In 2023, an estimated 4.8 million children died before reaching their fifth birthday, which translates to approximately 13,100 children dying every day.
The global under-five mortality rate stands at 37 deaths per 1,000 live births, down from 94 deaths per 1,000 live births in 1990—a 61% decline .
Infectious diseases remain leading causes of under-five deaths globally, including pneumonia, diarrhea, and malaria, along with preterm birth and complications during labor.
Nearly half of all under-five deaths in 2023 occurred within the first 28 days of life, with 2.3 million newborns dying during this critical period .
The leading causes of mortality in children under 5 years of age are preterm birth complications, lower respiratory tract infections, diarrheal diseases, malaria, congenital anomalies, and sepsis, with malnutrition acting as a major underlying risk factor that amplifies vulnerability to infectious diseases and other causes.
Globally, preterm birth complications and intrapartum-related events dominate neonatal deaths, while pneumonia, diarrhea, and malaria are the most common causes in children aged 1–59 months.
Congenital anomalies and birth defects are also significant, particularly in higher-income settings and among neonates.
Sepsis and meningitis are frequent contributors.
Malnutrition is a critical risk factor, often interacting with infections to increase mortality risk, as undernutrition—including stunting, wasting, and micronutrient deficiencies—underlies a substantial proportion of deaths from diarrhea, pneumonia, and other infections.
HIV is a major cause in high-burden regions, and injuries, such as drowning and road traffic accidents in socially deprived areas.
Contributing factors:
Prematurity and low birth weight
Undernutrition
Infectious exposures (malaria, HIV, pneumonia, diarrhea)
Limited access to skilled perinatal and pediatric care
Socioeconomic disadvantage and poor sanitation
– Congenital anomalies
Mass administration of azithromycin in Molly, limited to infant one to 11 months of age did not result in lower infant to a child mortality than placebo.