Child health

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This report was prepared at the United Nations Children’s Fund (UNICEF) headquarters by David Sharrow, Lucia Hug, Yang Liu, Naomi Lindt, Wanli Nie and Danzhen You on behalf of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).

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We would also like to recognize the important efforts of our UNICEF and WHO field office colleagues for supporting the country consultations.

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Differences between the estimates presented in this report and those in forthcoming publications by UN IGME members may arise because of differences in reporting periods or in the availability of data during the production process of each publication and other evidence.

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UN IGME estimates were reviewed by countries through a country consultation process but are not necessarily the official statistics of United Nations Member States, which may use a single data source or alternative rigorous methods.

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This accomplishment has the power to inspire action in every country and renew commitment at local, national and regional levels towards achieving the SDG targets and eliminating preventable child deaths once and for all.

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To realize these goals, we must take a closer look at the details and complexities behind global estimates.

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While this is progress to be lauded, the tragic loss of nearly 5 million children younger than 5 in 2022 must not be forgotten or overlooked.

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The knowledge and interventions to drive that number much lower are available – and greater investments must be made at local, national and global levels to deliver these solutions to every child in every corner of the globe.

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The slower decline in neonatal deaths is due to factors like population change and differences in the cause-of-death structure by age, with mortality among 1–59-month-olds being generally more responsive to basic public health interventions, while neonatal mortality relates more to complications around the time of birth.

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Central Asia’s under-five mortality rate was 70 in 1990, 61 in 2000 and 17 in 2022; Southern Asia’s under-five mortality rate was 127 in 1990, 92 in 2000, and 35 in 2022.

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Central Asia’s neonatal mortality rate was 28 in 1990, 27 in 2000 and 9 in 2022; Southern Asia’s neonatal mortality rate was 57 in 1990, 46 in 2000 and 22 in 2022.

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This map does not reflect a position by UN IGME agencies on the legal status of any country or territory or the delimitation of any frontiers.

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Central Asia’s under-five mortality rate in 2022 was 15 for females and 20 for males; Southern Asia’s under-five mortality rate in 2022 was 34 for females and 36 for males.

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Central Asia’s number of under-five deaths (in thousands) was 13 for females and 18 for males; Southern Asia’s number of under-five deaths (in thousands) was 590 for females and 668 for males.

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The greater than 75 per cent reduction in the U5MR in the Democratic People’s Republic of Korea was primarily driven by elevated rates at the start of the period, 2000, when the country was still affected by famine and its aftermath.

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The required ARR was derived based on the assumption that all countries in the region need to achieve the SDG target by 2030.

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If countries have already reached the target or are on track to do so before 2030, they should continue the observed 2015 to 2022 trend (as measured by ARR).

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Europe and Northern America and Australia and New Zealand do not have a required ARR because all countries in these regions already achieved the SDG target by 2022.

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The observed ARR of under-five mortality rate in Central Asia was 6.5 per cent in 2000–2015 and 3.9 per cent in 2015–2022; in Southern Asia, it was 4.3 per cent in 2000–2015 and 4.5 per cent in 2015–2022.

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The required ARR to meet the SDG target on under-five mortality is 4.2 per cent for Central Asia and 7.2 per cent for Southern Asia.

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The observed ARR in the neonatal mortality rate in Central Asia was 5.4 per cent in 2000–2015 and 3.7 per cent in 2015–2022; in Southern Asia, it was 3.1 per cent in 2000–2015 and 3.8 per cent in 2015–2022.

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Five countries/territories with mortality estimates do not have income classification available.

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Rates by mother’s education and urban/rural residence are UNICEF analysis based on DHS, MICS and other nationally representative sources.

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In 2022, Central Asia’s 5 –14-year mortality rate was 2.3 for females and 3.2 for males; Southern Asia’s 5 –14-year mortality rate was 4.0 for females and 5.1 for males.

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Central Asia’s deaths in the 5 –14-year age group (in thousands) was 1.7 for females and 2.6 for males; Southern Asia’s deaths in the 5–14-year age group (in thousands) was 71 for females and 97 for males.

