The under age 5 mortality rate is an indicator of child health as well as the overall development and well-being of a population. As part of their Sustainable Development Goals, the United Nations has set a target of reducing under age 5 mortality to at least as low as 25 per 1 000 live births by 2030 (UN, 2015[1]).
The main causes of death amongst children under age 5 are those occurring in the newborn period (31.6%), lower respiratory infections (13.9%), and diarrhoea (9.1%). Communicable and infectious diseases are continuously some of the leading causes of under age 5 mortality, contribute to about 49% of deaths in children belonging to this age group (Perin et al., 2022[2]; UN IGME, 2022[3]). Malnutrition, as the underlying cause of some of these childhood diseases, is an impediment to the progress towards achieving the SDGs. In view of the importance of improving nutrition to promote heath and development, in 2012 the World Health Assembly endorsed a “Comprehensive implementation plan on maternal, infant and young child nutrition”, which specified a set of six global nutrition targets. The UN General Assembly has also proclaimed the UN Decade of Action on Nutrition (2016‑25). Oral rehydration therapy is an affordable and effective means to offset the debilitating effects of diarrhoea (WHO/UNICEF, 2006[4]).Countries and territories can also implement relatively inexpensive public health interventions including immunisation, and provide clean water and sanitation to reduce mortality due to communicable conditions (see indicator “Water and sanitation” in Chapter 4 and “Childhood vaccination” in Chapter 7).
In 2022, 4.9 million children died worldwide before their fifth birthday; although there has been a reduction in under-five mortality, the rate of reduction has decreased going from 3.8% in 2000‑15 to 2.1% in 2015‑22 (UN IGME, 2022[3]; UNICEF, 2024[5]). The average under age 5 mortality rate across lower-middle- and low- and upper middle‑income Asia-Pacific countries and territories was 28.2 and 14.4 deaths per 1 000 live births respectively (Figure 3.8). Singapore, Japan, Korea and Australia achieved rates of less than four deaths per 1 000 live births, similar to the average across OECD countries (3.4 deaths per 1 000 live births). Mortality rates in Pakistan, Papua New Guinea, Lao PDR and Myanmar were high at more than 40 deaths per 1 000 live births.
Whilst under age 5 mortality has significantly declined in lower-middle- and low-income Asia-Pacific countries and territories, progress varies amongst countries and territories. In China, Cambodia and Mongolia, mortality rate in 2022 was nearly less than half of the rate reported in 2010 (Figure 3.8). Evidence (WHO, 2015[6]) suggests that reductions in Cambodia are associated with better coverage of effective preventive and curative interventions such as essential immunisations, malaria prevention and treatment, vitamin A supplementation, birth spacing, early and exclusive breastfeeding and improvements in socio‑economic conditions. In order to achieve the SDG target, countries and territories need to accelerate their efforts, for example by scaling effective preventive and curative interventions, targeting the main causes of post-neonatal deaths, namely pneumonia, diarrhoea, malaria and undernutrition, and reaching the most vulnerable newborn babies and children (UNICEF, 2013[7]). In addition, focused efforts need to be undertaken to improve neonatal survival as nearly half of under age 5 deaths occur in the neonatal period (UN IGME, 2022[3]).
As is the case for infant mortality (see indicator “Infant mortality” in Chapter 3), inequalities in under age 5 mortality rates are widely prevalent (Figure 3.9). Across countries and territories, under age 5 mortality rates consistently vary based on household income and mother’s education level, and to a certain extent by geographical location. For example, Myanmar reported almost 80 more deaths in children under 5 per 1 000 live births for mothers with no education than those whose mothers had more than secondary education. Likewise, Myanmar reported 73 more deaths per 1 000 live births of children under 5 in the lowest income quintile than the highest-income group. Asia Pacific countries such as, DPRK and Fiji have similar under age 5 mortality rates for both income groups. Inequalities in mortality rates based on geographic locations (rural or urban) are not as evident in most Asia Pacific countries as in the income and education disaggregation, but there is considerable absolute gap in the Lao PDR, Myanmar and Pakistan. (Figure 3.9). Accelerating reductions in under age 5 mortality will require identifying these populations and tailoring health interventions to effectively address their needs.
