Covid-19 to reverse child survival gains

The world recorded an all-time low under-five deaths in 2019, but the COVID-19 pandemic has resulted in major disruptions to health services that threaten to undo decades of hard-won progress and put millions of additional lives at stake.

There were 5.2 million children who died of preventable causes last year, compared to 12.5 million in 1990. But UNICEF, the World Health Organisation (WHO) and World Bank say the pandemic may force the mortality rate up again.

“The global community has come too far towards eliminating preventable child deaths to allow the Covid-19 pandemic to stop us in our tracks,” says Henrietta

Fore, UNICEF Executive Director. “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.”

Indeed, although SARS-CoV-2 seems to spare the younger population, disruptions in medical care and in the supply chain for essential medicines is leading to a spike in non-coronavirus fatalities among children.

For instance, the under-5 child mortality rate in Nepal had declined substantially from 271 deaths per 1,000 live births in 1969 to 31 in 2019 -- a dramatic 78% reduction from 1990 levels.

Health services to prevent or treat causes of child death such as preterm, low birth weight, complications during birth, neonatal sepsis, pneumonia, diarrhoea and malaria, as well as vaccination, have played a large role in this progress.

But following Covid-19 lockdown, Nepal saw a 30% increase in the number of under-fives who have died in the March-April-June this year compared to the same period last year – mainly due lack of transport to take sick children to hospital, or reluctance to seek medical attention because of the fear of the virus.

A rapid assessment conducted by UNFPA in coordination with Family Welfare Division during the initial phase of the lockdown period in Nepal also reported more than 60% decline in antenatal visits and 35% decrease in institutional delivery as compared to before the restriction.

A UNICEF survey conducted over the past few months across 77 countries found that almost 68% of countries reported disruption in health checks for children and immunisation services, 63% in antenatal checkups and 59% in post-natal care.

A recent WHO survey in 105 countries revealed that 52% of countries were experiencing disruptions in health services for sick children and 51% in services for management of malnutrition.

“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,” says Tedros Adhanom Ghebreyesus, WHO Director-General. “Now, we must not let the COVID-19 pandemic turn back remarkable progress for our children and future generations.”

Based on the responses from countries that participated in the 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, and greater financial difficulties.

Back in May, initial modelling by Johns Hopkins University also showed that 6,000 additional children worldwide could die per day due to disruptions due to COVID-19.

To be sure, newborns across the world were at highest risk of death even before Covid-19 pandemic. In 2019, a newborn baby died every 13 seconds. Moreover, 47% of all under-five deaths occurred in the neonatal period, up from 40% in 1990. Severe disruptions in essential health services due to Covid-19 have only added to the challenge.

Says John Wilmoth, Director of the Population Division of the UN Department of Economic and Social Affairs, “While this report highlights the negative effects of the Covid-19 pandemic, it also draws attention to the need to redress the vast inequities in a child’s prospects for survival and good health.”