Global, regional, and national levels and trends in under 5, infant, and neonatal mortality during 1990-2024 with scenario based projections to 2030: modelling study.

To estimate all cause neonatal, infant, and under 5 mortality for 200 countries and areas in 1990-2024; assess levels and trends to identify where mortality declines have slowed or accelerated and which countries risk missing international child survival targets; and project possible numbers of deaths during 2025-30 under scenarios of accelerating, decelerating, or stagnating mortality trends. Modelling study. Country specific household surveys, vital registration and sample vital registration systems, UNAIDS, CRED International Disaster Database, Uppsala Conflict Data Program/PRI Oslo datasets, the Armed Conflict Location and Event Data Project, the Center for Systemic Peace/Integrated Network for Societal Conflict Research, UN and other organisational crisis reports, and the World Population Prospects 2024 revision. Nationally representative data. Surveys were excluded from estimation if data quality concerns or crisis related fieldwork disruptions were documented or suspected. Vital registration data needed to include at least 80% population coverage. An estimated 4.9 million (90% uncertainty interval 4.7 to 5.2 million) children died before age 5 years in 2024, including 2.3 million (2.1 to 2.5 million) neonatal deaths. Mortality was highest in sub-Saharan Africa and South Asia, where uncertainty intervals were widest due to data sparsity and quality. The rate of decline was slower for neonates compared with children aged 1-59 months: the global neonatal mortality rate declined by 1.3% (0.5% to 1.9%) annually during 2015-24, compared with 1.7% (0.8% to 2.3%) for children aged 1-59 months. Progress has slowed significantly since 2015, with the global mortality rate in under 5s declining by 3.9% (3.7% to 4.0%) annually during 2000-15 versus 1.5% (0.8% to 1.9%) during 2015-24. Based on recent trends, 60 countries will not meet the sustainable development goal target for under 5 mortality, and 66 will not meet the neonatal mortality target. If recent trends continue, 27.3 million deaths in under 5s are projected between 2025 and 2030, nearly half in the neonatal period and predominantly in sub-Saharan Africa and South Asia. Millions of preventable deaths occur in children each year, and progress in reducing child mortality has slowed since 2015. Achieving global targets requires renewed commitment and sustained investment across the continuum of care, with emphasis on the neonatal period and regions with high mortality. Faster progress could avert millions of deaths, whereas stagnation or slower progress could result in substantially higher numbers of deaths. Strengthening data systems remains essential for tracking progress and guiding policy.