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      A wake-up call: COVID-19 and its impact on children's health and wellbeing

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      The Lancet. Global Health

      The Author(s). Published by Elsevier Ltd.

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          Abstract

          As cases of COVID-19 surge worldwide and threaten to overwhelm life-saving health services, the survival of mothers and children is at great risk. In The Lancet Global Health, Timothy Roberton and colleagues 1 present startling new evidence on the potential rise in maternal and child mortality in low-income and middle-income countries if essential health services are disrupted as a result of COVID-19. Building on lessons learned from previous outbreaks of Ebola virus disease and severe acute respiratory syndrome (SARS), the authors estimate a devastating increase in the numbers of maternal and child deaths resulting from reductions in routine health service coverage. Left unchecked, these reductions (due to, for example, disruptions in medical supply chains or the availability of human and financial resources) along with declines in the uptake of health services by communities fearful of infection will be more catastrophic for mothers and children than COVID-19 itself. The projection of an additional 1·2 million child deaths and 56 700 maternal deaths in 118 countries if coverage of essential services drops by around 45% for 6 months is alarming. It is also avoidable if we act now. These findings reinforce the multi-part approach that UNICEF has adopted from the start of the outbreak. 2 First, we are working to prevent COVID-19 transmission and treat those who fall sick. Second, we are working to address the effects of the policy responses aimed at containing the spread, including maintaining routine health services for all children and mothers, ensuring continuity of learning, keeping mothers and children safe and protected from violence, and scaling up social protections to keep children and their families afloat. Third, we are working to strengthen the systems that underpin all of these services. The evidence is already showing the negative effects of COVID-19, and the unprecedented measures to contain it, on maternal and child health. Children are at risk not only of infection, but also of losing or being separated from family members and caregivers. Mothers and children are affected by the disruption of essential preventative and curative support and supplies resulting from suspensions in services and transportation systems, as well as by financial constraints.3, 4 Constrained access to clinics, schools, social workers, water, and sanitation is a particular threat to the most vulnerable populations, and the lack of child protection and broader social services is particularly harmful to women and children in need of safety. Looming above all of these concerns is the economic impact of both the pandemic control measures governments are taking and the predicted knock-on effects of the projected global recession: 5 reduced incomes, public and private debt, and reduced access to goods will affect many aspects of household health and nutrition. In short, these effects threaten to roll back the hard-won progress countries have made in recent decades. As a global community, overcoming the negative impacts of the pandemic will require focus on six key areas of action and investment. First, we must keep children healthy and well nourished by providing supplies and protective equipment, which must reach health workers and affected communities. At the same time, life-saving maternal, newborn, and child health services, routine vaccinations, and access to HIV treatment must be maintained. Second, we must urgently prioritise funding and support for maintaining and strengthening water, sanitation, and hygiene. The combined work of governments and the private sector will be required to increase the practice of handwashing across the board, tapping into local innovation and global partnerships. Third, learning and connectedness among children must be maintained, and support must be given to governments to provide no-technology, low-technology, and digital solutions. Already before the crisis, UNICEF was working on an initiative 6 with partners to extend digital infrastructure to ensure all children can learn, no matter who and where they are, and this work needs to be brought quickly to scale. Fourth, we must recognise parents and families as essential front-line workers. They need support through social protection measures that include cash and nutrition support. Fiscal response packages must target women and children. More than ever, everyone needs access to paid family leave, paid sick leave, and childcare. Fifth, services to prevent and address gender-based violence—including counselling and support—must be designed and delivered. These services should be designated as essential, and moved online. The current crisis makes women and children even more vulnerable to violence. 3 Finally, we must not forget about refugee and migrant children or children affected by conflict. An effective COVID-19 response is one that includes all children in a country—whatever their status. As we think through new and innovative ways to support children and their families, it is encouraging to see that many local initiatives have already begun. 7 These initiatives push us all to consider the new opportunities that this crisis creates for communities to recover better, build stronger systems, and orient these services to reach all people, rich and poor alike. This kind of long-term thinking can help us to prevent further loss of life from COVID-19 and to reduce the effects of the global recession, while making progress towards the healthier, more equal, resilient, and sustainable future envisioned in the UN Sustainable Development Goals. This future is not automatic. It begins by heeding the findings of models like those presented by Roberton and colleagues, and by realising that the full effects of the disease on health and wellbeing of children reach beyond the immediate illness. These effects threaten global progress in a number of areas, as well as the lives and rights of a generation of children. By working together as a global community, we can learn from these data and invest in future-oriented solutions now, and spur a lasting recovery that will benefit children and communities for decades to come.

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          Most cited references 1

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          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

          Summary 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.
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            Author and article information

            Contributors
            Journal
            Lancet Glob Health
            Lancet Glob Health
            The Lancet. Global Health
            The Author(s). Published by Elsevier Ltd.
            2214-109X
            12 May 2020
            12 May 2020
            Affiliations
            [a ]UNICEF, New York, NY 10017, USA
            Article
            S2214-109X(20)30238-2
            10.1016/S2214-109X(20)30238-2
            7217644
            © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

            Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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