The number of global under-five deaths dropped to its lowest point on record in 2019, down to 5.2 million from 12.5 million in 1990, according to new mortality estimates released by UNICEF, the World Health Organisation (WHO), the Population Division of the United Nations Department of Economic and Social Affairs and the World Bank Group.
Since then, however, surveys by UNICEF and WHO reveal that the Covid-19 pandemic has resulted in major disruptions to health services that threaten to undo decades of hard-won progress.
“The global community has come too far towards eliminating preventable child deaths to allow the Covid-19 pandemic to stop us in our tracks,” said UNICEF executive director Henrietta Fore. “When children are denied access to health services because the system is overrun, and when women are afraid to give birth at the hospital for fear of infection, they, too, may become casualties of Covid-19,” Fore said, adding that without urgent investments to re-start disrupted health systems and services, millions of children under five, especially newborns, could die.
Over the past 30 years, health services to prevent or treat causes of child death such as preterm, low birth weight, complications during birth, neonatal sepsis, pneumonia, diarrhea and malaria, as well as vaccination, have played a large role in saving millions of lives.
Recent child mortality estimates generated by the UN Inter-agency Group for Child Mortality Estimation (UN IGME) showed that Nepal has demonstrated remarkable progress in reducing the under-five mortality rate. In 2019, it was estimated at 31 per 1000 live births, or a 78 per cent reduction from the level of 1990. Nepal is one of the few countries meeting the targets of the Millenium Development Goal (MDG) 4.
Now countries worldwide are experiencing disruptions in child and maternal health services, such as health checkups, vaccinations and prenatal and post-natal care, due to resource constraints and a general uneasiness with using health services due to a fear of getting Covid-19.
A UNICEF survey conducted over the summer across 77 countries found that almost 68 per cent of countries reported at least some disruption in health checks for children and immunization services. In addition, 63 per cent of countries reported disruptions in antenatal checkups and 59 per cent in post-natal care.
A recent WHO survey based on responses from 105 countries revealed that 52 per cent of countries reported disruptions in health services for sick children and 51 per cent in services for management of malnutrition.
Similarly, in Nepal, rapid assessment conducted by UNFPA in coordination with Family Welfare Division during the initial phase of the lockdown period reported more than 60 per cent decline in antenatal visits and 35 per cent decrease in institutional delivery as compared to before the lockdown. Routine antenatal care and delivery at health facilities is extremely critical for the survival of both mothers and their newborns, according to the report.
Health interventions such as these are critical for stopping preventable newborn and child deaths. For example, women who receive care by professional midwives trained according to international standards are 16 per cent less likely to lose their baby and 24 per cent less likely to experience pre-term birth, according to WHO.
"The fact that today more children live to see their first birthday than any time in history is a true mark of what can be achieved when the world puts health and well-being at the centre of our response,” WHO director-general Dr Tedros Adhanom Ghebreyesus. “Now, we must not let the Covid-19 pandemic turn back remarkable progress for our children and future generations,” Ghebreyesus said, adding, ”Rather, it’s time to use what we know works to save lives, and keep investing in stronger, resilient health systems.”
Based on the responses from countries that participated in the UNICEF and WHO surveys, the most commonly cited reasons for health service disruptions included parents avoiding health centres for fear of infection; transport restrictions; suspension or closure of services and facilities; fewer healthcare workers due to diversions or fear of infection due to shortages in personal protective equipment such as masks and gloves; and greater financial difficulties. Afghanistan, Bolivia, Cameroon, the Central African Republic, Libya, Madagascar, Pakistan, Sudan and Yemen are among the hardest hit countries.
Seven of the nine countries had high child mortality rates of more than 50 deaths per 1000 live births among children under five in 2019.
Even before Covid-19, newborns were at highest risk of death. In 2019, a newborn baby died every 13 seconds. Moreover, 47 per cent of all under-five deaths occurred in the neonatal period, up from 40 per cent in 1990. With severe disruptions in essential health services, newborn babies could be at much higher risk of dying.
In May, initial modelling by Johns Hopkins University showed that almost 6,000 additional children could die per day due to disruptions due to Covid-19.
These reports and surveys highlight the need for urgent action to restore and improve childbirth services and antenatal and postnatal care for mothers and babies, including having skilled health workers to care for them at birth. Working with parents to assuage their fears and reassure them is also important.
“The Covid-19 pandemic has put years of global progress to end preventable child deaths in serious jeopardy,” said global director for Health, Nutrition and Population at the World Bank Muhammad Ali Pate. “It is essential to protect life-saving services which have been key to reducing child mortality,” Pate said, adding that they will continue to work with governments and partners to reinforce healthcare systems to ensure mothers and children get the services they need.
“The new report demonstrates the ongoing progress worldwide in reducing child mortality,” said director of the Population Division of the United Nations Department of Economic and Social Affairs John Wilmoth. “While the report highlights the negative effects of the Covid-19 pandemic on interventions that are critical for children’s health, it also draws attention to the need to redress the vast inequities in a child's prospects for survival and good health.”
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