Global Health Observatory (GHO) data

Child mortality indicators: latest situation and change over time

Under-five mortality rate

54 low- and middle-income study countries, DHS 2005–2013

In over half of low- and middle-income study countries, at least 75 children out of every 1000 live births died before reaching their fifth birthday. The countries reporting the highest under-five mortality rates were in the WHO African Region.

Under-five mortality rates varied greatly by country income group: whereas half of the middle-income study countries reported child mortality rates in excess of 50 deaths per 1000 live births, half of the low-income study countries had rates of over 100 deaths per 1000 live births.

Latest situation: by place of residence

54 low- and middle-income study countries, DHS 2005-2013

The under-five mortality rate was higher in rural areas than in urban areas in most of the low- and middle-income study countries. In half of countries, the under-five mortality rate in rural areas was 84 deaths per 1000 live births or higher. In urban areas, the under-five mortality rate was about 61 deaths per 1000 live births or higher in half of study countries.

The magnitude of the difference in under-five mortality rates between rural and urban areas varied by country. Half of study countries reported a difference of about 16 deaths per 1000 live births or less. In Burkina Faso, Burundi, Cameroon, Guinea, Niger and Nigeria, however, the difference in under-five mortality rates between rural and urban areas was at least 50 deaths per 1000 live births.

Certain study countries reported no – or very low – place-of-residence inequality in child mortality rates. For example, the Dominican Republic, Honduras, Jordan, Kyrgyzstan, Ukraine, the United Republic of Tanzania and Zimbabwe reported an under-five mortality rate difference of less than 3 deaths per 1000 live births between rural and urban areas. In some cases, such as Jordan and Ukraine, low inequality was achieved alongside low national under-five mortality rates (around 20 deaths per 1000 live births). The United Republic of Tanzania and Zimbabwe, however, had moderately high national rates of under-five mortality (around 80–90 deaths per 1000 live births) and low inequality, indicating that the situation was equally unfavourable in both rural and urban areas.

Change over time: by place of residence

37 low- and middle-income study countries, DHS 1995–2004 and 2005–2013

Change-over-time analyses revealed improvements in national average child mortality rates in nearly all study countries. Notably, Mail, Niger and Rwanda reported an average reduction in under-five mortality of more than 10 deaths per 1000 live births per year.

Reductions in under-five mortality rates across both rural and urban areas were seen in most study countries. Faster decreases tended to be reported for rural areas. For instance, the pace of improvement in rural areas outpaced that in urban areas by more than 45 deaths per 1000 live births over 10 years in Burkina Faso, Malawi, Mozambique, Niger and Rwanda. In contrast, Cambodia and Cameroon reported faster improvements in urban areas, but the pro-urban advantage did not exceed 15 deaths per 1000 live births over 10 years in any of these countries.

A clear majority of study countries reported decreasing national under-five mortality rates alongside pro-rural changes in the degree of inequality over time. Furthermore, in nearly one quarter of study countries, the decrease in national under-five mortality rates was particularly fast (at least 60 deaths per 1000 live births over 10 years) and achieved through pro-rural reductions.

Other key findings: inequality in child mortality:

  • In half of study countries, the infant mortality rate was at least 8 deaths per 1000 live births higher in rural than in urban areas.
  • In about one quarter of study countries, the gap in neonatal mortality rates between the most- and least-educated subgroups was at least 15 deaths per 1000 live births.
  • In half of study countries, the under-five mortality rate decreased more rapidly in the poorest than in the richest subgroup, by a margin of at least 26 deaths per 1000 live births over a 10-year period.

For more information about this feature story, including considerations for interpreting the results, please refer to the report State of inequality: reproductive, maternal, newborn and child health.

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