From 1990 to 2008, over 200 million children under five (including almost 80 million newborns) died needlessly from preventable causes.1 Another four billion children survived but were unable to reach their full potential.

Despite these sobering statistics, there are reasons for optimism. The number of deaths among the under-fives has fallen from 12.4 million in 1990 to 8.1 million in 2009.3 Despite this downward trend, the mortality rate has only fallen by a third – from 89 deaths per 1000 live births in 1990 to 60 in 2009. This decline remains insufficient to reach Millennium Development Goal 4 (MDG 4), particularly in sub-Saharan Africa, Southern Asia and Oceania.

About half of all child deaths in 2009 occurred in just five countries: India (21%), Nigeria (10%), Democratic Republic of the Congo, Pakistan and China. The two biggest killers of children under-five are pneumonia (18% of deaths) and diarrheal diseases (15%). Most of these deaths could be prevented with simple and cost-effective interventions. Additional efforts are urgently needed to help prevent an additional 4 million child deaths per year and achieve a two-thirds reduction by 2015 (MDG 4).