Objective  To investigate the under-5 mortality rate (U5MR) in Guangdong province and to analyze the variation in causes of U5MR for developing interventions for decreasing U5MR.

  Methods  The data on 20 057 deaths of children under 5 years old registered in Guangdong province from 2015 through 2018 were collected and analyzed statistically.

  Results  The neonatal mortality rate (NMR), infant mortality rate (IMR), and U5MR were 1.37‰, 2.06‰, and 2.73‰, respectively. The top five causes of the neonatal mortalities were preterm labor or low birth weight (21.97%), birth asphyxia (21.97%), other diseases of newborn (12.40%), other congenital anomalies (7.08%), and congenital heart disease (5.70%). During the 4-year period, the top five causes of the neonatal mortality and under five mortality were the same roughly, but the rank order of the top five causes of the mortalities varied slightly. The region-specific U5MR differed among the 21 municipalities of the province and the ratio of deaths with unclear diagnosis increased yearly.

  Conclusion  The under-5 mortality rate was at a low level in Guangdong province during 2015 – 2018 at the national level, indicating that maternal and child healthcare measures are effective.