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6.9 Million Reasons

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6.9 Million Child Deaths (under-5s) in 2011

They die quietly in some of the poorest villages on earth, far removed from the scrutiny and the conscience of the world. Being meek and weak in life makes these dying multitudes even more invisible in death."

— A spotty scorecard, UNICEF, Progress of Nations 2000

They die quietly in some of the poorest villages on earth...
photo: UNICEF

6.9 million children under five years of age died in 2011

– nearly 19 000 children each day and almost 800 every hour. Progress has been made in recent decades, but is unequally distributed across regions and countries and within countries. Important challenges remain for the global goal to be achieved.

About 80 percent of the world's under-five deaths in 2011 occurred in only 25 countries, and about half in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China.

India (24 percent) and Nigeria (11 percent) together account for more than a third of under-five deaths worldwide.

Global under-five mortality trend, 1980-2011


Mortality: Under-five mortality
6.9 million children under five years of age died in 2011, nearly 800 every hour

Causes of death: Causes of under-five mortality
58% of deaths in children under age five are caused by infectious diseases. Pneumonia is the largest single cause of death in under-fives.

Preventing under-five deaths: Care seeking for pneumonia
78% of children with suspected pneumonia are taken for treatment to an appropriate care provider

Mortality and causes of death - Rates and trends

Prevention - Intervention coverage and trends

More Child Health Data: Maps | Reports | Links

WHO — Children: reducing mortality

Key facts
  • 6.9 million children under the age of five died in 2011.

  • 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 pneumonia, preterm birth complications, diarrhoea, birth asphyxia and malaria. About one third of all child deaths are linked to malnutrition.

  • Children in sub-Saharan Africa are about 16.5 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. 43% 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 over one third 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 87 deaths per 1,000 live births in 1990 to 51 in 2011. 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.

Leading causes of death in children under five in the world - 2011
Deaths of children under five
Pneumonia 18%
Preterm birth complications 14%
Diarrhoea 11%
Birth asphyxia 9%
Malaria 7%
Other causes 41%

Who is most at risk?

Over 70% of all child deaths occur in Africa and South-East Asia. Within countries, child mortality is higher in rural areas, and among poorer and less educated families.

More than three million babies die every year in their first month of life and a similar number are stillborn. Within the first month, one quarter 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 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 are also 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 age five
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.

In 2010 about 20 million children worldwide were estimated to suffer from severe acute malnutrition, leaving them more vulnerable to serious illness and early death. Most of these children can be successfully treated at home with ready-to-use therapeutic foods (RUTF). Globally, in 2010, an estimated 171 million children below five years of age, were stunted and 104 million were underweight.

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


Non-breastfed children

Overcrowded conditions


Adequate nutrition

Exclusive breastfeeding

Appropriate care by a trained health provider


Oxygen for severe illness
Childhood diarrhoea Non-breastfed children

Unsafe drinking water and food

Poor hygiene practices

Exclusive breastfeeding

Safe water and food

Adequate sanitation and hygiene

Adequate nutrition


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.

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 more than one third 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.

ChildInfo - Monitoring the Situation of Children and Women

Progress Towards Millennium Development Goal 4:

Key Facts and Figures
  • Overall, substantial progress has been made towards achieving MDG 4. The number of under-five deaths worldwide has declined from nearly 12 (11.7, 12.2)1 million in 1990 to 6.9 (6.8, 7.4) million in 2011. While that translates into 14,000 fewer children dying every day in 2011 than in 1990, it still implies the deaths of 19,000 children under age five every day in 2011.

  • Since 1990 the global under-five mortality rate has dropped 41 percent—from 87 (85, 89) deaths per 1,000 live births in 1990 to 51 (51, 55) in 2011. Latin America and the Caribbean, East Asia and Pacific, Central and Eastern Europe/Commonwealth of Independent States (CEE/CIS) and Middle East and North Africa2 have reduced their under-five mortality rate by more than 50 percent.

  • The annual rate of reduction in under-five mortality has accelerated—from 1.8 (1.7, 2.1) percent a year over 1990–2000 to 3.2 (2.5, 3.2) percent over 2000–2011—but remains insufficient to reach MDG 4, particularly in sub-Saharan Africa and South Asia.

  • The highest rates of child mortality are still in sub-Saharan Africa—where 1 in 9 children dies before age five.

  • Under-five deaths are increasingly concentrated in sub-Saharan Africa and Southern Asia, while the share in the rest of the world dropped from 32 percent in 1990 to 18 percent in 2011. As under-five mortality rates have fallen more sharply elsewhere, the disparity between these two regions and the rest of the world has grown.

  • By 2050, 1 in 3 children will be born in sub-Saharan Africa, and almost 1 in 3 will live there, so the global number of under-five deaths may stagnate or even increase without more progress in the region.

  • However, sub-Saharan Africa has seen a faster decline in its under-five mortality rate, with the annual rate of reduction doubling between 1990–2000 and 2000–2011.

  • About half of under-five deaths occur in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. India (24 percent) and Nigeria (11 percent) together account for more than a third of all under-five deaths.

  • The proportion of under-five deaths that occur within the first month of life (the neonatal period) has increased 17 percent since 1990, from 36 percent to about 43 percent, because declines in the neonatal mortality rate are slower than those in the mortality rate for older children.

  • Almost 30 percent of neonatal deaths occur in India. Sub-Saharan Africa has the highest risk of death in the first month of life and is the region showing the least progress.

  • The leading causes of death among children under age five are pneumonia (18% of all under-five deaths); preterm birth complications (14%); diarrhoea (11%); intrapartum-related complications (complications during birth; 9%); and malaria (7%). Globally, more than a third of under-five deaths are attributable to undernutrition.
Click to read more about under-five mortality and neonatal mortality.

1 Values in parentheses indicate 90 percent uncertainty intervals for the estimates.
2 Regional classifications used here are UNICEF regions.

The UN Inter-agency Group on Child Mortality Estimation

The UN Inter-agency Group on Child Mortality Estimation was established in 2004 to share data on child mortality, harmonize estimates within the UN system, improve methods for child mortality estimation, report on progress towards the Millennium Development Goals and enhance country capacity to produce timely and properly assessed estimates of child mortality. The IGME, led by the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO), also includes the World Bank and the United Nations Population Division of the Department of Economic and Social Affairs as full members. An independent Technical Advisory Group of leading experts in the areas of demography and biostatistics advises the group. The group updates the estimates on child mortality annually.

Child mortality database

The child mortality database contains estimates for infant mortality and under-five mortality generated by the Inter-agency Group for Child Mortality Estimation. Please visit the child mortality database to access the estimates. Click here to access the 2010 CME brochure.

Child mortality estimation methods

Details on the child mortality estimation methods can be found in the PLOS Medicine Collection on Child Mortality Estimation methods.

Levels and Trends in Child Mortality, Report 2012 The latest estimates on child mortality generated by the
UN Inter-agency Group on Child Mortality Estimation
were released on 13 September 2012:
Levels and Trends in Child Mortality, Report 2012.
Committing to Child Survival: A Promise Renewed – Progress Report 2012
UNICEF also released
Committing to Child Survival:
A Promise Renewed – Progress Report 2012

7 May, 2015


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