Children: reducing mortality

Fact sheet

---

Key facts

5.6 million children under the age of 5 years died in 2016. 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.
• 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.

---

A child's risk of dying is highest in the first 28 days of life (the neonatal period). Improving the quality of antenatal care, care at the time of childbirth, and postnatal care for mothers and their newborns are all essential to prevent these deaths. Globally 2.6 million children died in the first month of life in 2016. There are approximately 7 000 newborn deaths every day, amounting to 46% of all child deaths under the age of 5-years.

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 5 years of life, the main causes of death are pneumonia, diarrhoea and malaria. Malnutrition is the underlying contributing factor, making children more vulnerable to severe diseases.

The world has made substantial progress in child survival since 1990. The global under-5 mortality rate has dropped by 56 per cent from 93 deaths per 1000 live births in 1990 to 41 in 2016. Nonetheless, 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 is most at risk?

Newborns

2.6 million babies die every year in their first month of life and a similar number are stillborn. Within the first month, up to 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 quality follow-up care to prevent and treat illness.

Globally, the number of neonatal deaths declined from 5.1 million in 1990 to 2.6 million in 2016. However, the decline in neonatal mortality from 1990 to 2016 has been slower than that of post-neonatal under-5 mortality: 49% compared with 62% globally. The relative decline in the neonatal mortality rate was slower in sub-Saharan Africa. The modest decline in neonatal mortality in this region was offset by an increasing number of births so that the number of neonatal deaths remained almost the same from 1990 to 2016. Moreover, 52 countries need to accelerate progress to reach the SDG target of a neonatal mortality rate of 12 deaths per 1000 live births by 2030.

Prior to birth, a 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 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 5.6 million in 2016 – 15 000 every day compared with 35 000 in 1990. Since 1990, the global under-5 mortality rate has dropped 56%, from 93 deaths per 1 000 live births in 1990 to 41 in 2016.

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. Inequity also persists within countries geographically or by social-economic status. The latest mortality estimates by wealth quintile show that in 99 low and middle income countries (2), under-5 mortality among children born in the poorest households is on average twice that of children born in the wealthiest households. Eliminating this gap between mortality in the poorest and wealthiest households would have saved 2 million lives in 2016.

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.

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.

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 adolescents.

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 aim to ensure healthy lives and promote well-being for all children. The SDG goal 3 target 3.2 is to end preventable deaths of newborns and under-5 children by 2030. These are two targets:

• reduce newborn mortality to at least as low as 12 per 1 000 live births in every country (SDG 3.2); and
• reduce under-five mortality to at least as low as 25 per 1,000 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.

The plan to achieve the SDG targets, has been translated into several global initiatives (3). Member States need to set their own targets and develop specific strategies to reduce child mortality and monitor their progress towards the reduction.

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.

---

Notes

(1) Reduce under-five mortality to at least as low as 25 per 1,000 live births in every country

(2) Based on World Bank classification of world economies according to estimates of gross national income per capita (GNI)

(3) Global initiatives include: Ending Preventable Maternal Mortality, Every Newborn Action Plan, the Global action Plan for the Prevention and Treatment of Pneumonia and Diarrhoea, the Comprehensive Implementation Plan on Maternal, and Infant and Young Child Nutrition", Global Technical Strategy for Malaria, Global Vaccine Action Plan, and the United Nations Decade of Action on Nutrition 2016–2025              ( Collected) 

Play Learning Games

• Play Learning Games

  
  

  

   Try simple, fun learning games that get your kids excited. Photo © Robert Daly / Getty Images

  Put learning in motion. Play games that get your kids moving while learning about a variety of subjects.
  
  For preschoolers, start with a basic game that helps him learn farm animals, numbers, colors and shapes. Adapt the game for school-age children to cover anatomy, world government, foreign language and history. What you choose to teach with this game is only limited by your imagination.
• 02of 11
  Learn Phonics Basics

  
  

  

  
  

  Teaching your child to read is one of the most wonderful gifts you will ever give him. Learning the basics of phonics prepares him for spelling and reading readiness.
  
