Of the 5 million children under-5 years who died in 2020, approximately 400,000 died from congenital conditions, representing nearly 8% of total under-5 deaths globally. A large proportion of children with congenital conditions (over 90%) are born in low- and middle-income countries.

A small proportion of these conditions are genetic i.e. chromosomal abnormalities (e.g. Patau’s Syndrome or trisomy 13). Environmental factors like maternal infections (rubella, Zika), exposure to radiation, certain pollutants, maternal nutritional deficiencies (e.g., iodine, folate), illness (maternal diabetes) or certain drugs (alcohol, phenytoin), also increase the risk. The cause of most birth defects is unknown. Complex genetic and environmental interactions are proposed but these have not yet been clearly elucidated.

A focus on these conditions is important now. The proportion of deaths resulting from congenital conditions is increasing and infectious causes of under-5 mortality are falling. Public health prevention measures (like food fortification) are needed as well as ensuring that systems are in place to detect, treat and provide the long-term care that children born with these conditions may require.