What are the leading causes of death in children under 5?

The leading causes (UN IGME 2023) are: preterm birth complications (~18%); pneumonia (~14%); intrapartum events — complications during delivery (~11%); diarrhoeal diseases (~9%); neonatal sepsis and infections (~7%); and malaria (~5%). Most of these deaths are preventable with known, affordable interventions. In the neonatal period specifically, prematurity, birth asphyxia and sepsis dominate.

Why do so many children still die preventably?

Child mortality reflects deep inequities in access to care. A child in Sierra Leone is 80 times more likely to die before age 5 than a child in Norway. The barriers include: distance to and cost of health facilities; shortages of trained health workers and essential medicines; poor quality of care at facility level; malnutrition weakening immune defences; poor water and sanitation (enabling diarrhoeal disease); and inadequate immunisation coverage.

What is neonatal mortality and why is it rising as a share of child deaths?

Neonatal mortality refers to deaths in the first 28 days of life — now 47% of all under-5 deaths (2.3 million in 2022). As interventions against post-neonatal causes (pneumonia, diarrhoea, malaria) have scaled up, the neonatal period has become proportionally more important. Reducing neonatal deaths requires interventions at birth and in the immediate postnatal period: kangaroo mother care, neonatal resuscitation, treatment of sepsis, and management of prematurity.

What is the SDG 3.2 target for child mortality?

SDG 3.2 targets ending preventable deaths of newborns and children under 5 by 2030 — defined as achieving an under-5 mortality rate of at most 25 per 1,000 live births and a neonatal mortality rate of at most 12 per 1,000 live births in every country. The global U5MR was 37 in 2022. Many countries remain far from these targets, and the COVID-19 pandemic has slowed progress.

What is kangaroo mother care?

Kangaroo mother care (KMC) involves a parent holding a preterm or low-birth-weight newborn skin-to-skin on their chest, continuously or near-continuously. WHO updated its guidelines in 2022 to recommend starting KMC immediately after birth. Evidence shows that early KMC reduces neonatal mortality by up to 36% in low-resource settings, stabilises temperature and breathing, promotes breastfeeding and reduces infections — at negligible cost.

How does nutrition affect child survival?

Malnutrition — including undernutrition, micronutrient deficiency and, increasingly, overweight — underlies an estimated 45% of all child deaths. A malnourished child is far more susceptible to infections and far less likely to survive them. Stunting (chronic undernutrition) affects 148 million children globally and impairs cognitive development, reducing future productivity. Wasting (acute malnutrition, affecting 45 million) dramatically increases mortality risk. Ready-to-use therapeutic food (RUTF) can treat severe acute malnutrition.

What vaccines protect children the most?

The most impactful vaccines for child survival are: measles vaccine (prevents one of the most contagious and deadly childhood diseases); Hib vaccine (prevents bacterial meningitis and pneumonia); pneumococcal conjugate vaccine (PCV); rotavirus vaccine (prevents severe diarrhoea — the second leading cause of vaccine-preventable death in children); oral polio vaccine; and DTP (diphtheria, tetanus, pertussis). Malaria vaccines (RTS,S, R21) are now being rolled out across sub-Saharan Africa.

What is oral rehydration therapy (ORT)?

Oral rehydration therapy is the use of a glucose-electrolyte solution to replace fluids and salts lost in diarrhoea and prevent dehydration. It was described as "potentially the most important medical advance of this century" by The Lancet (1978). Before ORT, diarrhoeal dehydration required expensive IV fluids in hospitals. ORT can be administered by mothers at home — dramatically reducing child deaths from diarrhoeal disease which had killed millions annually. It remains a cornerstone of child health.

What is the Every Newborn Action Plan?

The Every Newborn Action Plan (ENAP), co-led by WHO and UNICEF, is a global roadmap to end preventable newborn deaths and stillbirths by 2035. It sets coverage milestones for: antenatal care; skilled birth attendance; postnatal care; kangaroo mother care for preterm babies; and neonatal resuscitation. ENAP's newborn metrics are now integrated into the SDG monitoring framework.

How does the COVID-19 pandemic affect children?

COVID-19 had profound indirect effects on child health: 25 million children were under-vaccinated in 2021 (worst decline in 30 years); school closures disrupted learning for over 1.5 billion children; malnutrition worsened as economic shocks hit household food security; and disruptions to health services increased deaths from malaria, pneumonia and diarrhoea. Children themselves rarely suffered severe COVID-19 but were significantly harmed by the pandemic's systemic effects.

What is UNICEF's role in child health?

