Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

Abstract

Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food.Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9•8-51•9% and the prevalence of wasting is increased by 10-50%. 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 used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months.Findings Our least severe scenario (coverage reductions of 9•8-18•5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39•3-51•9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9•8-44•7% in under-5 child deaths per month, and an 8•3-38•6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence 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.Interpretation 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. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come.Funding Bill & Melinda Gates Foundation, Global Affairs Canada.

Missing during COVID‐19 lockdown: Children with onset of type 1 diabetes

“…Post‐epidemic data analysis revealed that deaths due to non‐Ebola conditions exceeded those due to Ebola virus infection because the national healthcare systems failed to provide essential care to non‐Ebola patients 8 . Similarly, the indirect effects of COVID‐19 pandemic on child mortality are expected to be devastating due to widespread disruption to health systems in the low‐resource countries 1 . Early estimates represent a 9.8%‐44.7% increase in child deaths per month due to reduced care‐seeking for common childhood killer diseases in countries with poor healthcare systems 1 .…”

COVID‐19 and maternal and child food and nutrition insecurity: a complex syndemic

“…Globally, the COVID‐19 pandemic has already led to major increases in unemployment (International Labour Organization, 2020a) and is expected to lead to unprecedentedincreases in poverty (International Labour Organization, 2020b; International Monetary Fund, 2020), as well as poor physical and mental health. COVID‐19 is projected to hit particularly hard the food, nutrition, and health security of vulnerable groups including young children, pregnant and lactating women further exacerbating social and health inequities (Roberton et al, 2020; UNICEF, WHO, WFP, &FAO, 2020). One mechanism by which this is likely to happen is through a major decline in food security which exists when ‘all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food which meets their dietary needs and food preferences for an active and healthy life’ (FAO, 2006).…”

“…A major concern is the increasing evidence of the high risk of major disruptions in maternal, newborn, and child health services (MNCH), particularly in low‐ and middle‐ income countries during COVID‐19 times (Roberton et al, 2020). This may be due in part due to fears related to seeking health care, but may also be due to limited transportation availability during lockdowns as well as limited health service provision as health facilities turn their attention to the pandemic.…”

Is the effect of COVID‐19 on children underestimated in low‐ and middle‐ income countries?

“…It is therefore imperative that other methods of estimating the burden of COVID‐19 in LMICs may have to be utilised including syndromic surveillance as well as modelling data. However, modelling in COVID‐19 has led to different predictions depending on assumptions made 3 . It is therefore difficult to tell which path the pandemic will follow in reality.…”