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In 2022, Central Asia’s 15 –24-year mortality rate was 5.5 for females and 8.1 for males; Southern Asia’s 15 –24-year mortality rate was 7.5 for females and 10.7 for males.

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Central Asia’s deaths in the 15 –24-year age group (in thousands) was 3.1 for females and 4.8 for males; Southern Asia’s deaths in the 15–24-year age group (in thousands) was 132 for females and 205 for males.

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In 2022, Central Asia’s 10 –19-year mortality rate was 3.8 for females and 5.2 for males; Southern Asia’s 10–19-year mortality rate was 5.4 for females and 7.1 for males.

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Central Asia’s deaths in the 10 –19-year age group (in thousands) was 2.4 for females and 3.4 for males; Southern Asia’s deaths in the 10 –19-year age group (in thousands) was 97 for females and 136 for males.

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Accurate and up-to-date information regarding child mortality is not universally available.

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On average, the latest high-quality data point (i.e., a data point that is included in the UN IGME estimation model) on child mortality across all countries is 4.6 years old, with only half of the world’s countries having a data point within the past three years.

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Amid the unjust realities of inequity, fragility and conflict, this year’s UN IGME findings show that, with proper resources and unwavering commitment, children’s lives can be saved even when the threats are grave.

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Let us ensure the hard-won gains resulting from decades long efforts by governments, organizations, communities, families and individuals are honoured, sustained and increased.

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The GGBSEG method is implemented in the DDM package of the R statistical software.

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It can more accurately capture short-term fluctuations in the U5MR and its annual rate of reduction and, thus, is better able to account for evidence of acceleration in the decline of under-five mortality from new surveys.

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Solid points and lines represent data series/observations that were included in the statistical model.

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Unfilled circles and dash lines represent data series/ observations that were excluded.

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Ninety per cent uncertainty intervals for the U5MR are given by the pink bands.

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Not all countries had age-specific data available for all age groups, and countries that are not among the 200 countries that UN IGME produces annual estimates for are excluded from this figure.

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Thus, the number of countries in each age category is not necessarily the same.

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Australia and New Zealand), only one country out of 14 had data available, covering only 6 per cent of the under-five population, and is therefore not shown.

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The observed ARR in the U5MR for included countries in Central Asia was 7.6 per cent in 2000–2015 and 4.7 per cent in 2015–2022; in Southern Asia, it was 4.2 per cent in 2000–2015 and 4.6 per cent in 2015–2022.

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The required ARR to meet the SDG target on under-five mortality is 4.6 per cent for Central Asia and 7.3 per cent for Southern Asia.

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The observed ARR in the NMR for included countries in Central Asia was 6.6 per cent in 2000–2015 and 4.4 per cent in 2015–2022; in Southern Asia, it was 3.0 per cent in 2000–2015 and 3.9 per cent in 2015–2022.

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The Sample Registration System (SRS) of ORGI is the official data source of India for all mortality estimates.

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Aggregates presented for member organizations of the United Nations Inter-agency Group for Child Mortality Estimation may differ, and regional groupings with the same name from different member organizations (e.g., ‘Sub-Saharan Africa’) may include different countries.

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The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) was formed in 2004 to share data on child mortality, improve methods for child mortality estimation, report on progress towards child survival goals and enhance country capacity to produce timely and properly assessed estimates of child mortality.

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The UN IGME’s independent Technical Advisory Group, comprising leading academic scholars and independent experts in demography and biostatistics, provides technical guidance on estimation methods, technical issues and strategies for data analysis and data quality assessment.

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This report contains the latest UN IGME estimates of child mortality at country, regional and global levels.

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Suggested citation: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), Levels & Trends in Child Mortality: Report 2023, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation , United Nations Children’s Fund, New York, 2024.

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This report was prepared at the United Nations Children’s Fund (UNICEF) headquarters by David Sharrow, Lucia Hug, Yang Liu, Naomi Lindt and Danzhen You on behalf of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).

