Child deaths drop by half since 2000, but progress slows as 4.9 million still die before age 5

An estimated 4.9 million children died before reaching their fifth birthday in 2024, including 2.3 million newborns, according to new data released today. Most of these deaths could be prevented with simple, low-cost health care and proven treatments.

The report, called “Levels & Trends in Child Mortality,” shows that the number of children dying before age five has dropped by more than half since the year 2000. But since 2015, the rate of improvement has slowed by more than 60 percent.

This year’s report gives the most detailed picture yet of how many children, teenagers, and young adults are dying, where they are dying, and — for the first time — includes complete estimates on what causes their deaths.

For the first time, the report estimates deaths directly caused by severe acute malnutrition (SAM). It found that more than 100,000 children between the ages of 1 month and 59 months — about 5 percent of all child deaths — died from it in 2024. The real toll is likely much higher when indirect effects are counted, because malnutrition weakens children’s immune systems and makes them more likely to die from common childhood illnesses. Death records often fail to list SAM as an underlying cause, so the problem is probably much bigger than reported. Countries with the highest numbers of direct deaths include Pakistan, Somalia, and Sudan.

Newborn deaths make up nearly half of all deaths of children under five, showing that progress in preventing deaths around the time of birth has been slow. The leading causes among newborns were complications from premature birth (36 percent) and problems during labor and delivery (21 percent). Infections, including newborn sepsis and birth defects, were also major causes.

After the first month of life, infectious diseases such as malaria, diarrhea, and pneumonia were the biggest killers. Malaria remained the single largest cause of death in this age group (17 percent), with most deaths happening in parts of sub-Saharan Africa where the disease is common. After big drops between 2000 and 2015, progress against malaria deaths has slowed in recent years. Deaths are still concentrated in a few countries where the disease is widespread, such as Chad, Democratic Republic of the Congo, Niger, and Nigeria. In these places, conflict, climate disasters, invasive mosquitoes, drug resistance, and other threats make it harder for people to get prevention and treatment.

Child deaths are still heavily concentrated in just a few regions. In 2024, sub-Saharan Africa had 58 percent of all deaths of children under five. In that region, the top infectious diseases caused 54 percent of all under-five deaths. In Europe and Northern America, that number drops to 9 percent, and in Australia and New Zealand, it drops to 6 percent. These big differences show that not all children have equal access to proven, life-saving care.

In Southern Asia, which had 25 percent of all under-five deaths, most deaths were caused by problems in the first month of life — including premature birth, birth asphyxia or trauma, birth defects, and newborn infections. These mostly preventable problems show the urgent need for better prenatal care, skilled health workers at birth, care for small and sick newborns, and essential newborn services.

Countries affected by conflict and instability continue to carry a much heavier burden. Children born in these settings are nearly three times more likely to die before their fifth birthday than children born elsewhere.

The report also estimates that 2.1 million children, adolescents, and young people aged 5 to 24 died in 2024. Infectious diseases and injuries are the leading causes among younger children. For older teens, the risks change: suicide is the leading cause of death among girls aged 15 to 19, and road traffic injuries are the leading cause among boys in the same age group.

Changes in global development funding are putting critical programs for mothers, newborns, and children under growing pressure. Surveys, health information systems, and the basic functions that support effective care all need steady funding — not just to protect the progress already made, but to speed it up.

Evidence shows that investments in child health are among the most cost-effective development measures. Proven, low-cost interventions — such as vaccines, treatment for severe acute malnutrition, and skilled care at birth — give some of the highest returns in global health. They improve productivity, strengthen economies, and reduce future public spending. Every dollar invested in child survival can generate up to twenty dollars in social and economic benefits.

To speed up progress and save lives, governments, donors, and partners must:
1. Make child survival a political and funding priority, with commitment from high-burden countries to raise domestic resources and improve access to quality, affordable care.
2. Focus on those at highest risk, especially mothers and children in sub-Saharan Africa and Southern Asia, and in conflict and fragile settings.
3. Strengthen accountability for existing promises to reduce maternal, newborn, and child deaths, including transparent data collection, tracking, and reporting.
4. 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.

“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 Mr. 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,” says Li Liu, PhD, 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 programs, and quality and timely data systems can save millions of lives