An estimated 4.9 million children died before reaching their fifth birthday in 2024, highlighting a concerning slowdown in global efforts to reduce child deaths, according to newly released data.

According to the report – Levels & Trends in Child Mortality – under-five deaths globally have fallen by more than half since 2000. However, since 2015, the pace of reduction in child mortality has slowed by more than 60 per cent.

This year’s report provides the clearest and most detailed picture yet of how many children, adolescents, and youth are dying, where they are dying, and – for the first time – fully integrates estimates on the causes of death.*

For the first time, the report estimates deaths directly caused by severe acute malnutrition (SAM), finding that more than 100 000 children aged 1-59 months – or 5 per cent – died from it in 2024. The toll is far greater when indirect effects are considered, as malnutrition weakens children’s immunity and increases their risk of dying from common childhood diseases.

Mortality data also frequently fail to capture SAM as an underlying cause of death, suggesting the burden is likely substantially underestimated. Some of the countries with the highest numbers of direct deaths include Pakistan, Somalia, and Sudan.

Newborn deaths account for nearly half of all under-five deaths, reflecting slower progress in preventing deaths around the time of birth. Leading causes among newborns were complications from preterm birth (36 per cent) and complications during labour and delivery (21 per cent). Infections, including neonatal sepsis and congenital anomalies, were also important causes.

Beyond the first month, infectious diseases such as malaria, diarrhoea, and pneumonia were major killers. Malaria remained the single largest killer in this age group (17 per cent) – with most deaths occurring in endemic areas of sub-Saharan Africa. After steep declines between 2000 and 2015, progress towards reducing malaria mortality slowed in recent years. Deaths remain concentrated in a handful of endemic countries – such as Chad, the Democratic Republic of the Congo, Niger, and Nigeria – where conflict, climate shocks, invasive mosquitos, drug resistance, and other biological threats continue to affect access to prevention and treatment.

Child deaths remain heavily concentrated in a small number of regions. In 2024, sub-Saharan Africa accounted for 58 per cent of all under-five deaths. In the region, the leading infectious diseases were responsible for 54 per cent of all under-five deaths. In Europe and Northern America this proportion drops to 9 per cent and in Australia and New Zealand, drops further to 6 per cent. These stark disparities reflect unequal access to proven, life-saving interventions.

In Southern Asia, which accounted for 25 per cent of all under-five deaths, mortality was driven largely by complications in the first month of life – including preterm delivery, birth asphyxia/ trauma, congenital anomalies, and neonatal infections. These largely preventable conditions underscore the urgent need for investing in quality antenatal care, skilled health-care personnel at birth, care of small and sick newborns, and essential newborn services.

Fragile and conflict-affected countries continue to bear a disproportionate share of the burden. Children born in these settings are nearly three times more likely to die before their fifth birthday than those elsewhere.

The report also finds that an estimated 2.1 million children, adolescents and youth aged 5–24 died in 2024. Infectious diseases and injuries remain leading causes among younger children, while risks shift in adolescence: self-harm is the leading cause of death among girls aged 15–19, and road traffic injuries among boys.

Shifts in the global development financing landscape are placing critical maternal, newborn, and child health programmes under growing pressure. Surveys, health information systems, and the core functions that underpin effective care all need sustained funding not only to protect the progress made, but to accelerate it

Evidence shows that investments in child health remain among the most cost-effective development measures. Proven, low-cost interventions – such as vaccines, treatment for severe acute malnutrition, and skilled care at birth – deliver some of the highest returns in global health, improving productivity, strengthening economies and reducing future public spending. Every dollar invested in child survival can generate up to twenty dollars in social and economic benefits.

To accelerate progress and save lives, governments, donors, and partners must:

1. make child survival a political and financing priority, with political commitment from high-burden countries to mobilize domestic resources, and improve access to evidence-based, quality services that are affordable for all;
2. focus on those at highest risk, especially mothers and children in sub-Saharan Africa and Southern Asia, and in conflict and fragile settings;
3. strengthen accountability for existing commitments to reduce maternal, newborn, and child deaths, including transparent data collection, tracking, and reporting; and
4. invest in primary health care systems to prevent, diagnose and treat the leading causes of death in children, including through community health workers and skilled care at birth.