An estimated 4.9 million children will die before their fifth birthday in 2024, including 2.3 million newborns, according to new estimates released today. Most of these deaths are preventable through proven, low-cost interventions and access to quality health care.
The number of deaths of children under five worldwide has more than halved since 2000, according to the report Levels and Trends in Child Mortality. However, since 2015, the pace of decline in child mortality rates has slowed by more than 60%.
This year’s report provides the clearest and most detailed picture yet of how many children, adolescents and young people are dying and where, and for the first time fully integrates estimates of cause of death.
For the first time, the report estimates the number of deaths directly attributable to severe acute malnutrition (SAM) and finds that more than 100,000 children (5%) between the ages of 1 and 59 months will die from SAM in 2024. The toll is far greater when indirect effects are taken into account, as malnutrition weakens children’s immune systems and increases their risk of dying from common childhood diseases.
Additionally, mortality data often do not capture SAM as the underlying cause of death, suggesting that the burden is likely to be significantly underestimated. Countries with the highest number of direct deaths include Pakistan, Somalia, and Sudan.
Neonatal deaths account for almost half of all deaths under the age of five, reflecting delays in preventing deaths at birth. The main causes for newborns were complications from preterm birth (36%) and intrapartum and delivery complications (21%). Infectious diseases such as neonatal sepsis and congenital abnormalities were also important causes.
After the first month, infectious diseases such as malaria, diarrhea, and pneumonia were the main killers. Malaria remains the biggest killer in this age group (17%), with most deaths occurring in endemic areas in sub-Saharan Africa. After a sharp decline between 2000 and 2015, progress towards reducing malaria mortality has slowed in recent years. Deaths remain concentrated in a few endemic countries, including Chad, the Democratic Republic of the Congo, Niger and Nigeria, where conflict, climate change, invasive mosquitoes, drug resistance and other biological threats continue to impact prevention and access to treatment.
Child deaths remain concentrated in a few areas. In 2024, sub-Saharan Africa will account for 58% of all under-five deaths. In this region, major infectious diseases were responsible for 54% of all under-five deaths. In Europe and North America, this rate drops to 9 percent, and in Australia and New Zealand it falls further to 6 percent. These clear disparities reflect unequal access to proven life-saving interventions.
In South Asia, which accounts for 25% of all under-five deaths, the main causes of mortality were complications during the first month of life, including preterm birth, birth asphyxia/trauma, congenital abnormalities, and neonatal infections. These largely preventable conditions highlight the need for high-quality antenatal care, skilled health workers at birth, care for small and sick newborns, and urgent investment in essential neonatal services.
Fragile and conflict-affected countries continue to bear a disproportionate burden. Children born in these environments are almost three times more likely to die before their fifth birthday than children in other areas.
The report also reveals that an estimated 2.1 million children, adolescents and young people aged 5 to 24 years will have died in 2024. While infections and injuries remain the leading cause of death in younger children, risks change during adolescence, with self-harm becoming the leading cause of death for girls aged 15 to 19, and road injuries becoming the leading cause of death for boys.
The changing global development funding environment has placed critical maternal and child health programs under increasing pressure. Research, health information systems, and the core capabilities that support effective care all require sustained funding to not only protect the progress made, but also accelerate it.
Evidence shows that investing in children’s health remains one of the most cost-effective development tools. Proven, low-cost interventions, such as vaccines, treatment of severe acute malnutrition, and skilled care at birth, have the highest benefits for global health, increasing productivity, strengthening economies, and reducing future public spending. Every dollar invested in a child’s survival can generate up to $20 in social and economic benefits.
To accelerate progress and save lives, governments, donors and partners must:
- Make child survival a political and financial priority through the political commitment of high-burden countries to mobilize domestic resources and improve universal access to affordable, evidence-based, quality services.
- The focus will be on those most at risk, particularly mothers and children in sub-Saharan Africa and South Asia, and in conflict and fragile situations.
- Strengthen accountability for existing efforts to reduce maternal, neonatal 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 through community health workers and skilled care at birth.
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“No child should die from a disease that we know how to prevent, but there are worrying signs that progress in child survival rates is slowing, at a time when we are seeing further budget cuts around the world,” said UNICEF Executive Director Catherine Russell. “History shows what is possible when the world commits to protecting children. With sustained investment and political will, we can continue to build on that achievement for future generations.”
WHO Director-General Dr Tedros Adhanom Ghebreyesus said: “The world has made remarkable progress in saving children’s lives, but too many still die from preventable causes.” “Children living in the midst of conflict and crisis are almost three times more likely to die by their fifth birthday. We must protect essential health and nutrition services and reach the most vulnerable families so that every child has the opportunity not only to survive, but to thrive.”
“These findings are a collective call to accelerate the adoption of proven, scalable solutions that we know are within our reach,” said Monique Vreder, World Bank Group Health Director. “The World Bank Group’s health goal of reaching 1.5 billion people is our concrete commitment to accelerate access to quality primary health care services for more children and families.”
“The latest estimates from the United Nations Interagency Group on Child Mortality Estimates are a stark reminder that progress on child survival is slowing and too many countries are off track to achieving the Sustainable Development Goals,” said Li Junhua, Under-Secretary-General for Economic and Social Affairs. “We know how to prevent these deaths. What we need now is renewed political commitment, continued investment in primary health care, and stronger data systems to ensure no child is left behind.”
“These estimates show that many deaths in children under five from causes such as preterm birth, lower respiratory tract infections, and trauma can be avoided through proven, cost-effective interventions,” said Dr. Li Liu, associate professor at the Johns Hopkins Bloomberg School of Public Health and co-director of CA-CODE. “The science is clear: Targeted investments in primary health care, maternal and newborn health services, routine immunizations, nutrition programs and quality, timely data systems can save millions of lives.”
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