September 20, 2020

Indirect effects of Covid-19 on child death rates could be devastating

According to an article published in the Lancet the indirect effects of the Covid-19 pandemic on maternal and child mortality rates in low-income and middle-incomes countries could reach a devastating possible maximum of 56 700 additional maternal deaths and 1 157 000 additional child deaths over 6 months in the 118 countries reviewed.

These additional deaths would represent an increase of 44·7% in under-5 child deaths per month, and a 6% increase in maternal deaths per month across these countries.

The authors explain they do not intend these as predictions, but as real possibilities resulting from the potential disruption of health systems and decreased access to food. “Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic.”

While the Covid-19 pandemic will increase mortality due to the virus, it is also likely to increase child and maternal mortality indirectly

This study, conducted in May, which were relatively early days in the pandemic, warned that while the Covid-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly and focused this study on estimates of additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food.

“The global community is responding in unprecedented ways to limit the spread of severe acute respiratory syndrome coronavirus 2 and reduce mortality from Covid 19. Global organisations have called for maintaining routine health services during the pandemic; however, the potential indirect effects on mortality from maternal and child health service disruption have not been quantified.”

The report warns that previous infectious disease outbreaks indirectly resulted in increases in mortality caused by reductions in the provision and use of routine health services. These are the unexpected outcomes of the pandemic which are not hitting the headlines as the focus continues to be on containing Covid-19. Little research has been done so far on the broader consequences of the pandemic as medical resources are diverted away from ongoing health services.

While we are seeing severe interruptions of the treatment of ongoing care of chronic and serious illnesses, as outpatients fear that visiting hospitals and clinics pose the risk of incurring Covid-19 infections, the focus so far has largely been on the treatment of HIV/AIDS, TB and malaria patients and not on maternal and child mortality as an outcome of the pandemic.

The Lancet article raised concerns over consequent cuts in four childbirth interventions ‑ parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments‑ which it estimates would account for approximately 60% of additional maternal deaths.

A possible increase in wasting among children under five due to decreased access to food would account for 18-23% of additional child deaths, and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths.

The authors stress that “although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic... We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months.

“Although mortality rates for COVID-19 appear to be low in children and in women of reproductive age, these groups might be disproportionately affected by the disruption of routine health services, particularly in low-income and middle-income countries.

“Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. “

The article emphasises that in weighing their options, policy makers must consider not only the immediate health effects of the pandemic but also its indirect effects and the response to it. An analysis of the 2014 outbreak of Ebola virus in west Africa, for example, showed that the indirect effects of the outbreak were more severe than the outbreak itself.

Past epidemics have shown that governments struggle to maintain routine services in health services and utilisation of services decreases.

The study quotes the World Health Organisation that notes, “People, efforts, and medical supplies all shift to respond to the emergency. This often leads to the neglect of basic and regular essential health services. People with health problems unrelated to the epidemic find it harder to get access to health care services.”

It uses as an example to illustrate this point a study of the 2014 epidemic of the Ebola virus in which it was estimated that, “during the outbreak, antenatal care coverage decreased by 22 percentage points, and there were declines in the coverage of family planning (6 percentage points), facility delivery (8 percentage points), and postnatal care (13 percentage points).”

Studies show that this resulted from the fear of contracting the Ebola virus at health facilities, an overall distrust of the health system, and rumours about the source of the disease.

“We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come,” the authors write.

 

Moira Levy

Additional Info

  • Author: Moira Levy
Last modified on Thursday, 06 August 2020 20:14

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