Sub‑Saharan Africa remains the epicentre of global child mortality, with East African countries contributing a significant share of deaths among children under five despite decades of progress, according to the 2025 UN Inter-agency Group for Child Mortality Estimation (UN IGME) report.
The report shows that sub‑Saharan Africa recorded an estimated 2.83 million under‑five deaths in 2024, up from 3.03 million in 2015 but still far higher than any other region and now accounting for 58 per cent of all such deaths worldwide. The regional under‑five mortality rate stands at 71.6 deaths per 1,000 live births—almost 19 times higher than in Australia and New Zealand and 14 times higher than in Europe and Northern America.
While under‑five mortality in sub‑Saharan Africa has fallen by 53 per cent since 2000, the pace of decline has slowed sharply in the Sustainable Development Goals (SDG) era, dropping from an annual rate of reduction of 3.8 per cent in 2000–2015 to just 2.0 per cent in 2015–2024. Neonatal deaths—those in the first 28 days of life—have fallen even more slowly, with the regional neonatal mortality rate decreasing by only 32 per cent since 2000 and remaining high at 26.7 deaths per 1,000 live births in 2024.
Across East Africa and the wider sub‑region, nearly two‑thirds of under‑five deaths now occur after the first month of life, largely from preventable infectious causes. In sub‑Saharan Africa, pneumonia and malaria together account for nearly one‑third of all under‑five deaths, while diarrhoea, sepsis, meningitis and severe acute malnutrition also remain major killers. The region now represents 75 per cent of global diarrhoea deaths and 65 per cent of pneumonia deaths in children under five, reflecting both population growth and slower progress than in Southern Asia.
The report warns that fragile and conflict‑affected settings—many of them in East Africa and the Horn—face particularly stark risks. In countries classified as fragile or conflict‑affected, the under‑five mortality rate reaches 74.1 deaths per 1,000 live births, nearly three times the rate in non‑fragile states, with neonatal mortality also roughly double. Somalia and parts of Ethiopia, Sudan and South Sudan fall within this high‑risk category, where weak health systems, displacement and recurrent shocks undermine child survival.
On current trajectories, 27.3 million children worldwide are projected to die before their fifth birthday between 2025 and 2030, with 62 per cent of those deaths expected in sub‑Saharan Africa and 23 per cent in Southern Asia. If countries off track to meet SDG child survival targets—most of them in Africa—accelerate sufficiently to hit the 2030 benchmarks, more than 8 million of those deaths could be averted; if mortality rates instead stall at 2024 levels, total under‑five deaths over the period would climb to nearly 29.7 million.
UN agencies stress that East Africa’s child mortality burden is increasingly concentrated in the neonatal period and in poor, rural and conflict‑affected communities, calling for urgent investments in basic maternal and newborn care, treatment of infectious diseases, nutrition, and primary health systems to avert preventable deaths.
