Trends, causes, and risk factor-attributable under-five mortality in low-income and middle-income countries: a systematic analysis of the Global Burden of Disease Study 2023
1
Curtin School of Population Health, Curtin University, Perth, Australia
2
Department of Reproductive and Family Health , School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
3
School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
4
Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
5
enAble Institute, Curtin University, Perth, Australia
6
World Health Organization Collaborating Centre for Climate Change and Health Impact Assessment, Perth, Australia
7
Faculty of Medicine, Universitas Negeri Malang, Malang, Indonesia
8
Institute for Health Research, University of Notre Dame, Fremantle, Australia
9
School of Public Health, University of Adelaide, Adelaide, Australia
Popul. Med. 2026;8(Supplement Supplement 1):A2346
ABSTRACT
INTRODUCTION:
Nearly five million children die each year before the age of five, with more than 98% occurring in low- and middle-income countries (LMICs). Despite global commitments to reduce preventable under-five deaths, comprehensive evidence on all-cause, cause composition, risk-attributable mortality across LMICs remains limited.
METHODS:
We analysed the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2023) estimates for 131 LMICs to examine all-cause, cause-specific, sex-specific, and risk-attributable under-five, infant, neonatal mortality from 1990 to 2023. Progress towards Sustainable Development Goal (SDG) under-five mortality (U5M) targets was assessed.
RESULTS:
Under-five deaths in LMICs declined by 59.6%, from 11.4 million (95% uncertainty interval [UI] 11.2–11.5) in 1990 to 4.6 million (4.5–4.7) in 2023. Over the same period, the under-five mortality rate (U5MR) decreased from 94.5 (89.8–99.3) to 39.2 (33.4–46.1) deaths per 1000 livebirths. In 2023, infant deaths accounted for 73.1% (3.4 million) and neonatal deaths for 43.6% (2.0 million) of under-five deaths. Five causes, neonatal disorders (34.9%), lower respiratory infections (13.2%), congenital birth defects (9.6%), malaria (8.9%), and diarrheal diseases (6.9%), accounted for 73.4%. Low birth weight, short gestation, and child undernutrition remained the leading attributable-risk factors. Progress slowed in recent years, with the relative contribution of non-communicable diseases and injuries, including deaths from conflict and terrorism and exposure to natural forces, increasing. Meanwhile deaths from measles and pertussis increased by 93.4% and 57.4%, respectively, and nearly one-fifth of LMICs experienced reversal in annual rate of reduction. Nearly half (49.6%) of LMICs remain off track to meet SDG target for U5MR.
CONCLUSIONS:
Despite substantial gains over the past three decades, U5M in LMICs faces risks of stagnation and reversal. Accelerated, integrated actions, strengthening maternal and child health services and building resilient health systems, are needed. Further research should investigate rising vaccine-preventable deaths and persistent disparities.
Nearly five million children die each year before the age of five, with more than 98% occurring in low- and middle-income countries (LMICs). Despite global commitments to reduce preventable under-five deaths, comprehensive evidence on all-cause, cause composition, risk-attributable mortality across LMICs remains limited.
METHODS:
We analysed the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2023) estimates for 131 LMICs to examine all-cause, cause-specific, sex-specific, and risk-attributable under-five, infant, neonatal mortality from 1990 to 2023. Progress towards Sustainable Development Goal (SDG) under-five mortality (U5M) targets was assessed.
RESULTS:
Under-five deaths in LMICs declined by 59.6%, from 11.4 million (95% uncertainty interval [UI] 11.2–11.5) in 1990 to 4.6 million (4.5–4.7) in 2023. Over the same period, the under-five mortality rate (U5MR) decreased from 94.5 (89.8–99.3) to 39.2 (33.4–46.1) deaths per 1000 livebirths. In 2023, infant deaths accounted for 73.1% (3.4 million) and neonatal deaths for 43.6% (2.0 million) of under-five deaths. Five causes, neonatal disorders (34.9%), lower respiratory infections (13.2%), congenital birth defects (9.6%), malaria (8.9%), and diarrheal diseases (6.9%), accounted for 73.4%. Low birth weight, short gestation, and child undernutrition remained the leading attributable-risk factors. Progress slowed in recent years, with the relative contribution of non-communicable diseases and injuries, including deaths from conflict and terrorism and exposure to natural forces, increasing. Meanwhile deaths from measles and pertussis increased by 93.4% and 57.4%, respectively, and nearly one-fifth of LMICs experienced reversal in annual rate of reduction. Nearly half (49.6%) of LMICs remain off track to meet SDG target for U5MR.
CONCLUSIONS:
Despite substantial gains over the past three decades, U5M in LMICs faces risks of stagnation and reversal. Accelerated, integrated actions, strengthening maternal and child health services and building resilient health systems, are needed. Further research should investigate rising vaccine-preventable deaths and persistent disparities.
| eISSN: | 2654-1459 |
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