UNICEF reports that the number of deaths for children under 5 declined significantly over the last 20 years. Last year, 6.9 million children died before their fifth birthday, a significant decrease from 1990 when roughly 12 million children died. Improvements were driven by poor countries becoming richer and large amounts of well-targeted international aid. The agency said civil strife also was an important factor related to child mortality, as eight of the 10 countries with the highest mortality rates are also in conflict or fragile political situations. Globally, the five leading causes of death for children under 5 include pneumonia (18 percent), pre-term birth complications (14 percent), diarrhea (11 percent), birth complications (9 percent), and malaria (7 percent).