COVID-19 could reverse decades of progress in reducing child deaths

With the number of under-five deaths at an all-time recorded low of 5.2 million in 2019, disruptions in child and maternal health services due to the COVID-19 pandemic are putting millions of additional lives at stake, global health and welfare agencies said.

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 Organization (WHO), the population division of the United Nations Department of Economic and Social Affairs (UN DESA) and the World Bank Group.

Since then, however, surveys by UNICEF and WHO show the COVID-19 pandemic has caused major disruptions to health services which 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 Henrietta Fore, executive director of UNICEF.

“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. Without urgent investments to restart disrupted health systems and services, millions of children under five, especially newborns, could die.”

Disruptions to service

Over the past 30 years, health services to prevent or treat causes of child death such as pre-term, low birth weight, complications during birth, neonatal sepsis, pneumonia, diarrhoea and malaria, as well as vaccination, have played a large role in saving millions of lives.

Now countries worldwide are experiencing disruptions in child and maternal health services such as health check-ups, vaccinations and prenatal and post-natal care because of resource constraints and a general unease with using health services triggered by a fear of catching COVID-19.

A survey by UNICEF across 77 countries found that almost 68% of countries reported at least some disruption in health checks for children and immunisation services. In addition, 63% of countries reported disruptions in antenatal check-ups and 59% in post-natal care.

A recent WHO survey based on responses from 105 countries showed that 52% of countries were reporting disruption to health services for sick children, and 51% to services for the management of malnutrition.

The WHO says these health interventions are critical for stopping preventable newborn and child deaths. For example, women who receive care by professional midwives trained to international standards are 16% less likely to lose their baby and 24% less likely to experience pre-term birth.

Hardest hit

“The fact that today more children live to see their first birthday than at 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,” said WHO’s director general, Tedros Adhanom Ghebreyesus.

“Now, we must not let the COVID-19 pandemic turn back remarkable progress for our children and future generations. Rather, it’s time to use what we know works to save lives, and keep investing in stronger, resilient health systems.”

In responses from countries that participated in the UNICEF and WHO surveys, the most commonly cited reasons for health service disruptions include parents avoiding health centres for fear of infection; transport restrictions; suspension or closure of services and facilities; fewer health-care workers because of diversions or fear of infection caused by shortages in personal protective equipment such as masks and gloves; and financial difficulties.

Fear of COVID-19

Afghanistan, Bolivia, Cameroon, the Central African Republic, Libya, Madagascar, Pakistan, Sudan and Yemen are among the countries hardest hit.

Seven of these nine countries had high child mortality rates of more than 50 deaths per 1,000 live births among children under the age of five in 2019.

In Afghanistan, where one in 17 children died before reaching age five in 2019, the Ministry of Health reported a significant reduction in visits to health facilities.

For fear of contracting COVID-19, families are attaching less priority to pre and post-natal care, adding to the risk faced by pregnant women and newborn babies.

Even before COVID-19, newborns were at highest risk of death. 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. With severe disruptions to essential health services, newborn babies could be at much higher risk of dying.

For example, in Cameroon, where one out of every 38 newborns died in 2019, the UNICEF survey reported an estimated 75% disruptions in services for essential newborn care, antenatal check-ups, obstetric care and post-natal care.

In May, initial modelling by Johns Hopkins University showed that almost 6,000 more children every day could die due to disruptions due to COVID-19.

The reports and surveys highlight the need for urgent action to restore and improve childbirth services and antenatal and post-natal 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.

Grave jeopardy

“The COVID-19 pandemic has put years of global progress to end preventable child deaths in serious jeopardy,” said Muhammad Ali Pate, global director for health, nutrition and population at the World Bank.

“It is essential to protect life-saving services which have been key to reducing child mortality. We will continue to work with governments and partners to reinforce health-care systems to ensure mothers and children get the services they need.”

“The new report demonstrates the ongoing progress worldwide in reducing child mortality,” said the director of the population division of UN DESA, 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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