An estimated 4.9 million children are expected to die before their fifth birthday in 2024, including 2.3 million newborns, according to new estimates released today. Most of these deaths are preventable with proven, low-cost interventions and access to quality health care.
According to the report – Levels and Trends in Child Mortality – under-five deaths globally have declined by more than half since 2000. However, since 2015, the pace of decline in child mortality has slowed by more than 60 percent.
This year’s report provides the clearest and most detailed picture yet of how many children, adolescents and youth are dying, where they are dying, and – for the first time – fully integrates estimates on the causes of death.
For the first time, the report directly estimates deaths caused by severe acute malnutrition (SAM), finding that more than 100,000 children aged 1-59 months – or 5 percent – are expected to die in 2024. When indirect effects are considered, the death toll is much higher, as malnutrition weakens children’s immunity and increases the risk of dying from common childhood diseases.
Mortality data also often fail to capture SAM as an underlying cause of death, suggesting that the burden is largely underestimated. Some of the countries with the highest number of direct deaths include Pakistan, Somalia and Sudan.
Nearly half of all deaths under the age of five occur in newborns, reflecting slow progress in preventing deaths around the time of birth. The leading causes among newborns were prematurity (36 percent) and complications during labor and delivery (21 percent). Infections, including neonatal sepsis and congenital anomalies, were also important causes.
After the first month, infectious diseases such as malaria, diarrhea and pneumonia were the major killers. Malaria remains the biggest killer in this age group (17 percent) – with most deaths occurring in endemic areas of sub-Saharan Africa. After a sharp decline between 2000 and 2015, progress toward reducing malaria mortality has slowed in recent years. Deaths are concentrated in a handful of endemic countries – such as Chad, the Democratic Republic of the Congo, Niger and Nigeria – where conflict, climate shocks, invasive mosquitoes, drug resistance and other biological threats impact access to prevention and treatment.
Child deaths are concentrated in very few areas. In 2024, 58 percent of deaths among children under five years of age will occur in sub-Saharan Africa. In the region, major infectious diseases were responsible for 54 percent of all deaths under the age of five. In Europe and North America this proportion falls to 9 percent and in Australia and New Zealand it falls further to 6 percent. These stark disparities reflect unequal access to proven, life-saving interventions.
In Southern Asia, where 25 percent of all under-five deaths occur, mortality is primarily due to complications in the first month of life – including preterm delivery, birth asphyxia/trauma, congenital anomalies, and neonatal infections. These largely preventable conditions underline the urgent need for quality prenatal care, skilled health care personnel at birth, care for small and sick newborns, and investment in essential neonatal services.
Fragile and conflict-affected countries continue to bear a disproportionate share of the burden. Children born in these environments are almost three times more likely to die before their fifth birthday than those born in other places.
The report also found that an estimated 2.1 million children, adolescents and youth aged 5-24 died in 2024. Infectious diseases and injuries remain the leading causes of death in young children, while risks change in adolescence: self-harm among girls aged 15–19 and road traffic injuries among boys are the leading causes of death.
Changes in the global development financing landscape are placing increasing pressure on vital maternal, newborn and child health programmes. Surveys, health information systems and the core functions underpinning effective care need continued funding not only to protect progress, but to accelerate it.
Evidence shows that investing in child health is one of the most cost-effective development measures. Proven, low-cost interventions – such as vaccines, treatments for severe acute malnutrition, and skilled care at birth – deliver the highest returns in global health, improving productivity, strengthening economies, and reducing future public spending. Every dollar invested in children’s survival can generate social and economic benefits of up to twenty dollars.
To accelerate progress and save lives, governments, donors and partners must:
- Making child survival a political and financing priority, with a political commitment from high-burden countries to mobilize domestic resources, and improving access to affordable evidence-based, quality services for all;
- Focus on those most at risk, particularly mothers and children in sub-Saharan Africa and Southern Asia, and in conflict and fragile situations;
- Strengthening accountability for existing commitments to reduce maternal, newborn and child deaths, including transparent data collection, tracking and reporting; And
- Invest in primary health care systems to prevent, diagnose, and treat the leading causes of death in children, including community health workers and skilled care at birth.
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UNICEF Executive Director Catherine Russell said, “No child should die from diseases we know how to prevent. But we are seeing worrying signs that progress on child survival is slowing – and at a time when we are seeing further cuts to global budgets.” “History has shown what is possible when the world is committed to protecting its children. With continued investment and political will, we can continue those achievements for future generations.”
“The world has made remarkable progress in saving children’s lives, but too many still die from preventable causes,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “Children living amid conflict and crisis are almost three times more likely to die before their fifth birthday. We must protect essential health and nutrition services and reach the most vulnerable families so that every child has the chance not only to survive, but to thrive.”
“These findings are a collective call to action to accelerate the implementation of proven, scalable solutions that we know are within reach,” said Monique Welker, World Bank Group Director for Health. “The World Bank Group’s health goal of reaching 1.5 billion people is our concrete commitment to accelerate access to quality primary health services for more children and families.”
“The latest estimates from the UN Inter-Agency Group for Child Mortality Estimates are a stark reminder that progress on child survival is slowing and that many countries have lost track of meeting the Sustainable Development Goals,” said Mr Li Junhua, Under-Secretary-General for Economic and Social Affairs. “We know how to prevent these deaths. What is now needed is renewed political commitment, continued investment in primary health care and strong data systems to ensure that no child is left behind.”
“These estimates demonstrate that many deaths of children under five years of age – from causes such as preterm birth, lower respiratory infections, injuries – could be avoided with proven, cost-effective interventions,” says Li Liu, PhD, associate professor at the Johns Hopkins Bloomberg School of Public Health and co-PI of CA-CODE. “The science is clear: targeted investments in primary health care, maternal and newborn health services, routine immunization, nutrition programs, and quality and timely data systems could save millions of lives.”
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