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Children: reducing mortality

Fact sheet N°178
Updated September 2014


Key facts

  • 6.3 million children under the age of five died in 2013.
  • More than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable interventions.
  • Leading causes of death in under-five children are preterm birth complications, pneumonia, birth asphyxia, diarrhoea and malaria. About 45% of all child deaths are linked to malnutrition.
  • Children in sub-Saharan Africa are more than 15 times more likely to die before the age of five than children in developed regions.

A child's risk of dying is highest in the neonatal period, the first 28 days of life. Safe childbirth and effective neonatal care are essential to prevent these deaths. 44% of child deaths under the age of five take place during the neonatal period.

Preterm birth, intrapartum-related complications (birth asphyxia or lack of breathing at birth), and infections cause most neonatal deaths. From the end of the neonatal period and through the first five years of life, the main causes of death are pneumonia, diarrhoea and malaria. Malnutrition is the underlying contributing factor in about 45% of all child deaths, making children more vulnerable to severe diseases.

Overall, substantial progress has been made towards achieving Millennium Development Goal (MDG) 4. Since 1990 the global under-five mortality rate has dropped from 90 deaths per 1000 live births in 1990 to 46 in 2013. But the rate of this reduction in under-five mortality is still insufficient to reach the MDG target of a two-thirds reduction of 1990 mortality levels by the year 2015.

Who is most at risk?

Newborns

Nearly 3 million babies die every year in their first month of life and a similar number are stillborn. Within the first month, up to one half of all deaths occur within the first 24 hours of life, and 75% occur in the first week. The 48 hours immediately following birth is the most crucial period for newborn survival. This is when the mother and child should receive follow-up care to prevent and treat illness.

Prior to birth, the mother can increase her child's chance of survival and good health by attending antenatal care consultations, being immunized against tetanus, and avoiding smoking and use of alcohol.

At the time of birth, a baby's chance of survival increases significantly with delivery in a health facility in the presence of a skilled birth attendant. After birth, essential care of a newborn should include:

  • ensuring that the baby is breathing;
  • starting the newborn on exclusive breastfeeding right away;
  • keeping the baby warm; and
  • washing hands before touching the baby.

Identifying and caring for illnesses in a newborn is very important, as a baby can become very ill and die quickly if an illness is not recognized and treated appropriately. Sick babies must be taken immediately to a trained health care provider.

Children under the age of five

Under-five deaths are increasingly concentrated in sub-Saharan Africa and Southern Asia, while the proportion in the rest of the world dropped from 32% in 1990 to 18% in 2013.

Children in sub-Saharan Africa are more than 15 times more likely to die before the age of five than children in developed regions. About half of under-five deaths occur in only five countries: China, Democratic Republic of the Congo, India, Nigeria and Pakistan. India (21%) and Nigeria (13%) together account for more than a third of all under-five deaths.

Children are at greater risk of dying before age five if they are born in rural areas, poor households, or to a mother denied basic education.

More than half of under-five child deaths are due to diseases that are preventable and treatable through simple, affordable interventions. Strengthening health systems to provide such interventions to all children will save many young lives.

Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illness such as diarrhoea, pneumonia, and malaria. Nutrition-related factors contribute to about 45% of deaths in children under five years of age.

Leading causes of death in post-neonatal children: risk factors and response


Cause of death Risk factors Prevention Treatment
Pneumonia, or other acute respiratory infections Low birth weight

Malnutrition

Non-breastfed children

Overcrowded conditions


Vaccination

Adequate nutrition

Exclusive breastfeeding

Reduction of household air pollution

Appropriate care by a trained health provider

Antibiotics

Oxygen for severe illness
Childhood diarrhoea Non-breastfed children

Unsafe drinking water and food

Poor hygiene practices

Malnutrition
Exclusive breastfeeding

Safe water and food

Adequate sanitation and hygiene

Adequate nutrition

Vaccination



Low-osmolarity oral rehydration salts (ORS)

Zinc supplements

Prevention with vaccines

For some of the most deadly childhood diseases, such as measles, polio, diphtheria, tetanus, pertussis, pneumonia due to Haemophilius influenzae type B and Streptococcus pneumoniae and diarrhoea due to rotavirus, vaccines are available and can protect children from illness and death.

WHO response

In June 2014, WHO, UNICEF and partners issued the first-ever global plan to end preventable newborn deaths and stillbirths by 2035. The Every Newborn Action Plan calls for all countries to take steps to provide basic, cost-effective health services—in particular around the time of childbirth, as well as for small and sick babies—and to improve the quality of care.

Global response: Millennium Development Goals 4 and 5

The Millennium Development Goals adopted by the United Nations in 2000 aim to decrease child and maternal deaths worldwide by 2015. The fourth Millennium Development Goal (MDG) is to reduce the 1990 mortality rate among under-five children by two thirds. Child mortality is also closely linked to MDG 5 to improve maternal health.

Since 44% of all child deaths occur within the first month of life, providing skilled care to mothers during pregnancy, as well as during and after birth, greatly contributes to child survival. Member States have set targets and developed specific strategies to reduce child mortality and monitor progress.

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