UNICEF is the UN's lead agency for children's health. It procures vaccines (the world's largest vaccine buyer), supplies ready-to-use therapeutic food for severe acute malnutrition, supports integrated management of childhood illness (IMCI) in primary care, promotes breastfeeding and complementary feeding, delivers WASH (water, sanitation and hygiene) programmes, and advocates for child health policy globally. UNICEF co-leads the UN IGME, which produces annual child mortality estimates.

How does GMJ News cover child health?

GMJ News tracks UN IGME child mortality data, UNICEF nutrition reports, vaccine coverage updates and Every Newborn Action Plan milestones. Georgia has significantly reduced its child and neonatal mortality since independence — the Georgian Medical Journal has documented this progress and covers ongoing challenges including neonatal intensive care quality and zero-dose children in remote regions.

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Child Health

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

An estimated 4.9 million children died before their fifth birthday in a single recent year — roughly 13,000 every day — and nearly half were newborns (UN IGME), overwhelmingly from preventable and treatable causes: prematurity, birth complications, pneumonia, diarrhoea and malaria. The SDG target 3.2 calls for ending preventable child deaths by 2030, which demands quality newborn care, breastfeeding support, nutrition, and closing the immunization gap for the millions of zero-dose children who receive no vaccines at all (WHO Immunization Agenda 2030). Where a child is born still determines whether it survives — the accountability story at the heart of GMJ News coverage.

Key messages

Scale

An estimated 4.9 million children died before their fifth birthday in 2022 — roughly 13,000 every day — almost entirely from preventable and treatable causes (UN IGME 2023).

Newborns most vulnerable

2.3 million newborns die in their first month of life — nearly half of all under-five deaths. Prematurity, birth complications and neonatal sepsis are the leading newborn killers.

Equity

Sub-Saharan Africa and Southern Asia account for over 80% of under-five deaths. A child born in Sierra Leone is 80 times more likely to die before age 5 than a child born in Norway.

Prevention is primary

Most child deaths could be prevented with known, affordable interventions: vaccines, oral rehydration therapy, zinc, ready-to-use therapeutic food, kangaroo mother care and skilled birth attendance.

Zero-dose children

14.3 million children received zero vaccines in 2023 — concentrated in fragile, conflict-affected and hard-to-reach settings. They face the highest risk of preventable disease and death.

SDG 3.2

SDG target 3.2 aims to end preventable deaths of newborns and children under 5 by 2030, reaching a neonatal mortality rate of at most 12/1,000 live births and under-5 mortality rate of 25/1,000 live births.

Key statistics

4.9M

under-5 deaths (2022)

UN IGME 2023

13K

under-5 deaths/day

UN IGME 2023

2.3M

neonatal deaths/year

UN IGME 2023

80%+

of deaths in sub-Saharan Africa and S. Asia

UN IGME 2023

14.3M

zero-dose children (2023)

WHO/UNICEF

SDG 3.2

end preventable child deaths by 2030

UN SDG

Under-5 mortality rate (per 1,000 live births) globally 2000-2022 — UN IGME

Source: UN Inter-agency Group for Child Mortality Estimation (IGME) — WHO, UNICEF, World Bank, UN DESA. Annual estimates.

Glossary of key terms

Under-5 mortality rate (U5MR)
WHO/UNICEFThe probability that a newborn will die between birth and exactly 5 years of age, expressed per 1,000 live births. The primary indicator for tracking child survival progress (SDG 3.2).

Neonatal mortality rate
WHO/UNICEFDeaths occurring in the first 28 days of life per 1,000 live births. Neonatal deaths now represent 47% of all under-5 deaths globally. SDG target: <=12 per 1,000.

Kangaroo mother care (KMC)
WHOSkin-to-skin care of preterm or low birth weight newborns by a parent — continuously day and night. WHO recommends early KMC (starting immediately after birth) as the standard of care. Reduces neonatal mortality by up to 36%.

RUTF
WHO/UNICEFReady-to-use therapeutic food — an energy-dense, nutrient-enriched paste (typically peanut-based) used to treat severe acute malnutrition in children. Can be used at home without refrigeration and has transformed SAM treatment.

ORT
WHO/UNICEFOral rehydration therapy — the use of a glucose-electrolyte solution to treat dehydration from diarrhoea. One of the greatest public health advances of the 20th century; dramatically reduces child deaths from diarrhoeal disease.

ENAP
WHO/UNICEFEvery Newborn Action Plan — a global roadmap to end preventable newborn deaths and stillbirths by 2035. Sets coverage targets for antenatal care, skilled birth attendance, neonatal resuscitation and kangaroo mother care.