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Global, regional, and national progress towards Sustainable Development Goal 3. Sustainable Development Goal 3. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study GBD findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in that include the consideration of potential effects of COVID, and a novel framework for quantifying optimal child survival.

Methods: We completed all-cause mortality and cause-specific mortality analyses from countries and territories for detailed age groups separately, with aggregated mortality probabilities per livebirths computed for neonatal mortality rate NMR and under-5 mortality rate U5MR.

Scenarios for represent different potential trajectories, notably including potential effects of the COVID pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years.

The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in , followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria.