The following evidence-based interventions have been proven to reduce under-five mortality associated with the most common causes of death in low-income countries:

Causes of death and associated evidence-based interventions

Below is further detail on some of these evidence-based interventions.


Vaccines are the single most powerful tool for reducing under-five mortality. Key vaccines for preventing premature child death include measles, polio, diphtheria, tetanus, & pertussis (DTP3), Haemophilius influenzae type B, pneumococcal vaccines, and rotavirus. All of these can be administered efficiently and effectively through community health programs.

Community-based prevention and management of common child illnesses

Community health workers and community health posts have helped extend the reach of the public health system to rural and vulnerable communities.


Community health workers have led public education activities to improve health through prevention. Their efforts have improved immunization and breastfeeding rates, promoted use of prevention tools such as ITNs for malaria, and improved hygiene and health-seeking behavior in general to reduce child death.

In many geographies, community health workers also provide diagnostic and treatment services. They can effectively diagnose and treat some of the biggest killers of children under five, including lower respiratory infections, diarrheal diseases, and malaria. Community health workers have also been leveraged to administer antibiotics, oral rehydration therapy, zinc supplements, and antimalarial combination therapy.


Additionally, in an increasing number of countries, community health workers have helped with the long-term management and treatment of HIV and tuberculosis. This includes the prevention of mother-to-child transmission and the testing of children born to HIV-positive mothers.1

Integrated management of childhood illness

Integrated management of childhood illness (IMCI), developed by the WHO and UNICEF, is an integrated approach to child health that focuses on the well-being of the whole child. 2


The strategy, which has already been adopted by more than 100 countries, includes three main components:

  • Improving case management skills of health care staff
  • Improving overall health systems
  • Improving family and community health practices 2

At the heart of the IMCI strategy is an emphasis on prevention through immunization and improved nutrition, combined with the integrated management of five leading causes of childhood deaths: acute respiratory infections, diarrheal diseases, measles, malaria, and malnutrition. 

Nutrition education and management of malnutrition

One of the most effective tools for preventing early child death is the promotion of breastfeeding. Exclusive breastfeeding for six months not only improves a child’s nutrition, but also shields the child from unclean local water which might be used to wash and cook household foods.

Community Health Workers and facility-based health professionals have been effective educators and promoters of exclusive breastfeeding and proper complementary feeding for infants over six months old. They have also promoted Vitamin A supplementation, which has been proven to reduce risk of illness and death due to common causes such as measles and diarrhea. Lastly, they have also conducted screening for severe acute malnutrition and have helped manage it, through providing ready-to-use food, rehydration, and antibiotics. 34

Nutrition education and promotion, including breastfeeding and proper complementary feeding, is also a key part of the IMCI strategy.

What Works? 

Table 1: Infant and Child Under-5 Mortality Evidence Based Interventions

Lower respiratory infections

Diarrheal diseases


Antibiotic treatment


Vaccination: PCV


Vaccination: Hib


Community-based management


Facility-based management

Oral rehydration therapy


Zinc supplementation


Vaccination: Rotavirus


Community-based management


Facility-based management

Antimalarial combination therapy


Rapid diagnostic testing


Insecticide-treated nets


Indoor residual spray


Intermittent preventative therapy for high-risk groups


Community-based management


Facility-based management





Vaccination: Measles


Vitamin A supplementation

Exclusive breastfeeding for 6 months


Continued breastfeeding and complementary feeding after 6 months


Vitamin A supplementation


Management of severe acute malnutrition (ready-to-use food, rehydration, antibiotics)


Early diagnosis and antiretroviral treatment for infants and children


HIV testing of children born to HIV+ mothers


Prevention of mother-to-child transmission



Other vaccine preventable diseases

Vaccination: PCV meningococcal


Vaccination: Hib


Vaccination: Meningococcal


Vaccination: BCG


Antibiotic treatment


Chemoprophylaxis during acute outbreaks

Vaccination: Tetanus


Vaccination: Diphtheria


Vaccination: Pertussis


Vaccination: Polio


Neonatal care

Although about one in ten neonatal deaths are the result of congenital abnormalities, there are still opportunities to reduce neonatal deaths through providing care at the following stages.


