The global under-five mortality rate declined by 59 per cent, from 93 deaths per 1,000 live births in 1990 to 39 in 2018. Despite this considerable progress, improving child survival remains a matter of urgent concern. In 2018 alone, roughly 15,000 under-five deaths occurred every day, an intolerably high number of largely preventable child deaths.
Most regions in the world and 148 out of 195 countries at least halved their under-five mortality rate from 1990-2018. Among all countries, more than a 40 per cent (81) cut their under-five mortality by at least two-thirds over this same period – 31 of them are low- or lower-middle-income countries, indicating that, while the burden of child mortality is unevenly distributed throughout the world, improving child survival is possible even in resource-constrained settings.
More than 80 countries reduced their under-five mortality rates by at least two-thirds from 1990 levels.
Children continue to face widespread regional and income disparities in their chances of survival. Sub-Saharan Africa continues to be the region with the highest under-five mortality rate in the world—78 deaths per 1,000 live births. In 2018, 1 in 13 children in sub-Saharan Africa died before reaching her or his fifth birthday—15 times higher than the risk for children born in high-income countries. Disparities in child survival abound at the country level as well where the risk of dying before age five for a child born in the highest mortality country is about 70 times higher than in the lowest mortality country, and all six countries with mortality rates above 100 deaths per 1,000 live births are in sub-Saharan Africa.
With shifting demographics, the burden of child deaths in heaviest in sub-Saharan Africa. Approximately 82 per cent of all under-five deaths in the world occur in just two regions: sub-Saharan Africa (54 per cent) and South Asia (28 per cent). Due to growing child populations and a shift of the population distribution towards high-mortality regions, the share of global under-five deaths that occur in sub-Saharan Africa increased from 31 per cent in 1990 to 54 per cent in 2018 and is expected to increase even further in the next few decades.
The highest national under-five mortality rates are found in sub-Saharan Africa
Ending preventable child deaths worldwide will require targeted interventions to the age-specific causes of death among children and young adolescents. Despite strong advances in fighting childhood illnesses, infectious diseases, which disproportionately affect children in poorer settings, remain highly prevalent, particularly in sub-Saharan Africa. Globally, pneumonia, diarrhoea and malaria remain among the leading causes of death among children under age 5 – accounting for almost a third of global under-five deaths. The leading causes of death among children under age 5 in 2018 included preterm birth complications (18 per cent), pneumonia (15 per cent), intrapartum-related events (13 per cent), congenital abnormalities (9 per cent), diarrhoea (8 per cent), neonatal sepsis (7 per cent) and malaria (5 per cent).