Relevance: mains: G.S paper I: Social Issues & G.S paper III: Health
Key facts
- An estimated 6.3 million children under the age of 15 years died in 2017. 5.4 million of them were under the age of 5 and 2.5 million of those children died within the first month of life. This translates into 15 000 under-five deaths per day.
- 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 children under-5 years are preterm birth complications, pneumonia, birth asphyxia, diarrhoea and malaria.
- Nearly half of these deaths are in newborns, a figure that will rise as the mortality rate for older infants continues to fall.
- Children in sub-Saharan Africa are more than 15 times more likely to die before the age of 5 than children in high income countries.
Who is most at risk?
Children under the age of 5
Substantial global progress has been made in reducing child deaths since 1990. The total number of under-5 deaths worldwide has declined from 12.6 million in 1990 to 5.4 million in 2017 – 15 000 every day compared with 34 000 in 1990. Since 1990, the global under-5 mortality rate has dropped by 58%, from 93 deaths per 1 000 live births in 1990 to 39 in 2017.
Although the world as a whole has been accelerating progress in reducing the under-5 mortality rate, disparities exist in under-5 mortality across regions and countries. Sub-Saharan Africa remains the region with the highest under-5 mortality rate in the world, with 1 child in 13 dying before his or her fifth birthday, 14 times higher than in high income countries. Inequity also persists within countries geographically or by social-economic status. In 2017 alone, some 4.4 million deaths could have been averted had under-5 mortality in each country been as low as in the lowest mortality country in the region; the total number of under-5 deaths would have been reduced to one million.
More than half of under-5 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-5 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
Vaccines are available for some of the most deadly childhood diseases, such as measles, polio, diphtheria, tetanus, and pertussis, pneumonia due to Haemophilius influenzae type B and Streptococcus pneumonia and diarrhoea due to rotavirus. Vaccines can protect children from illness and death.
Mortality among children aged 5-14 years
The probability of dying among children aged 5 to 14 years was 7.2 deaths per 1 000 children aged 5 in 2017, roughly 18% of the under-5 mortality rate in 2017. About 2 500 children in this age group die every day. Globally deaths among children aged 5-9 accounted for 61% of all deaths of children aged 5 to 14 years. Injuries (including road traffic injuries, drowning, burns, and falls) rank among the top causes of death and lifelong disability among children aged 5-14 years. The patterns of death in older children and adolescents reflect the underlying risk profiles of the age groups, with a shift away from infectious diseases of childhood and towards accidents and injuries, notably drowning and road traffic injuries for older children and young adolescents.
Emerging priorities for children’s health
Congenital anomalies, injuries, and non-communicable diseases (chronic respiratory diseases, acquired heart diseases, childhood cancers, diabetes, and obesity) are the emerging priorities in the global child health agenda. Congenital anomalies affect an estimated 1 in 33 infants, resulting in 3.2 million children with disabilities related to birth defects every year. The global disease burden due to non-communicable diseases affecting children in childhood and later in life is rapidly increasing, even though many of the risk factors can be prevented.
Similarly, the worldwide number of overweight children increased from an estimated 31 million in 2000 to 42 million in 2015, including in countries with a high prevalence of childhood undernutrition.
Global response: Sustainable Development Goal 3
The Sustainable Development Goals (SDGs) adopted by the United Nations in 2015 were developed to promote healthy lives and well-being for all children. The SDG Goal 3 is to end preventable deaths of newborns and under-5 children by 2030. There are two targets:
- Reduce newborn mortality to at least as low as 12 per 1000 live births in every country (SDG 3.2); and
- Reduce under-five mortality to at least as low as 25 per 1000 live births in every country (SDG 3.2).
Target 3.2 is closely linked with target 3.1, to reduce the global maternal mortality ratio to less than 70 deaths per 100 000 live births, and target 2.2 on ending all forms of malnutrition, as malnutrition is a frequent cause of death for under-5 children.
These have been translated into the new “Global Strategy for Women’s, Children’s and Adolescent’s Health” (Global Strategy), which calls for ending preventable child deaths while addressing emerging child health priorities. Member States need to set their own targets and develop specific strategies to reduce child mortality and monitor their progress towards the reduction.
Accelerated progress will be needed in more than a quarter of all countries, to achieve the Sustainable Development Goal (SDG) target [1] on under-five mortality by 2030. Meeting the SDG target would reduce the number of under-5 deaths by 10 million between 2017 and 2030.
Focused efforts are still needed in Sub-Saharan Africa and South East Asia to prevent 80 per cent of these deaths.
WHO response
WHO calls on Member States to address health equity through universal health coverage so that all children are able to access essential health services without undue financial hardship. Moving from “business as usual” to innovative, multiple, and tailored approaches to increase access, coverage, and quality of child health services will require strategic direction and an optimal mix of community and facility (based care. Health sector and multisectoral efforts are also needed to overcome the inequalities and the social determinants of health