Child Growth Failure Drives a Major Hidden Share of Global Under-Five Mortality

Childhood mortality has long been a sensitive measure of a Nation’s Health Architecture, an indicator shaped by nutrition, infectious disease burden, maternal health, and socioeconomic stability. This finding reframes growth failure not merely as a nutritional concern, but as one of the most lethal and preventable risk factors in early life.

Nearly one million children worldwide die before their fifth birthday each year due to health consequences stemming from child growth failure, according to the Global Burden of Disease (GBD) 2023 analysis published in The Lancet Child & Adolescent Health . The study positions growth failure, including stunting, underweight, and wasting as the third leading risk factor for mortality and morbidity in children under five, emphasizing a silent crisis that continues despite decades of global health progress.

A New Light on an Old Threat

Early childhood is a period of rapid growth and development: the brain is expanding, the immune system is maturing, organs are developing, nutritional needs are high, and resilience to infection depends heavily on adequate reserves. When a child’s growth falters, due to inadequate nutrition, disease, poor maternal health, or adverse environmental conditions that fragile developmental foundation can crumble.

Child growth failure (CGF) – manifested as underweight, wasting, stunting or low birthweight, is increasingly recognized not merely as a long-term developmental risk, but as a direct and potent contributor to mortality and severe illness in early life. Recent global evidence suggests that growth failure may now represent one of the leading risk factors for under-five death and disease burden.

The Data: What the Global Analysis Reveals

Annual Mortality Burden Attributable to Growth Failure

According to the most recent comprehensive global analysis (GBD 2023), approximately 880,000 deaths among children under five years of age in 2023 are attributable to child growth failure.

This corresponds to roughly 18–20% of all under-five deaths globally nearly one in five child deaths worldwide.

While this is a substantial improvement compared to earlier years (e.g., in 2000, growth-failure, related under-five mortality was estimated at around 2.75 million), the absolute burden remains large and deeply inequitable.

Regional Disparities: Where the Burden Is Concentrated

The majority of CGF-related child deaths occur in sub-Saharan Africa and South Asia.

In sub-Saharan Africa, there were approximately 618,000 CGF-related under-five deaths in 2023.

In South Asia, approximately 165,000 under-five deaths were attributable to growth failure that year.

Together, these two regions account for over 90% of the global burden of CGF-related child mortality.

Anthropometric Malnutrition: Prevalence of Growth Failure

Available demographic and global nutrition data show:

• A large number of children under five worldwide experience chronic or acute malnutrition manifested as stunting, underweight, or wasting.
• Many children suffer from overlapping deficits, for example, both stunting (height deficit) and underweight or wasting (weight deficit).
• Because different forms of malnutrition often co-exist in the same child, the cumulative risk of disease and death grows dramatically.

Growth Failure as a Multiplier of Infection-Induced Mortality

Data from 2023 indicate that nearly 800,000 under-five deaths due to common infections, such as lower respiratory infections (pneumonia), diarrhoeal diseases, malaria, and measles occurred in children with underlying growth failure. In high-burden regions:

• In sub-Saharan Africa, 77% of diarrhoeal-disease deaths and 65% of lower respiratory infection deaths among under-fives involved children with growth failure.
• In South Asia, the comparable proportions were 79% (diarrhoeal deaths) and 53% (respiratory infection deaths).

Even in high-income regions, where CGF prevalence and overall under-five mortality are lower, a non-negligible fraction (33–35%) of infection-related under-five deaths still occurred in children with some degree of growth limitation.

