Preterm birth, intrapartum-related complications (birth asphyxia or lack of breathing at birth), and infections cause most neonatal deaths. From the end of the neonatal period and through the first 5 years of life, the main causes of death are pneumonia, diarrhoea and malaria. Malnutrition is the underlying contributing factor, making children more vulnerable to severe diseases.
The world has made substantial progress in child survival since 1990. The global under-5 mortality rate has dropped by 56 per cent from 93 deaths per 1000 live births in 1990 to 41 in 2016. Nonetheless, accelerated progress will be needed in more than a quarter of all countries, to achieve the Sustainable Development Goal (SDG) target (1) on under-five mortality by 2030. Meeting the SDG target would reduce the number of under-5 deaths by 10 million between 2017 and 2030. Focused efforts are still needed in Sub-Saharan Africa and South East Asia to prevent 80 per cent of these deaths.
Who is most at risk?
2.6 million babies die every year in their first month of life and a similar number are stillborn. Within the first month, up to half of all deaths occur within the first 24 hours of life, and 75% occur in the first week. The 48 hours immediately following birth is the most crucial period for newborn survival. This is when the mother and child should receive quality follow-up care to prevent and treat illness.
Globally, the number of neonatal deaths declined from 5.1 million in 1990 to 2.6 million in 2016. However, the decline in neonatal mortality from 1990 to 2016 has been slower than that of post-neonatal under-5 mortality: 49% compared with 62% globally. The relative decline in the neonatal mortality rate was slower in sub-Saharan Africa. The modest decline in neonatal mortality in this region was offset by an increasing number of births so that the number of neonatal deaths remained almost the same from 1990 to 2016. Moreover, 52 countries need to accelerate progress to reach the SDG target of a neonatal mortality rate of 12 deaths per 1000 live births by 2030.
Prior to birth, a mother can increase her child's chance of survival and good health by attending antenatal care consultations, being immunized against tetanus, and avoiding smoking and use of alcohol.
At the time of birth, a baby's chance of survival increases significantly with delivery in a health facility in the presence of a skilled birth attendant. After birth, essential care of a newborn should include:
- ensuring that the baby is breathing;
- starting the newborn on exclusive breastfeeding right away;
- keeping the baby warm; and
- washing hands before touching the baby.
Identifying and caring for illnesses in a newborn is very important, as a baby can become very ill and die quickly if an illness is not recognized and treated appropriately. Sick babies must be taken immediately to a trained health care provider.
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 5.6 million in 2016 – 15 000 every day compared with 35 000 in 1990. Since 1990, the global under-5 mortality rate has dropped 56%, from 93 deaths per 1 000 live births in 1990 to 41 in 2016.
Although the world as a whole has been accelerating progress in reducing the under-5 mortality rate, disparities 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. Inequity also persists within countries geographically or by social-economic status. The latest mortality estimates by wealth quintile show that in 99 low and middle income countries (2), under-5 mortality among children born in the poorest households is on average twice that of children born in the wealthiest households. Eliminating this gap between mortality in the poorest and wealthiest households would have saved 2 million lives in 2016.
More than half of under-5 child deaths are due to diseases that are preventable and treatable through simple, affordable interventions. Strengthening health systems to provide such interventions to all children will 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.
Leading causes of death in post-neonatal children: risk factors and response
|Cause of death||Risk factors||Prevention||Treatment|
|Pneumonia, or other acute respiratory infections||Low birth weight
Reduction of household air pollution
Appropriate care by a trained health provider
Oxygen for severe illness
|Childhood diarrhoea||Non-breastfed children
Unsafe drinking water and food
Poor hygiene practices
Safe water and food
Adequate sanitation and hygiene
Low-osmolarity oral rehydration salts (ORS)
Prevention with vaccines
Vaccines are available for some of the most deadly childhood diseases, such as measles, polio, diphtheria, tetanus, and pertussis, pneumonia due to Haemophilius influenzae type B and Streptococcus pneumonia and diarrhoea due to rotavirus. Vaccines can protect children from illness and death.
Emerging priorities for children’s health
Congenital anomalies, injuries, and non-communicable diseases (chronic respiratory diseases, acquired heart diseases, childhood cancers, diabetes, and obesity) are the emerging priorities in the global child health agenda. Congenital anomalies affect an estimated 1 in 33 infants, resulting in 3.2 million children with disabilities related to birth defects every year. The global disease burden due to non-communicable diseases affecting children in childhood and later in life is rapidly increasing, even though many of the risk factors can be prevented.
Injuries (including road traffic injuries, drowning, burns, and falls) rank among the top causes of death and lifelong disability among children aged 5-14 years. The patterns of death in older children and adolescents reflect the underlying risk profiles of the age groups, with a shift away from infectious diseases of childhood and towards accidents and injuries, notably drowning and road traffic injuries for older children and adolescents.
Similarly, the worldwide number of overweight children increased from an estimated 31 million in 2000 to 42 million in 2015, including in countries with a high prevalence of childhood undernutrition.
Global response: Sustainable Development Goal 3
The Sustainable Development Goals (SDGs) adopted by the United Nations in 2015 aim to ensure healthy lives and promote well-being for all children. The SDG goal 3 target 3.2 is to end preventable deaths of newborns and under-5 children by 2030. These are two targets:
- reduce newborn mortality to at least as low as 12 per 1 000 live births in every country (SDG 3.2); and
- reduce under-five mortality to at least as low as 25 per 1,000 live births in every country (SDG 3,2).
Target 3.2 is closely linked with target 3.1, to reduce the global maternal mortality ratio to less than 70 deaths per 100 000 live births, and target 2.2 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.
The plan to achieve the SDG targets, has been translated into several global initiatives (3). Member States need to set their own targets and develop specific strategies to reduce child mortality and monitor their progress towards the reduction.
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.
(1) Reduce under-five mortality to at least as low as 25 per 1,000 live births in every country
(2) Based on World Bank classification of world economies according to estimates of gross national income per capita (GNI)
(3) Global initiatives include: Ending Preventable Maternal Mortality, Every Newborn Action Plan, the Global action Plan for the Prevention and Treatment of Pneumonia and Diarrhoea, the Comprehensive Implementation Plan on Maternal, and Infant and Young Child Nutrition", Global Technical Strategy for Malaria, Global Vaccine Action Plan, and the United Nations Decade of Action on Nutrition 2016–2025