The number of children who died before their fifth birthday has fallen to a historic low, at 4.9 million in 2022, according to estimates released by the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).

While these numbers stand testimony to the work of midwives and community health workers, it still meant one death every six seconds, and more work needed to reduce preventable child deaths, the report said. This included addressing global threats, inequities and data gaps, besides improvement in the working conditions of community health workers with more investments and commitment, it said.

“Behind these numbers lie the stories of midwives and skilled health personnel helping mothers safely deliver their newborns, health workers vaccinating and protecting children against deadly diseases, and community health workers who make home visits to support families to ensure the right health and nutrition support for children,” said UNICEF Executive Director Catherine Russell.

More children are surviving today than ever before, with the global under-five mortality rate declining 51 per cent since 2000, the report noted. Several low- and lower-middle-income countries “have outpaced this decline, showing that progress is possible when resources are sufficiently allocated to primary healthcare, including child health and well-being,” the note said, pointing to Cambodia, Malawi, Mongolia, and Rwanda — where under-five mortality has reduced by over 75 per cent since 2000.

But there’s more work needed to end all preventable child and youth deaths. In addition to the 4.9 million lives lost before the age of five — nearly half of which were newborns — the lives of another 2.1 million children and youth aged 5-24 were cut short — mostly in sub-Saharan Africa and Southern Asia, it added. This was primarily from preventable or treatable causes, such as pre-term birth, complications around the time of birth, pneumonia, diarrhoea, and malaria, the note said. “Many lives could have been saved with better access to high-quality primary healthcare, including essential, low-cost interventions, such as vaccinations, availability of skilled health personnel at birth, support for early and continued breastfeeding, and diagnosis and treatment of childhood illnesses,” it added. 

Threats and inequities

The report noted the threats and inequities that jeopardise child survival, including increasing inequity and economic instability, new and protracted conflicts, the intensifying impact of climate change, and the fallout of Covid-19, which could lead to stagnation or reversal of gains.

At current rates, 59 countries will miss the SDG (sustainable development goals) under-five mortality target, and 64 countries will fall short of the newborn mortality goal, the note said. “That means an estimated 35 million children will die before reaching their fifth birthday by 2030 — a death toll that will largely be borne by families in sub-Saharan Africa and Southern Asia or in low- and lower-middle-income countries.”

Data gaps

Pointing to large gaps in data, particularly in sub-Saharan Africa and Southern Asia (where mortality burden is high), the report said that data and statistical systems needed to be improved to better track and monitor child survival and health, including indicators on mortality and health via household surveys, birth and death registration through Health Management Information Systems (HMIS), and Civil Registration and Vital Statistics (CRVS).

Improving access to quality health services and protecting children from preventable deaths require investment in education, jobs, and decent working conditions for health workers to deliver primary healthcare, including community health workers, the joint statement said. 

Given the critical role community health workers play, they should be integrated into primary healthcare systems and paid fairly, trained well, and equipped with the means to provide the highest quality of care, it added.

“Where a child is born should not dictate whether they live or die. It is critical to improve access to quality health services for every woman and child, including during emergencies and in remote areas,” said the World Health Organization Director General Dr Tedros Adhanom Ghebreyesus.

Lauding the milestone, Dr Juan Pablo Uribe, Global Director for Health, Nutrition and Population, World Bank, and Director, Global Financing Facility for Women, Children and Adolescents, said, “This is simply not enough. We need to accelerate progress with more investments, collaboration and focus to end preventable child deaths and honour our global commitment.”

The UNIGME is led by UNICEF and includes the WHO, World Bank Group and the Population Division of the United Nations Department of Economic and Social Affairs.