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Leading Causes of Death in Children Under Five Could be Eliminated by 2025


Diarrhea and pneumonia – regarded as relatively minor illnesses in high-income countries – are together the leading causes of death for children worldwide. This is according to a new series in The Lancet on childhood diarrhea and pneumonia, which provides the evidence for integrated global action to address these conditions, including treatment and prevention interventions. The series also details the costs of preventing deaths from childhood diarrhea and pneumonia by 2025. The report  features a number of articles authored by Johns Hopkins Bloomberg School of Public Health faculty, and will be published to coincide with the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD).

“Diarrhea and pneumonia are devastating illnesses which needlessly claim of the lives of children worldwide,” said Robert Black, MD, MPH, senior author of the first paper in the series and the Bloomberg School’s chair and Edgar Berman Professor in International Health. “The Lancet Childhood Pneumonia and Diarrhea Series identifies key interventions that, if implemented effectively, could prevent the unnecessary deaths of millions of children every year.”

The first paper in the series, written by Black and colleagues, examines the global impact of diarrhea and pneumonia on childhood mortality rates. According to researchers, pneumonia and diarrhea account for over a quarter of all deaths in children worldwide, and were responsible for around two million child deaths in 2011. Diarrhea caused some 700,000 deaths in children under five and pneumonia was responsible for 1.3 million deaths in the same age group. Nearly 72 percent of deaths from diarrhea and over 81 percent of pneumonia deaths are in children under two years old.

The researchers also found that sub-Saharan Africa and Southeast Asia experienced the highest burden of these diseases, with nearly 74 percent of deaths from diarrhea and pneumonia occurring in just fifteen countries. Although mortality rates from the diseases are falling in most areas, some countries are still experiencing a growing number of deaths each year, including Afghanistan, Burkina Faso, Democratic Republic of Congo, Cameroon, Chad and Mali.

“While diarrhea and pneumonia have very different symptoms and causes, several risk factors for the two diseases are the same, including under-nutrition, sub-optimal breastfeeding, and zinc deficiency, meaning that they can be effectively prevented and treated as part of a coordinated program,” noted Black.

According to the study’s authors, “mass vaccination campaigns will need to play an important role, and nearly a third of episodes of severe diarrhea could be prevented by widespread vaccinations against rotavirus and cholera, with up to two thirds of pneumonia deaths thought to be vaccine preventable.”

The series’ authors report the following conclusions:

  • Modest further investment could eliminate diarrhea deaths in just over a decade.
  • Diarrhea and pneumonia remain low on the list of worldwide public health priorities, despite their huge global impact.
  • Ending all child deaths from pneumonia and diarrhea by 2025 is achievable.

The series will be launched on April 12, 2013, at a special event at the Royal College of Pediatrics and Child Health in London.

Series authors indicate, “The Lancet series identifies 15 key interventions that, if delivered at high coverage and quality, would eliminate 95 percent of diarrheal and 67 percent of pneumonia deaths in children younger than 5 years by 2025.”

Johns Hopkins Bloomberg School of Public Health media contact: Natalie Wood-Wright at 410-614-6029 or