Key interventions in the antenatal period can have a large impact on neonatal mortality. All pregnant women should have at least four antenatal visits with a trained provider, including an early visit in the first trimester. (WHO recommendations have recently increased to eight visits). These visits are an opportunity to prevent or diagnose and treat preeclampsia and eclampsia. They are also an opportunity to provide pregnant women with supplements, such as folic acid and iron, which help improve the health of the fetus and test pregnant women for HIV to prevent mother-to-child transmission. Pregnant women should also be given two tetanus vaccinations before their third trimester. In malaria-endemic areas, antenatal visits are an opportunity to ensure pregnant women are provided appropriate prevention interventions, such as insecticide-treated bed nets. Lastly, antenatal care visits can encourage women to deliver at health facilities and can provide health education on subjects such as nutrition and how to identify warning signs of pregnancy complications.



Facility-based delivery should be encouraged and made available to all expectant mothers. Facilities should follow clean delivery practices, including handwashing, clean cord-cutting, and cord care. In addition, they should provide active management of delivery, including partograph use and provision of postpartum oxytocin. In settings where access to facilities is limited, communities rely on trained skilled birth attendants who can provide basic emergency obstetric and newborn care (BEmONC). However, it is critical to link these skilled birth attendants to referral and transport systems, to ensure access to higher level care when complications arise. This includes access to comprehensive emergency obstetric and newborn care (CEmONC) in higher-level facilities, which can provide the necessary care for mothers.


During delivery, quality care can greatly reduce the risk of early newborn and maternal harm. For example, antibiotics for preterm premature rupture of the membranes (PPROM), corticosteroids for preterm labor, and caesarean-section for breech or obstructed labor can reduce both neonatal and maternal mortality.


Facility providers should be trained and equipped to perform newborn resuscitation, prevent and manage hypothermia, and provide Kangaroo care for low birth weight and prematurity. In addition, they should encourage mothers to begin breastfeeding their newborn within the first hour of life and should keep mothers and newborns in the facility for at least 24 hours after birth.

Early postnatal visits to identify danger signs and provide active referral should be standard practice. Antibiotics can be given to newborns for suspected or confirmed infection, and neonatal intensive care units (with trained staff following established protocols) can safeguard newborns during this riskiest period of their lives.

What Works? 

Table 2: Neonatal Mortality Evidence-Based Interventions



Folic acid supplementation

Tetanus vaccination


Malaria prevention and treatment:

Intermittent presumptive treatment



Iodine supplementation (in endemic iodine deficient settings)


4 or more antenatal visits (ANC4)


Prevention and treatment of preeclampsia

and eclampsia




Antibiotics for PPROM


Corticosteroids for preterm labor


C-section for breech or obstructed labor


Active management of delivery (including partograph)


Clean delivery practices (incl. clean



Trained birth attendant


Facility-based delivery


Basic emergency obstetric and newborn care (BEmONC)


Comprehensive emergency obstetric and newborn care (CEmONC)


Timely transport for higher level care for mother

Newborn resuscitation


Immediate breastfeeding


Prevention and management of hypothermia:

Immediate drying and wrapping

Delayed bathing


Baby warming


Kangaroo care for LBW/prematurity


Timely transport for higher level care for mother


Post-partum visits to identify danger signs and provide active referral


Antibiotics for suspected or confirmed infection


Surfactant therapy for RDS and prematurity


Neonatal intensive care units (equipped, trained staff, standards and protocols established and followed)

  1. 1
    Schmitz K, Basera TJ, Egbujie B, Mistri P, Naidoo N, Mapanga W, et al. Impact of lay health worker programmes on the health outcomes of mother-child pairs of HIV exposed children in Africa: A scoping review. PLoS ONE. 2019;14(1): e0211439. Accessed January 21, 2020.
  2. 2
    Integrated Management of Childhood Illness (IMCI). WHO. Accessed January 7, 2020.
  3. 3
    Vitamin A supplementation in infants and children 6-59 months of age. Integrated Management of Childhood Illness (IMCI). WHO. Accessed January 7, 2020.
  4. 4
    Gottlieb J. Case 4: Reducing child mortality with vitamin A in Nepal. In: Levine R. Case Studies in Global Health: Millions Saved. Sudbury, MA: Jones and Bartlett Publishers; 2007:25-32. Accessed January 7, 2020.

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