Pneumonia was the leading killer in five of them, all in Africa: Angola, the Democratic Republic of Congo, Ethiopia, Nigeria and Tanzania, said a study published in The Lancet medical journal.
In Bangladesh, Indonesia, India and Pakistan, the main cause of death was preterm birth complications -- also the global leader -- while in China birth defects claimed most of the children who never made their fifth birthday.
"Accelerated investment in child survival is imperative," to meet the UN's Sustainable Development Goals (SDGs), the authors wrote.
The worst-performing countries today lose more than 90 children under five per 1,000 live births, said the researchers, citing including Angola, Central African Republic, Chad, Mali, Nigeria, Sierra Leone and Somalia.
The team recommended "the uptake of breastfeeding, providing vaccines for pneumonia, malaria and diarrhoea, and improving water and sanitation," to prevent child deaths in the worst-afflicted nations of the world.
In countries with low death rates such as the United States and Russia with fewer than 10 per 1,000 births, the causes were very different -- mainly birth defects, complications from preterm delivery, and injuries such as stove burns, car accidents or drowning.
The research was funded by the UN's World Health Organization and the Bill & Melinda Gates philanthropic organisation.
Globally, four million fewer under-five children died in 2015 than in 2000, the researchers found.
This represented a 53-percent decline -- short of the two-thirds reduction target for 1990-2015 set in the Millennium Development Goals which preceded the SDGs.
The slowest progress, said the new study, was in reducing newborn deaths.
"Child survival has improved substantially since the Millennium Development Goals were set," the study's lead author Li Liu of the Johns Hopkins Bloomberg School of Public Health said.
In a comment on the study, also published by The Lancet, Peter Byass of the Umea Centre for Global Research in Sweden said it was an indictment that researchers had to rely on estimates and not real, recorded numbers.
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