An additional 2,400 children could die every day from preventable causes over the next six months in South Asia as the novel coronavirus (Covid-19) pandemic continues to weaken health systems and disrupt routine services across the region, UNICEF said today.
The estimate is based on an analysis by researchers from the Johns Hopkins Bloomberg School of Public Health, newly published in The Lancet Global Health journal. Based on the worst of three scenarios in 118 low- and middle-income countries globally, the analysis estimates that an additional 1.2 million under-five deaths could occur in just six months, due to reductions in routine health service coverage levels and an increase in child wasting. The researchers estimate that in the next six months up to 300,000 children could die in India alone; 95,000 in Pakistan, 28,000 in Bangladesh, 13,000 in Afghanistan, and 4,000 in Nepal.
“We fear that the number of children dying before their fifth birthdays is going to increase for the first time in decades,” said UNICEF regional director for South Asia, Jean Gough. “We must protect the mothers, the pregnant women and children in South Asia at all cost,” he said, adding that fighting the pandemic is critical but we cannot lose momentum on the decades of progress we have made in the region to reduce preventable maternal and child deaths.
“It is crucial that childbirth, child health and nutrition services remain available for families during the time of Covid-19,” said UNICEF regional health adviser for South Asia Dr Paul Rutter. “It would be terrible to see a situation in which many thousands of children die, not because of the virus itself but because routine services are disrupted.”
In countries with already weak health systems, Covid-19 is causing disruptions in medical supply chains and straining financial and human resources. Visits to health care centres are declining due to lockdowns, curfews and transport disruptions, and as communities remain fearful of infection. In a commentary to the Lancet report, UNICEF warns these disruptions could result in potentially devastating increases in maternal and child deaths.
The paper analyses three scenarios for the impact of reductions in lifesaving interventions due to the crisis on child and maternal deaths globally. It warns that in the least severe scenario, where coverage is reduced around 15 per cent, there would be a 9.8 per cent increase in under-five child deaths, or an estimated 1,400 a day globally, and an 8.3 per cent increase in maternal deaths. In the worst-case scenario, where health interventions are reduced by around 45 per cent, there could be as much as a 44.7 per cent increase in under-five child deaths and 38.6 per cent increase in maternal deaths per month. These interventions range from family planning, antenatal and postnatal care, child delivery, vaccinations and preventive and curative services. The estimates show that if, for whatever reason, routine health care is disrupted and access to food is decreased, the increase in child and maternal deaths will be devastating. The greatest number of additional child deaths will be due to an increase in wasting prevalence among children, which includes the potential impact beyond the health system, and reduction in treatment of neonatal sepsis and pneumonia.
According to the modeling, and assuming reductions in coverage in the worst-case scenario, the 10 countries that could potentially have the largest number of additional child deaths are: Bangladesh, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Uganda and United Republic of Tanzania. The 10 countries that are most likely to witness the highest excess child mortality rates under the worst-case scenario are: Djibouti, Eswatini, Lesotho, Liberia, Mali, Malawi, Nigeria, Pakistan, Sierra Leone and Somalia. Continued provision of life-saving services is critical in these countries.
In addition to the estimated potential rise in under-five and maternal deaths described in the Lancet Global Health Journal analysis, UNICEF is deeply alarmed by the other knock-on effects of the pandemic on children:
• An estimated 77 per cent of children under the age of 18 worldwide – 1.80 billion out of 2.35 billion – were living in one of the 132 countries with stay-at-home policies, as of early May.
• Nearly 1.3 billion students – over 72 per cent – are out of school as a result of nationwide school closures in 177 countries.
• 40 per cent of the world’s population are not able to wash their hands with soap and water at home.
• Nearly 370 million children across 143 countries who normally rely on school meals for a reliable source of daily nutrition must now look to other sources as schools are shuttered.
• As of 14 April, over 117 million children in 37 countries may miss out on their measles vaccination as the pandemic causes immunization campaigns to stop to reduce the risk of spreading the virus.
The estimate is based on an analysis by researchers from the Johns Hopkins Bloomberg School of Public Health, newly published in The Lancet Global Health journal. Based on the worst of three scenarios in 118 low- and middle-income countries globally, the analysis estimates that an additional 1.2 million under-five deaths could occur in just six months, due to reductions in routine health service coverage levels and an increase in child wasting. The researchers estimate that in the next six months up to 300,000 children could die in India alone; 95,000 in Pakistan, 28,000 in Bangladesh, 13,000 in Afghanistan, and 4,000 in Nepal.
“We fear that the number of children dying before their fifth birthdays is going to increase for the first time in decades,” said UNICEF regional director for South Asia, Jean Gough. “We must protect the mothers, the pregnant women and children in South Asia at all cost,” he said, adding that fighting the pandemic is critical but we cannot lose momentum on the decades of progress we have made in the region to reduce preventable maternal and child deaths.
“It is crucial that childbirth, child health and nutrition services remain available for families during the time of Covid-19,” said UNICEF regional health adviser for South Asia Dr Paul Rutter. “It would be terrible to see a situation in which many thousands of children die, not because of the virus itself but because routine services are disrupted.”
In countries with already weak health systems, Covid-19 is causing disruptions in medical supply chains and straining financial and human resources. Visits to health care centres are declining due to lockdowns, curfews and transport disruptions, and as communities remain fearful of infection. In a commentary to the Lancet report, UNICEF warns these disruptions could result in potentially devastating increases in maternal and child deaths.
The paper analyses three scenarios for the impact of reductions in lifesaving interventions due to the crisis on child and maternal deaths globally. It warns that in the least severe scenario, where coverage is reduced around 15 per cent, there would be a 9.8 per cent increase in under-five child deaths, or an estimated 1,400 a day globally, and an 8.3 per cent increase in maternal deaths. In the worst-case scenario, where health interventions are reduced by around 45 per cent, there could be as much as a 44.7 per cent increase in under-five child deaths and 38.6 per cent increase in maternal deaths per month. These interventions range from family planning, antenatal and postnatal care, child delivery, vaccinations and preventive and curative services. The estimates show that if, for whatever reason, routine health care is disrupted and access to food is decreased, the increase in child and maternal deaths will be devastating. The greatest number of additional child deaths will be due to an increase in wasting prevalence among children, which includes the potential impact beyond the health system, and reduction in treatment of neonatal sepsis and pneumonia.
According to the modeling, and assuming reductions in coverage in the worst-case scenario, the 10 countries that could potentially have the largest number of additional child deaths are: Bangladesh, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Uganda and United Republic of Tanzania. The 10 countries that are most likely to witness the highest excess child mortality rates under the worst-case scenario are: Djibouti, Eswatini, Lesotho, Liberia, Mali, Malawi, Nigeria, Pakistan, Sierra Leone and Somalia. Continued provision of life-saving services is critical in these countries.
In addition to the estimated potential rise in under-five and maternal deaths described in the Lancet Global Health Journal analysis, UNICEF is deeply alarmed by the other knock-on effects of the pandemic on children:
• An estimated 77 per cent of children under the age of 18 worldwide – 1.80 billion out of 2.35 billion – were living in one of the 132 countries with stay-at-home policies, as of early May.
• Nearly 1.3 billion students – over 72 per cent – are out of school as a result of nationwide school closures in 177 countries.
• 40 per cent of the world’s population are not able to wash their hands with soap and water at home.
• Nearly 370 million children across 143 countries who normally rely on school meals for a reliable source of daily nutrition must now look to other sources as schools are shuttered.
• As of 14 April, over 117 million children in 37 countries may miss out on their measles vaccination as the pandemic causes immunization campaigns to stop to reduce the risk of spreading the virus.
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