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Where Do Child Deaths Occur?




<< Previous Causes of Child Deaths

Nearly all (99 percent) of child deaths occur in low- and middle-income countries.
  • One in four of the world’s 600 million children under the age of five live in a country where their risk of death is at least 20 times higher than in the U.S.1

  • Of deaths to children under five, 90 percent occur in 42 countries and 95 percent occur in 75 countries.2

  • In 2008 fifty-one percent of all child deaths occur in Africa and 42 percent in Asia, but the leading causes of death vary greatly by region.3

  • About half of under-five deaths occur in six countries with large populations: India, Nigeria, Democratic Republic of Congo, Ethiopia, Pakistan and China.4

  • Since 1990, the child mortality rate has either increased or remained constant in at least 26 other countries.5
The Ten Countries with the Highest Numbers of Child Deaths, 20076


Population
(thousands)		 Number of children
born per year
(thousands)		 Number of child
deaths per year
(thousands)		 Under-5 child mortality
rate (deaths per 1,000
live births)
India 1,169,016 27,119 1,953 72
Nigeria 148,093 5,959 1,126 189
Democratic
Republic of
Congo		 62,636 3,118 502 161
Pakistan 163,902 4,446 400 90
China 1,328,630 17,374 382 22
Ethiopia 83,099 3,201 381 119
Afghanistan 27,145 1,314 338 257
Bangladesh 158,665 3,998 244 61
Uganda 30,884 1,445 188 130
Tanzania 40,454 1,600 186 116


Although most of the countries with the highest numbers of child deaths have large populations, such as India and China, children in many smaller countries have a higher death rate (probability of dying before age five, expressed as the child or under-five deaths per 1,000 live births). Ten countries have under-five mortality rates (U5MR) that are equal to or exceed 180 per 1,000 live births.6 Some countries with high mortality rates have experienced recent armed conflict or a widespread AIDS epidemic in the general population.7
  • The countries with the highest child mortality rates also have among the highest infant mortality rates (IMR, a subset of deaths per 1,000 live births that occur in the first year of life ), fertility rates, maternal mortality ratios, lifetime risk of maternal death, and population growth rates.4

  • In 60 countries (with rates of child mortality exceeding 50 deaths/1,000 live births), the under-five population has increased in the last decade by 13 percent (37 million children).8
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The Ten Countries with the Highest Child Mortality Rates (Deaths Under-Five per 1,000 Live Births), 20076


Population
(millions)		 Number of children
born per year
(thousands)		 Number of child
deaths per year
(thousands)		 Under-5 child mortality
rate (deaths per 1,000
live births)
Sierra Leone 5,866 268 70 262
Afghanistan 27,145 1,314 338 257
Chad 10,781 492 103 209
Equatorial Guinea 507 20 4 206
Guinea-Bissau 1,695 84 17 198
Mali 12,337 595 117 196
Burkina Faso 14,784 654 125 191
Nigeria 148,093 5,959 1,126 189
Rwanda 9,725 435 79 181
Burundi 8,508 399 72 180


The 2008 overall under-five mortality rate for the world is 65 per 1,000 live births. The rate for the 21 least developed countries is twice the global rate (65 per 1,000 live births).3
  • Child mortality rates in Western and Central Africa, Eastern and Southern Africa, and South Asia are all higher than the global rate.

  • In the industrialized countries, the U5MR is six per 1,000 live births.
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Under-five Mortality Rates, by Country Type and by Region, 20076
  • The child mortality rate in some individual countries has not changed or has increased since 1990.6, 9

  • Of the 68 countries with 97 percent of child mortality, those with increased U5MR since 1990 are: Botswana, Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Kenya, Lesotho, South Africa, Swaziland, Zambia and Zimbabwe. In several of these countries, HIV/AIDS is driving child mortality higher.5
Overall, child mortality (U5MR) has declined over time, in both industrialized and developing countries.
  • Despite the declines, the 50 least developed countries still have very high child mortality rates – nearly four times higher than the rate that existed in industrialized countries in 1960.

  • In sub-Saharan Africa, the reductions in the past quarter century in sub-Saharan Africa have been less dramatic than the progress that occurred between 1960 and 1980.
Trends in Under-five Mortality Rate, by Country Type, 1960 - 200510



Trends in Under-five Mortality Rate, by Region, 1960 - 200510


<< Previous Causes of Child Deaths
1 Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet 2003;361:2226-34. 23, 2007).
2 Bryce J, Black RE, Walker N, Bhutta ZA, Lawn JE, Steketee RW. Can the world afford to save the lives of 6 million children each year? Lancet 2005;365(9478):2193-200.
3 You D, Wardlaw T, Salama P, Jones G. Levels and trends in under-5 mortality, 1990-2008. The Lancet. 2009;S0140-6736(09):61601-9.
4 UNICEF. The state of the world's children. 2007 [cited April 23, 2007]; Available from: www.unicef.org/publications/index_36587.html
5 UNICEF. Countdown to 2015: Tracking progress in maternal, newborn and child survival: the 2008 report; 2008. Available from: www.countdown2015mnch.org/documents/2008report/2008Countdown2015FullReport_2ndEdition_1x1.pdf
6 UNICEF. The state of the world's children 2009; 2009 Available from: www.unicef.org/sowc09/
7 Bryce J, Terreri N, Victora CG, Mason E, Daelmans B, Bhutta ZA, et al. Countdown to 2015: tracking intervention coverage for child survival. Lancet 2006;368:1067-76.
8 U.S. Census Bureau. International Data Base. [cited June 12, 2007]; Available from: www.census.gov/ipc/www/idb/
9 Ahmad OB, Lopez AD, Inoue M. The decline in child mortality: A reappraisal. Bulletin of the World Health Organization 2000;78:1175-91.
10 UNICEF. Statistics: Under 5 Mortality Rate. [cited May 11, 2007]; Available from: www.childinfo.org/areas/childmortality/u5data.php
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