Millenium Development Goal (MDG) 4
Updated September 2011
The fourth Millennium Development Goal (MDG 4) aims to reduce the 1990 mortality rate among under-five children by two thirds. Child mortality is also closely linked to MDG 5- to improve maternal health. Since more than one third of all child deaths occur within the first month of life, providing skilled care to mothers during pregnancy, as well as during and after birth, greatly contributes to child survival. Millennium Development Goals adopted by the United Nations in 2000 aim to decrease child deaths worldwide by 2015.
Main causes of children deaths
- Nearly 9 million children under the age of five die every year, according to 2007 figures.
- Around 70% of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable interventions.
- Leading causes of death in under-five children are pneumonia, diarrhoea and health problems during the first month of life.
- Over one third of all child deaths are linked to malnutrition.
- Children in developing countries are ten times more likely to die before the age of five than children in developed countries.
The challenge – accelerating child survival
Latest figures show that 9.2 million children under-five are dying every year, down from over 12 million in 1990. Most of these children are dying in developing countries from preventable causes for which there are known and cost-effective interventions. Unless efforts are increased there will be little hope of averting the additional 5.4 million child deaths per year, or a reduction of two-thirds, needed to achieve Millennium Development Goal (MDG) 4 by 2015.
Key facts: uneven and insufficient progress
- More than one billion children are severely deprived of at least one of the essential goods and services they require to survive, grow and develop—these include nutrition, water, sanitation facilities, access to basic health-care services, adequate shelter, education and information. As a result almost 9.2 million children under-five die every year. A further 3.3 million babies are stillborn.
- Most of the 25,000 children under five that die each day are concentrated in the world’s poorest countries in sub-Saharan Africa and South Asia. There, the child mortality rate is 29 times greater than in industrialized countries: 175 deaths per 1000 children compared with 6 per 1000 in industrialized countries.
Child mortality rates
Causes of under-five child deaths
Six conditions account for about 70% of all child deaths: acute lower respiratory infections, mostly pneumonia (19%), diarrhoea (18%), malaria (8%), measles, (4%), HIV/AIDS (3%), and neonatal conditions, mainly pre-term birth, birth asphyxia, and infections (37%). The relative contribution of HIV/AIDS to the total mortality of children under-five, especially in sub-Saharan Africa, has also been increasing steadily. Malnutrition is a factor in more than half of the children who die after the first month of life.
Why are death tolls still high?
- Poor families are often unable to obtain even the most basic health care for their children. Poor or delayed care-seeking contributes to up to 70% of all under-five child deaths.
- Of the 12 countries where more than 20% of children die before their fifth birthday, nine have suffered a major armed conflict in recently.
- Countries with weak and fragile health systems have not been able to provide effective child survival strategies that are crucial to reduce under-five child deaths, and especially neonatal deaths. Basic health services have been lacking as well as nutrition, water supplies and sanitation facilities.
- Almost half a million deaths each year due to malaria in children under-five in sub-Saharan Africa could have been prevented with the use of insecticide-treated bed nets, shown to reduce underfive mortality rates by up to 20%
What can be done?
- Scaling up effective health services: more than 60% of all under-five child deaths can be avoided with proven, low-cost preventive care and treatment. Preventive care includes: continuous breast-feeding, vaccination, adequate nutrition and, in Africa, the use of insecticide treated bed nets. The major causes of under-five deaths need to be treated rapidly: for example, with salt solutions for diarrhoea or simple antibiotics for pneumonia and other infections. To reach the majority of children who today do not have access to this care, we need more and better trained and equipped health workers. Families and communities need to know how best to bring up their children healthily and deal with sickness when it occurs.
- Political awareness, commitment and leadership are needed to ensure that child health receives the attention and resources needed to accelerate progress towards MDG4. Better information on the number and causes of under-five child deaths will help leaders to decide on the best course of action.
Countdown to 2015 – Tracking Progress in Maternal, Newborn and Child Survival
The Countdown to 2015 Initiative collects and analyses data from 68 countries that account for at least 95 % of maternal and child deaths, working to create an account of progress towards the achievement of MDGs 4 and 5. The Countdown Initiative has released Reports in 2005, 2008 and 2010 and produces country profiles that present coverage data for a range of key health services including:
- Contraceptive use
- Antenatal care
- Skilled attendance at delivery
- Postnatal care
- Child health
- Financial investments in MNCH
- Equity of access, health systems and policy
Coverage of essential interventions