Why Growth Failure Persists Causes and Mechanisms

Growth failure emerges from a complex interplay of socioeconomic, environmental, maternal, and biological factors. The major contributors and mechanisms include:

• Maternal undernutrition and prenatal adversity: Poor maternal nutrition, anemia, and inadequate prenatal care increase the risk of low birthweight, prematurity, and intrauterine growth restriction, setting the stage for growth failure from birth.
• Inadequate early-life nutrition: Suboptimal breastfeeding, delayed or insufficient complementary feeding, or nutrient-poor diets reduce energy and micronutrient intake, hindering growth.
• Recurrent infections and poor sanitation: Repeated diarrhoea, parasitic infections, environmental enteric dysfunction, and limited access to clean water or sanitation impair nutrient absorption and increase metabolic demands.
• Social determinants: Poverty, food insecurity, lack of maternal education, socio-political instability (e.g., conflict, displacement), and limited access to healthcare compound the risk.
• Cumulative and overlapping deficits: Chronic undernutrition (leading to stunting) weakens immunity and organ development, thereby increasing susceptibility to acute weight loss (wasting); acute wasting can, in turn, worsen chronic deficits, creating a vicious cycle that heightens mortality risk.

Young infants are especially vulnerable:early growth failure often starts within the first months of life, underscoring the importance of maternal and perinatal health, early breastfeeding, and infection prevention.

Implications for Health Policy and Practice

Given the magnitude, concentration, and biological consequences of CGF, addressing it must become a top global child-health priority. Key strategies should include:

Maternal and prenatal interventions: Ensure adequate maternal nutrition, iron and micronutrient supplementation, antenatal care, and prevention of low birthweight and prematurity.

Early-life nutrition support: Promote exclusive breastfeeding for the first six months, followed by timely, energy-dense, nutrient-rich complementary feeding.

Integrated infection control and WASH (water, sanitation, hygiene): Combine nutritional interventions with sanitation, vaccination, deworming, clean water access, and disease prevention to break the infection–malnutrition cycle.

Community-based growth monitoring and early detection: Use routine anthropometric surveillance (weight-for-age, height-for-age, weight-for-height) to flag growth faltering early and trigger prompt nutritional or medical interventions.

Targeted social protection and food security policies: In regions with high CGF burden, strengthen food distribution, social support, maternal education, and poverty-reduction initiatives.

Integrated maternal–child health systems: Create coordinated services spanning prenatal care, neonatal care, nutrition, immunization, sanitation, and growth monitoring.

Because reversing chronic growth failure (e.g., stunting) is difficult, prevention and early intervention remain the most effective strategies to reduce mortality and long-term health deficits.

Challenges, Data Gaps, and the Path Forward

While the global estimates provide a powerful summary of CGF-related mortality, several challenges and knowledge gaps remain:

Heterogeneity in data quality: Many high-burden regions lack robust vital registration systems; estimates rely partly on modeling, surveys, and extrapolations.

Overlap of growth-failure indicators: Children often present multiple deficits, making it difficult to attribute mortality risk to a single anthropometric measure.

Data on severity categories (e.g., moderate vs severe wasting) is limited, yet these distinctions may have large implications for risk and intervention strategy.

Longitudinal data scarcity: There is a need for more cohort studies following children over time to assess how early-life growth failure interacts with infections, development, and survival.

Implementation challenges: In many high-burden areas, scarcity of resources, political instability, climate change, and social inequities hinder outreach, nutrition programs, and health-system strengthening.

Addressing these gaps will require coordinated global research, improved data collection, investment in health systems, and policies that address upstream determinants of child health.

Conclusion: Growth Failure as a Preventable Global Crisis

The new global data present a stark but actionable truth: growth failure remains one of the most lethal yet preventable conditions affecting children under five years worldwide. With roughly 880,000 children dying in 2023 because of underlying malnutrition and growth deficits, the problem demands urgent, coordinated, and sustained action.

Reducing the mortality and morbidity burden associated with growth failure demands more than nutrition supplementation, it requires a holistic, multisectoral strategy spanning maternal health, early-life nutrition, infection control, sanitation, social protection, and health-system strengthening.

Every child lost to growth failure is a reminder that global inequities persist and that survival into childhood remains far more precarious in many parts of the world than in others. Confronting growth failure is not just a moral imperative, it is one of the most powerful opportunities for global health improvement.