In 2021, 5 million children died before turning 5 years old. Many of these tragedies occurred because children were deprived of their basic right to quality health care, vaccinations, proper food and clean water and sanitation. Too many children continue to die because efforts to address preventable communicable and infectious diseases remain inadequate.

An estimated 2.1 million children, adolescents and youth aged 5–24 years died that same year. Over half of these deaths occured among adolescents and youth aged 15–24 years. These losses are not only unacceptable on a personal level, but also represent an unnecessary setback to development. Focused measures are needed to ensure the survival of the most vulnerable children, adolescents and youth, to end preventable deaths and to deliver the promise of a healthy adulthood.

Children around the world face vastly different chances of survival. Globally, the under-five mortality rate was 38 deaths per 1,000 live births in 2021, but in sub-Saharan Africa, the rate was 74 deaths per 1,000 live births. In low-income countries, the 2021 under-five mortality rate was 67 deaths per 1,000 live births, versus just 5 deaths per 1,000 live births in high-income countries. Children and youth older than 5 years old also face the highest probability of dying in subSaharan Africa.

More children and youth died in subSaharan Africa and Southern Asia than all other regions in 2021. More than 80 per cent of under-five deaths and about 70 per cent of all deaths among 5–24-year-olds occurred in sub-Saharan Africa and Southern Asia. This unjust burden must be recognized, prioritized and addressed.

The first 28 days of life remain the most vulnerable period for child survival. In 2021, approximately 2.3 million children died during the first month of life – or about 6,400 babies every day. These deaths constituted nearly 47 per cent of the under-five deaths that took place that same year. Children in sub-Saharan Africa continue to face the greatest risk of dying during the neonatal period.

Renewed focus is needed to address mortality among children aged 1–59 months. Children in this age group accounted for 2.7 million of 2021’s under-five deaths. Moreover, that burden is not equitably shared around the world: Over 40 per cent of all under-five deaths globally in 2021 were among children aged 1–59 months in subSaharan Africa and Southern Asia.

Conflict and emergencies – including the COVID-19 pandemic – continue to threaten the survival of children. The under-five mortality rate in the 37 countries classified as fragile and conflict-affected situations was triple the rate in all other countries. And though available data on the impact of COVID-19 show no systematic evidence of excess child mortality, this area will require continued monitoring given limited data and the pandemic’s potential impact on access to health care and intervention provision.

Persistent data gaps are limiting efforts to end preventable child deaths. Quality data are vital to monitoring the survival of children during the neonatal period, the remainder of the under-five period, throughout adolescence and into early adulthood. Investing in data collection mechanisms and systems – particularly in conflict-affected situations – is an essential component of realizing children’s rights and achieving the SDGs.

Without urgent action, 54 countries will not meet the under-five mortality target by 2030 and an even larger number – 63 countries – will miss the neonatal mortality target. Most countries that are off track to meet the SDG target on underfive mortality are in sub-Saharan Africa or classified as low- or lower-middle-income countries. Increased investment is required across all ages – from the neonatal period through young adulthood – to reduce the number of these deaths, including a renewed focus on children aged 1–59 months. Ending preventable deaths is a critical step to upholding every child’s right to survive and thrive.

Source: UN Department of Economic and Social Affairs

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