EPI supported countries in setting up national immunization programmes, which were further bolstered by the creation of Gavi, the Vaccine Alliance, in the year 2000, and its rollout of low-cost vaccine procurement programmes. 

 “Since 1974 EPI has helped to save more than 150 million lives from diseases like measles et tetanus, diphtheria and pneumonia,” Tedros said, adding:

“WHO calls on governments, donors and partners to make child survival a political and financial priority, to focus on those at highest risk; to strengthen accountability; and to invest in primary health care so that every child has the chance not just to survive, but to thrive.” 

Image Credits: UNICEF/FrankDejongh, WHO , UNICEF .