Overview

In 2008, 8.8 million children born alive across the world died before their fifth birthday. Most of these children lived in developing countries and died from a disease or a combination of diseases that could easily have been prevented or treated. Undernutrition contributes to over a third of these deaths.
 
Millennium Development Goal 4 (MDG 4) aims, by 2015, to reduce by two-thirds the mortality rate among children under-5. According to the new estimates generated by the Inter-agency Group for Child Mortality Estimation (IGME), overall, substantial progress has been made towards the achievement of MDG 4. In 2008, 10,000 fewer children under age five died every day than in 1990, the baseline year for the MDGs. Moreover, the rate of decline in under-five mortality increased for the period 2000 to 2008 compared with the 1990s (the average annual rate of decline for 2000-2008 is 2.3% compared with 1.4% for 1990-2000).

        Significant declines in under-five mortality rates between 1990 and 2008 in all regions

                 Under-five mortality rates and under-five deaths: levels and trends, 1990-2008

However, the rate of decline in under-five mortality is still grossly insufficient to reach the MDG goal by 2015, particularly in sub-Saharan Africa and South Asia. It is alarming that among the 67 countries with high mortality rates (40 per 1,000 or more), only ten are on track to meet MDG 4.

                                                                 Progress towards MDG 4

In addition, under-five mortality is increasingly concentrated: 75% of the world’s under-5 deaths in 2008 occurred in only 18 countries. Half of the deaths occurred in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. India and Nigeria together account for nearly one-third of the total number of under-5 deaths worldwide (21% and 12%, respectively). Africa and Asia combined represent 93% of all under-5 deaths (51% and 42%, respectively).

Regional distribution of the 8.8 million children who died before they reached their fifth birthday in 2008 (in millions)

The sum of the number of deaths by region is not equal to 8.8 million due to rounding. CEE/CIS-Central and Eastern Europe/Commonwealth of Independent States.

Child mortality is closely linked to poverty. Advances in infant and child survival have come more slowly in poor countries and to the poorest people in wealthier countries. Improvements in public health services are essential, including safe water and better sanitation. Education, especially for girls and mothers, will also save children's lives. Raising income can help, but little will be achieved unless a greater effort is made to ensure that services reach those who need them most.

Child mortality is higher among children living in rural areas and in the poorest households
Under-five mortality rate (per 1,000 live births) by background characteristics (1998–2006)

Just five diseases – pneumonia, diarrhoea, malaria, measles and AIDS – account for half of all under-five deaths. Pneumonia and diarrhoeal diseases together account for 37 per cent of all deaths in children under five. Most of these lives could be saved by expanding low-cost prevention and treatment measures. These include antibiotics for acute respiratory infections, oral rehydration for diarrhoea, immunization, and the use of insecticide-treated mosquito nets and appropriate drugs for malaria. Ensuring proper nutrition is part of prevention, because malnutrition increases the risk of dying from these diseases.

                                             Causes of death among children under age five

References

D. You, T. Wardlaw, P. Salama, G. Jones, Levels and trends in under-5 mortality, 1990–2008, The Lancet, 2009, DOI:10.1016/S0140-6736(09)61601-9

UNICEF, The State of the World’s Children Special Edition: Celebrating 20 Years of the Convention on the Rights of the Child