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In order to guide efforts to achieve Millennium Development Goal 4 (a two-thirds reduction in under-5s mortality between 1990 and 2015) yearly estimates of global mortality in this age group are published. The estimates for 2008 (Lancet 2010;375:1969–87; see also Comment, ibid: 1941–3) include data from 193 countries. Worldwide in 2008 there were 8.795 million deaths of children aged <5 years. Infection was the cause of 68% of the deaths, pneumonia causing 18% of all deaths, diarrhoea 15%, and malaria 8%. Neonatal deaths were 41% of the total and the main causes were preterm birth complications (12% of all deaths in children <5 years old), birth asphyxia (9%), sepsis (6%), and pneumonia (4%). Congenital abnormalities caused 4.3% of all deaths in the under 5s, injuries 3.3%, AIDS 2.3%, pertussis 2.2%, and meningitis 1.9%. Almost half (49%) of all deaths (4.294 million deaths) were in five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. Most deaths from malaria or AIDS were in sub-Saharan Africa.

There has been considerable pessimism about Millennium Development Goal 4 (MDG4) because most countries are not on target to reduce under-5s mortality by two-thirds between 1990 and 2015. Nevertheless recent assessments have given some room for optimism in that the last 20 years has seen a 35% reduction in under-5s mortality in developing countries and the rate of decline has accelerated in many countries of sub-Saharan Africa. An assessment of trends in under-5s mortality …

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