Paulson KR, Kamath AM, Alam T, et al. - Between 2000 and 2019, global child mortality fell by over half, but progress in neonates slowed, and 65 (32%) of 204 countries, largely in Sub-Saharan Africa and South Asia, are on course to miss either SDG 3.2 target by 2030. Improved perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, a stronger focus on equity, continued poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to significantly improve under-5 mortality rate (U5MR). Given COVID-19's vast effects, maintaining and accelerating development will necessitate a significant amount of effort.

• Global U5MR fell from 71·2 fatalities per 1000 livebirths in 2000 to 37·1 in 2019, while global neonatal mortality rate (NMR) fell more slowly from 28·0 deaths per 1000 live births in 2000 to 17·9 in 2019.

• In 2019, 136 (67%) of 204 nations had a U5MR at or below the SDG 3.2 threshold, and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario implies that by 2030, 154 (75%) of all countries will have met the U5MR targets and 139 (68%) would have met the NMR targets.

• In 2000, there were 9·65 million deaths of children under the age of five, compared to 5·05 million in 2019, with the newborn death rate rising from 39% in 2000 to 48% in 2019.

• Although there was no statistically significant difference at the global level, males had higher NMR and U5MR than females. In 2019, the leading cause of death in children under the age of 5 remained neonatal disorders, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria.

• According to the global optimum analysis, NMR could be reduced to as low as 0·80 deaths per 1000 livebirths and U5MR to 1·44 deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million of 5·05 million more deaths of children under the age of 5 than the survival potential frontier.