  You don't have to sit still in a chair endlessly repeating letter sounds. Try phonics activities that make learning phonics an adventure instead of a tedious lesson. Kids can play games, hunt for letters and even use a digital camera to bring their phonics lessons to life.
• 03of 11
  Practice Writing

  
  

  

  
  

  Writing is a skill he'll use throughout his life. Teach him to write with methods that go beyond pencil to paper. Get messy. Let him trace. Connect the dots. He'll not only be entertained, he'll be better prepared for school.
  
  For preschoolers, help him learn the alphabet and the motions of each letter. For school-age children, encourage him to improve his penmanship by helping you in your everyday writing tasks.
• 04of 11
  Identify Colors

  
  

  

  
  

  Pink. Blue. Red. Black. Purple. Kids are interested in learning their colors at an early age.
  
  With a pack of pom poms, you put them on a path to identify colors, start sorting and learn how to count. At the same time, you're helping them develop their fine motor skills by letting them pick up the tiny objects and gross motor skills are encouraged with a sorting game.
• 05of 11

  Develop Counting Skills

  
  

  

  
  

  1, 2, 3! Teaching your child how to count seems so simple but reciting numbers in the correct order is only the beginning.
  
  Play a game that lets them physically touch the objects they're counting. Kids who are more advanced in their counting skills can try a variation of the game that will challenge them to think beyond 1, 2, 3 and in terms of how many objects they actually see before them.
• 06of 11
  Teach Math

  
  

  

  
  

  Math is an easy subject to teach because it's all around us. Add the number of people waiting at a restaurant. Divide the number of soccer players on the field by the number of water bottles on the bench to see how many people don't have anything to drink.
  
  For preschoolers, your future math whiz can get an early start on number recognition and learning to count. For school-age children, tackle fractions and other advanced math problems with math games, an abacus, even cookies!
• 07of 11
  Enrich Their Minds with Music

  
  

  

  
  

  Mary Had a Little Lamb and The Itsy, Bitsy Spider are on a constant loop in your children's playlists. But there are so many more musical activities you can play together to instill a love of music they'll carry with them throughout their lives.
  
  Hit the right note with fun music classes, making your own music instruments and playing musical games. Preschoolers love the one-on-one time with mom and dad and school-age children can begin formal training to enhance their musical skills.
• 08of 11
  Try Science Experiments at Home

  
  

  

  
  

  Think "science experiment" and you might have visions of a chemistry lab explosion. Fear not. You don't have to turn your kitchen into a blast zone to teach your kids about science at home.
  
  Preschoolers will enjoy simple science experiments that don't require much of an effort on your part, yet are jam-packed with fun learning opportunities. Your school-age children can try science experiments that are a bit more involved but won't leave your house a disaster area when they're finished.
• 09of 11
  Plant a Garden

  
  

  

  
  

  There's more to planting a garden than sticking a seed in the ground and waiting for something to grow. Gardens are lessons in science, nutrition and patience all rolled into one plot of dirt in your backyard.
  
  A garden teaches preschoolers how plants come to life. It's also an easy way to teach him about nutrition and get him excited about eating the vegetables he's grown. School-age children can keep a gardening journal, study a plant's scientific name and grow more difficult plants.
• 10of 11
  Create a Website

  
  

  

  
  

  That magic box on your desk is an open door to learning. Turn on the computer and create a website together.
  
  Preschoolers may not be the best website designers. But they're not too young to have their own website. With your help, they can take pictures for their site, tell you what they want to say on their blog and learn what it takes to make a website run smoothly. When they're older, you can redesign the site together and turn over the keys without having to do as much for them. School-age children are ready to manage most of their own site, which will help improve their writing and thinking skills. You can also use his website to teach him how to stay safe online.
• 11of 11
  Explore World Cultures

  
  

  

  
  

  Put down the textbook. A little creativity can help you teach your child about world cultures in a way that will make learning fun while enriching his awareness of other people's traditions and ways of life. The world will never look the same to him again.
  
  Preschoolers can enjoy making crafts he might find in other countries and tasting authentic foods you cook together. School-age children can study cultural etiquette, find a pen pal from that country and learn words from the official language.