Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction
of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less
than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential
trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk
Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than
5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects
of COVID-19, and a novel framework for quantifying optimal child survival.
Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for
detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal
mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories,
notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially
targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all
GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second
is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access
and Quality Index.
Findings Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in
2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per
1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR
at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference
scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet
the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000
and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million
[95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in
males than in female s, although there was no statistically significant difference at the global level. Neonatal
disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower
respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis
suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44
(95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58;
37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential
frontier.
Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower
in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet
either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded
delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity,
continued focus on poverty reduction and education, and investment in strengthening health systems across the
development spectrum have the potential to substantially improve U5MR. Given the widespread effects of
COVID-19, considerable effort will be required to maintain and accelerate progress.
 

Title

The Lancet

Publisher

Elsevier

Publisher Country

United Kingdom

Indexing

Scopus

Impact Factor

37.0

Publication Type

Both (Printed and Online)

Volume

398

Year

2021

Pages

870-905