Substantial progress in child mortality, experts say, but the world has missed Millennium Development Goal 4 Target

The research, by Dr Danzhen You and co-authors on behalf of the UN IGME, is the first to include U5MR estimates up to the MDG target year (2015) and to construct scenario-based projections from 2016 to 2030 to provide insights into the burden of under-five deaths in the next 15 years based on the newly proposed Sustainable Development Goal (SDG) target of 25 or fewer under-5 deaths per 1000 live births by 2030.

The global U5MR has fallen from 91 deaths per 1000 live births in 1990 to 43 in 2015. During the same period, absolute under-5 deaths worldwide dropped from 12·7 million to 5·9 million. In total, an estimated 236·3 million children under age five died in 1990-2015. The poorest global region of West and Central Africa continues to have the highest U5MR in the world.

Globally, U5MR reduced by 53% in the last 25 years and therefore missed the MDG 4 target (of two thirds). The data show that two regions -- East Asia and the Pacific, and Latin America and the Caribbean -- achieved the MDG 4 target. At the country level, 62 countries achieved the MDG 4 target [1]. Among them, 24 are low- and lower-middle income countries, from a variety of world regions -- including Ethiopia, Eritrea, Bangladesh, Georgia, El Salvador, Bolivia, Egypt, Cambodia, Nepal and Yemen.

Encouragingly, for 102 countries, the data suggest a faster decline in 2000-2015 as compared to 1990-2000. This acceleration since 2000, when the MDGs were established, resulted in about 18 million fewer under-five deaths globally, as compared to a scenario where the pace of decline would have remained the same as in the 1990s.

While there is no doubt that some countries have fared better than others, the data show that there is room for improvement, even in the 116 countries which already, in 2015, have a U5MR lower than 25. Should 2015 rates continue to 2030, a further 6 million children will die in these nations; yet if all of them reached the current lowest U5MR of 2.3 per 1000 live births recorded among countries with more than 10000 livebirths (Finland), then this would be reduced to 2 million. The authors also highlight the need to improve inequalities within countries, even in low-mortality countries.

Should the SDG target be met, this will save the lives of an extra 38 million children under 5 than if 2015 U5MR are maintained through to 2030. If current mortality rates are maintained, 94 million children will die in during 2015-2030; if the rate of progress from 2000-2015 is maintained from 2015-2030 then 69 million will die, while if the SDG target above is met, the death toll in under 5s will be 56 million.

In order to achieve the SDG goal on under-5 mortality, a total of 47 countries need to accelerate their U5MR progress, including 34 countries in sub-Saharan Africa along with 2 countries (Afghanistan and Pakistan) in South Asia. The authors highlight that, even with progress in U5MR , the actual numbers of child deaths may remain stagnant or even increase in sub-Saharan Africa, since in the region the under 5 child population is likely to increase by around 42 million from 2015-2030. Thus reduction in under-5 mortality rate must outpace increases in under 5 child population to continue the decline in total deaths.

The authors conclude, "The unfinished business of child survival looms large. Every child's death represents the loss of a unique human being. Countries and the international community must take immediate action to further accelerate further the pace of progress to fulfil children's rights to health and development. Without intensified efforts to reduce child mortality, particularly in the highest mortality areas and in contexts with persistent inequities, the post-2015 SDG target will be unattainable. Child survival must remain at the heart of the SDG agenda."

In a linked Comment, Dr Robert Black and Dr Li Liu, from John's Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, conclude: "That we have the necessary means to save these lives provides a moral imperative to implement the efficacious child survival interventions that are now available."