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We would also like to extend special thanks to UNICEF and WHO field office colleagues as well as Sebastian Bania, Ahamadi Dhoydine, John Paul-Joseph and the Platforms and Service Delivery O365 team at UNICEF for supporting the country consultations.

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While global under-five mortality declined by 59 per cent since 1990, several countries have managed to outpace that global decline despite relatively limited economic resources.

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While the analysis of CRVS data is a useful exercise in determining the extent of possible excess mortality, these data disproportionately represent high-income countries, which may differ in their mortality experience of the pandemic compared to low- or middle-income countries.

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Estimation of under-five mortality rates Estimation and projection of under-five mortality rates was undertaken using the Bayesian B-splines bias-adjusted model, referred to as the B3 model.

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This model was developed, validated and used to produce previous rounds of UN IGME child mortality estimates, including the previously published round in 2021.39, 40 In the B3 model, log(U5MR) is estimated with a flexible splines regression model.

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Data on infant mortality (<1 year) was available in a subset of countries.

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Confidence intervals, 95 per cent, were predicted using bootstrapping with 2,000 iterations.

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Aggregates presented for member organizations of the United Nations Inter-agency Group for Child Mortality Estimation may differ and regional classifications with the same name from different member organizations (e.g., “Sub-Saharan Africa”) may include different countries.

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Suggested citation: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), Levels & Trends in Child Mortality: Report 2022, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation, United Nations Children’s Fund, New York, 2023.

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This report was prepared at UNICEF headquarters by David Sharrow, Lucia Hug, Yang Liu, and Danzhen You on behalf of the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME).

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We would also like to extend special thanks to UNICEF and WHO field office colleagues as well as Sebastian Bania, Kassa Beyene, John Paul-Joseph and the Platforms and Service delivery O365 team at UNICEF for supporting the country consultations.

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This model was developed, validated, and used to produce the previous rounds of the UN IGME child mortality estimates, including the previously published round in September 2019.43,44 In the B3 model, log(U5MR) is estimated with a flexible splines regression model.

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It can more accurately capture short-term fluctuations in the U5MR and its annual rate of reduction and thus, is better able to account for evidence of acceleration in the decline of under-five mortality from new surveys.

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The B3 method was developed and implemented for the UN IGME by Leontine Alkema and Jin Rou New with guidance and review by the UN IGME’s TAG.

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This is to restrict the IMR estimate to be lower than the U5MR estimate for any given year.

Evidence card JSONRendered card

Download the PDF to a local file, then run the committed verifier. A changed PDF is reported as drift rather than silently accepted.

python scripts/verify_primary_public_claim_group.py artifacts/cb7k_dom025_t07_primary_claims.json --source-file <local-raw-pdf>

This analysis could lead to a different adjustment approach in future estimates.

Evidence card JSONRendered card

Download the PDF to a local file, then run the committed verifier. A changed PDF is reported as drift rather than silently accepted.

python scripts/verify_primary_public_claim_group.py artifacts/cb7k_dom025_t07_primary_claims.json --source-file <local-raw-pdf>

The International Disaster Database’, Université Catholique de Louvain, Brussels, Belgium, < www.emdat.be >.

Evidence card JSONRendered card

Download the PDF to a local file, then run the committed verifier. A changed PDF is reported as drift rather than silently accepted.

python scripts/verify_primary_public_claim_group.py artifacts/cb7k_dom025_t07_primary_claims.json --source-file <local-raw-pdf>

This report contains the latest UN IGME estimates of child mortality at the country, regional and global levels.

Evidence card JSONRendered card

Download the PDF to a local file, then run the committed verifier. A changed PDF is reported as drift rather than silently accepted.

python scripts/verify_primary_public_claim_group.py artifacts/cb7k_dom025_t07_primary_claims.json --source-file <local-raw-pdf>

Suggested citation: United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), ‘Levels & Trends in Child Mortality: Report 2020, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation’, United Nations Children’s Fund, New York, 2020.

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