Child death reduction slows as 4.9 million die yearly

GENEVA/NEW YORK – An estimated 4.9 million children died before their fifth birthday in 2024, including 2.3 million newborns, according to new estimates from the United Nations. Most of these deaths are preventable with proven, low-cost interventions and access to quality health care.

The report, Levels & Trends in Child Mortality, found that under-five deaths globally have fallen by more than half since 2000. However, since 2015, the pace of reduction in child mortality has slowed by more than 60 per cent.

This year’s report provides the 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.

The integration was made possible by the UN Inter-agency Group for Child Mortality Estimation (UN IGME) unifying global child mortality and cause-of-death data through estimates from the Child and Adolescent Causes of Death Estimation (CA CODE) group, a research consortium led by the Johns Hopkins Bloomberg School of Public Health.

For the first time, the report estimates deaths directly caused by severe acute malnutrition (SAM), finding that more than 100,000 children aged 1–59 months — or 5 per cent — died from it in 2024. The toll is far greater when indirect effects are considered, as malnutrition weakens children’s immunity and increases their risk of dying from common childhood diseases.

Mortality data also frequently fail to capture SAM as an underlying cause of death, suggesting the burden is likely substantially underestimated. Some of the countries with the highest numbers of direct deaths include Pakistan, Somalia, and Sudan.

Newborn deaths account for nearly half of all under-five deaths, reflecting slower progress in preventing deaths around the time of birth. Leading causes among newborns were complications from preterm birth (36 per cent) and complications during labour and delivery (21 per cent). Infections, including neonatal sepsis and congenital anomalies, were also important causes.

Beyond the first month, infectious diseases such as malaria, diarrhoea, and pneumonia were major killers. Malaria remained the single largest killer in this age group (17 per cent), with most deaths occurring in endemic areas of sub-Saharan Africa.

After steep declines between 2000 and 2015, progress toward reducing malaria mortality slowed in recent years.

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.

In 2024, sub-Saharan Africa accounted for 58 per cent of all under-five deaths. In the region, the leading infectious diseases were responsible for 54 per cent of all under-five deaths. In Europe and Northern America, this proportion drops to 9 per cent, and in Australia and New Zealand, drops further to 6 per cent.

In Southern Asia, which accounted for 25 per cent of all under-five deaths, mortality was driven largely by complications in the first month of life — including preterm delivery, birth asphyxia/trauma, congenital anomalies, and neonatal infections. These largely preventable conditions underscore the urgent need for investing in quality antenatal care, skilled health-care personnel at birth, care of small and sick newborns, and essential newborn services.

Fragile and conflict-affected countries continue to bear a disproportionate share of the burden. Children born in these settings are nearly three times more likely to die before their fifth birthday than those elsewhere.

The report also finds that an estimated 2.1 million children, adolescents, and youth aged 5–24 died in 2024. Infectious diseases and injuries remain leading causes among younger children, while risks shift in adolescence: self-harm is the leading cause of death among girls aged 15–19, and road traffic injuries among boys.

Evidence shows that investments in child health remain among the most cost-effective development measures. Every dollar invested in child survival can generate up to USD 20 in social and economic benefits.

Shifts in the global development financing landscape are placing critical maternal, newborn, and child health programmes under growing pressure.

“No child should die from diseases that we know how to prevent. But we see worrying signs that progress in child survival is slowing – and at a time where we’re seeing further global budget cuts,” said UNICEF Executive Director Catherine Russell.

“History has shown what is possible when the world commits to protecting its children. With sustained investment and political will, we can continue to build on those achievements for future generations.”

“The world has made remarkable progress in saving children’s lives, but many still die from preventable causes,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “Children living amid conflict and crisis are nearly 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 every child has the chance not only to survive, but to thrive.”

“These findings are a collective call to speed up implementation of the proven, scalable solutions we know are within reach,” said Monique Vledder, World Bank Group Director, Health. “The World Bank Group health target of reaching 1.5 billion people is our concrete commitment to accelerating access to quality primary health services for more children and families.”

“The latest estimates from the United Nations Inter-agency Group for Child Mortality Estimation are a stark reminder that progress on child survival is slowing and too many countries are off track to meet the Sustainable Development Goals,” said Under-Secretary-General for Economic and Social Affairs Li Junhua.

“We know how to prevent these deaths. What is needed now is renewed political commitment, sustained investment in primary health care, and stronger data systems to ensure no child is left behind.”

“These estimates demonstrate that many deaths among children under five – from causes such as preterm birth, lower respiratory infections, to injuries – are avoidable with proven, cost effective interventions,” said Li Liu, an 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 programmes, and quality and timely data systems can save millions of lives.”

To accelerate progress and save lives, the report calls on governments, donors, and partners to make child survival a political and financing priority, focus on those at highest risk — especially mothers and children in sub-Saharan Africa and Southern Asia and in conflict and fragile settings — strengthen accountability for existing commitments to reduce maternal, newborn, and child deaths, and invest in primary health care systems to prevent, diagnose, and treat the leading causes of death in children.