Submission ID 131678
| Issue/Objective | Nearly five million children die each year before their fifth birthday, with over 98% of these deaths occurring in low- and middle-income countries (LMICs). We assessed trends in all-cause, cause-specific, and risk-factor-attributable under-five mortality (U5M) across LMICs from 1990 to 2023. |
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| Methodology/Approach | We analysed the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2023) estimates for 131 LMICs from 1990 to 2023. All-cause mortality was estimated using the OneMod framework; cause-specific mortality was derived from the Cause of Death Ensemble model; and risk-attributable mortality was quantified within the GBD comparative risk assessment framework. We examined trends in all-cause, cause-specific, sex-specific, and risk-attributable mortality among children younger than five years, including infants and neonates. National progress towards Sustainable Development Goal (SDG) 3·2 targets was assessed using annualised rates of change (AROC). |
| Results | Findings Under-five deaths in LMICs declined by 59·6%, from 11·4 million (95% uncertainty interval [UI] 11·2-11·5) in 1990 to 4·6 million (4·5-4·7) in 2023. The corresponding under-five mortality rate decreased from 98·8 (97·7-100·0) to 39·8 (39·1-40·5) deaths per 1000 livebirths. In 2023, Infant and neonatal deaths accounted for 73·1% (3·4 million) and 43·6% (2·0 million) of under-five deaths, respectively. Five leading causes, neonatal disorders (34·8%), lower respiratory infections (13·2%), congenital birth defects (9·6%), malaria (8·9%), and diarrhoeal diseases (6·9%), accounted for 73·4% of under-five deaths. Between 2020 and 2023, deaths from measles increased by 93·4% and pertussis by 57·4%. 100 of 131 LMICs (76·3%) experienced decelerated or reversed AROC, and 70 (53·4%) are projected to miss the SDG U5M target by 2030. |
| Discussion/Conclusion | Interpretation Despite substantial long-term reductions, progress in U5M in LMICs remains uneven, with recent slowdowns and reversals in many countries threatening the achievement of SDG child survival targets. Accelerated, targeted investments in maternal, perinatal, and child health services, including facility-based care, routine immunisation, and nutritional interventions, are critical to reducing preventable under-five deaths. |
| Presenters and Affiliations | Gizachew Tessema Curtin University Bereket Kefale Curtin University Gavin Pereira Curtin University Jonine Jancey Curtin University Amanuel Gebremedhin Curtin University |
