African countries

Fewer children die before their fifth birthday. But African countries are lagging behind

The world has seen a 59% drop in the number of deaths of children under the age of five since 1990. New mortality estimates indicate that the largest drop occurred in 2019, when the number of deaths of children under the age of five. children under five worldwide has been reduced to 5.2 million from 12.5 million in 1990.

Substantial progress in reducing child deaths came four years after the launch of the Sustainable Development Goals. These goals include the elimination of preventable infant mortality; reduce the number of neonatal deaths to less than 12 per 1,000 live births; and reduce deaths of children under five to less than 25 per 1,000 live births. The date for achieving these goals is 2030.

It may be too early to attribute any success to the Sustainable Development Goals. But progress may be the result of related efforts such as improved nutrition, housing, water, sanitation, education and financial security. The availability of health services to prevent or treat common causes of child death may also have played a role.

Despite this progress, sub-Saharan Africa recorded the highest neonatal mortality rate with 27 deaths per 1,000 children born alive in 2019. A child born in sub-Saharan Africa or South Asia is 10 times more likely to die in Africa. during the first month that a child. child born in a rich country.

Likewise, sub-Saharan Africa remains the region with the highest under-five mortality rate in the world. In 2019, one in 13 children in the region died before reaching their fifth birthday. This is 15 times higher than the risk for children born in high-income countries. It is clear that there is still a lot of work to be done.

We recently published a study that aims to show where countries should focus their public health efforts to meet the goals by 2030. Our article is part of the Global Burden of Disease study. It presents the rates and trends of under-five deaths between 2000 and 2019 and makes projections to 2030. These projections are based on several health scenarios. We hope they will help identify which countries and regions are on track to meet the goals of the Sustainable Development Goals and which are not – and what to do about them.

Study results

In this study, we analyzed secondary data, spanning two decades, from 204 countries and territories. The results show that each country saw some decrease in the number of child deaths between 2000 and 2019. Globally, the number of child deaths fell from 71.2 per 1000 births in 2000 to 37.1 in 2019.

Our research also identified the countries with the highest number of deaths in 2019. Among them were the Central African Republic, Mali and Chad. Regionally, sub-Saharan Africa and South Asia have recorded the highest number of deaths.

In 2015, 128 of the 204 countries in our study had already reached the Sustainable Development Goal threshold of deaths of children under five below 25 per 1,000 births. Egypt and Libya were the only African countries among those 128. In 2019, there were 136 countries below this threshold. With the exception of Morocco, no African country reached the threshold in 2019.

In terms of causes of death, neonatal disorders remained the leading cause of death in 2019, followed by lower respiratory tract infections, diarrheal diseases, birth defects and malaria. More male children died than female children.

Our projections show that 154 countries are likely to meet the goals of reducing child deaths by 2030. This means that 50 (25%) countries are off track. Most are located in low and middle income countries, especially in Africa, where Algeria is the only country on the right track. So much more work is needed to put African countries on target.

The progress described above may be hampered by the widespread effect of COVID-19. Infant mortality is not directly affected by COVID-19, but the effect on child health services in general cannot be underestimated. It will take considerable effort to sustain and accelerate progress.

The path to follow

Our analysis suggests the need for well-designed strategies to optimize child survival. They should include strategies and community efforts to address the social determinants of health, such as education, family planning, social support, food security, and financial security. Investments should aim for balance in all critical areas and overall strengthening of the system, with particular focus on reducing inequalities.


  • Balance early newborn care with continued prenatal and older child health initiatives.

  • Invest in stronger health systems to scale up interventions.

  • Reduce disparities within countries and integrate other determinants of health.

  • Expand community and facility strategies for pregnancy, labor, delivery and the postpartum period.

  • Combat shortages and retain qualified health workers, strengthen the infrastructure of establishments, develop and strengthen referral networks and expand the integrated services necessary to ensure access and quality of care.

  • Intensify community initiatives such as vaccination campaigns, insecticide-treated mosquito nets against malaria, prevention of mother-to-child transmission of HIV and nutrition as well as integrated management of childhood diseases.

  • Diarrhea treatment campaigns such as oral rehydration solution, zinc, and rotavirus vaccines have been successful. They still need improvements in drinking water, sanitation and nutrition.

  • Improve perinatal and newborn care and expand interventions such as vaccination and infection prevention.

A greater focus on equity, poverty reduction and education, and investing in strengthening health systems across the development spectrum, can dramatically reduce deaths in children under five .