Children and COVID-19 Research Library

The importance of mainstreaming gender into social protection policies and programmes is increasingly recognized. However, evidence on the extent to which this is actually happening remains limited. This report contributes to filling this evidence gap by drawing on the findings of two complementary research projects undertaken by UNICEF Office of Research – Innocenti and UN Women in 2019. Using a specifically developed analytical framework, these two projects reviewed 50 national social protection strategies and 40 social protection programmes across a total of 74 low- and middle-income countries (LMICs) to assess the extent to which they incorporate gender equality concerns.

Maternal and child health (MCH) has been a global priority for many decades and is an essential public health service. Ensuring seamless delivery is vital for desirable MCH outcomes. This systematic review outlined the challenges in accessing and continuing MCH services during public health emergencies—pandemics and disasters. A comprehensive search approach was built based on keywords and MeSH terms relevant to ‘MCH services’ and ‘pandemics/disasters’. The online repositories Medline, CINAHL, Psyc INFO, and Epistemonikos were searched for studies. We included twenty studies—seven were on the Ebola outbreak, two on the Zika virus, five related to COVID-19, five on disasters, and one related to conflict situations. The findings indicate the potential impact of emergencies on MCH services. Low utilization and access to services have been described as common challenges. The unavailability of personal safety equipment and fear of infection were primary factors that affected service delivery. The available evidence, though limited, indicates the significant effect of disasters and pandemics on MCH. However, more primary in-depth studies are needed to understand better the overall impact of emergencies, especially the COVID-19 pandemic, on MCH.

The aim of this study is to examine trends and projections of underweight (Body Mass Index, BMI < 18.5 kg/m2) and overweight (BMI ≥ 25.0 kg/m2) in women of reproductive age in 55 low- and middle-income countries (LMICs). It used data from 2,337,855 women aged 15–49 years from nationally representative Demographic and Health Survey conducted between 1990 and 2018. Bayesian linear regression analyses were performed.

This study aims to evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents. Cross-sectional, web-based survey administered between May and June, 2020.

This report aims to support timely and context-relevant policy and programming in Bangladesh, Ethiopia, the State of Palestine (Gaza and West Bank) and Jordan by adding to the evidence base on adolescent girls’ and boys’ experiences during COVID-19. Drawing on mixed methods research it captures the risks and opportunities adolescents face across four low- and middle-income country contexts six to nine months after lockdowns in response to the pandemic were first introduced. With a focus on the intersectional challenges faced by adolescents including by gender, age, marital status, disability and context, the report covers three key domains: education and learning; violence and bodily integrity; and voice, agency and community participation. This is the companion report to a report published in August 2020, ‘I have nothing to feed my family’, which focused on the immediate, short-term effects of COVID-19 and associated lockdowns on girls and boys across the same contexts. The report concludes with key recommendations for policy and programming actors so that efforts to ‘build back better’ post-pandemic can be more effectively informed by adolescents’ experiences and voices.

This study aims to evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents. This study design cross-sectional, web-based survey was administered between May and June, 2020.

Vaccines developed in high-income countries have been enormously successful in reducing the global burden of infectious diseases, saving perhaps 2.5 million lives per year, but even for successful cases, like the rotavirus vaccine, global implementation may take a decade or more. For unincentivized vaccines, the delays are even more profound, as both the supply of a vaccine from developing country manufacturers and vaccine demand from countries with the high disease burdens have to be generated in order for impact to be manifest. A number of poverty-associated infectious diseases, whose burden is greatest in low-income and middle-income countries, would benefit from appropriate levels of support for vaccine development such as Group A Streptococcus, invasive non-typhoid salmonella, schistosomiasis, shigella, to name a few. With COVID-19 vaccines we will hopefully be able to provide novel vaccine technology to all countries through a unique collaborative effort, the COVAX facility, led by the World Health Organization (WHO), Gavi, and the Coalition for Epidemic Preparedness Innovations (CEPI). Whether this effort can deliver vaccine to all its participating countries remains to be seen, but this ambitious effort to develop, manufacture, distribute, and vaccinate 60–80% of the world’s population will hopefully be a lasting legacy of COVID-19.

A year after the World Health Organization declared COVID-19 a pandemic, this research takes stock of an increasingly diverse set of new studies linking violence against women and children (VAW/C) to COVID-19 and associated pandemic response measures. This fourth round up focuses exclusively on research in low- and middle-income countries (LICs and MICs) published since December 2020 to highlight dynamics in settings that previously had fewer studies. As in previous round ups, this research only include studies that have sufficient information on indicator definition and analysis methods. In total, 26 new studies from LICs and MICs are summarized, with the majority focused on identifying trends (15 studies), while others present analysis of risk factors or dynamics (an additional ten studies), and one represents an impact analysis of prevention programming.

Compounding the COVID-19 pandemic is a looming debt crisis for low- and middle-income countries where a growing debt burden threatens to crowd out social spending for children.

This policy brief explores whether the current support from the international community is enough to maintain spending on basic services during COVID-19. It highlights countries that are most at risk due to high levels of poverty, as well as those less likely to benefit from the G20 Debt Standstill (DSSI). It concludes that a new international debt restructuring architecture, which encompasses the needs of poorer countries, is crucial to protecting children’s rights in the wake of COVID-19. 

This paper presents a new estimate that pre-primary school closures in 2020 may cost today’s young children US$1.6 trillion in lost earnings over their lifetimes. Children in middle-income countries will be most greatly affected. However, most low- and middle- income countries are leaving pre-primary education out of their responses to COVID-19. This paper also draws lessons from evaluations of accelerated, bridging and remedial programmes on how introducing or expanding these transition programmes in the early years can mitigate the long-term impact on learning from pre-primary school closures.

Global response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and largely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). This paper has explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic.

Compounding the COVID-19 pandemic is a looming debt crisis for low- and middle-income countries where a growing debt burden threatens to crowd out social spending for children.

This policy brief explores whether the current support from the international community is enough to maintain spending on basic services during COVID-19. It highlights countries that are most at risk due to high levels of poverty, as well as those less likely to benefit from the G20 Debt Standstill (DSSI). It concludes that a new international debt restructuring architecture, which encompasses the needs of poorer countries, is crucial to protecting children’s rights in the wake of COVID-19. 

13 years after the first Lancet Series on maternal and child undernutrition, we reviewed the progress achieved on the basis of global estimates and new analyses of 50 low-income and middle-income countries with national surveys from around 2000 and 2015. The prevalence of childhood stunting has fallen, and linear growth faltering in early life has become less pronounced over time, markedly in middle-income countries but less so in low-income countries. Stunting and wasting remain public health problems in low-income countries, where 4·7% of children are simultaneously affected by both, a condition associated with a 4·8-times increase in mortality. New evidence shows that stunting and wasting might already be present at birth, and that the incidence of both conditions peaks in the first 6 months of life. Global low birthweight prevalence declined slowly at about 1·0% a year. Knowledge has accumulated on the short-term and long-term consequences of child undernutrition and on its adverse effect on adult human capital. Existing data on vitamin A deficiency among children suggest persisting high prevalence in Africa and south Asia. Zinc deficiency affects close to half of all children in the few countries with data. New evidence on the causes of poor growth points towards subclinical inflammation and environmental enteric dysfunction. Among women of reproductive age, the prevalence of low body-mass index has been reduced by half in middle-income countries, but trends in short stature prevalence are less evident. Both conditions are associated with poor outcomes for mothers and their children, whereas data on gestational weight gain are scarce. Data on the micronutrient status of women are conspicuously scarce, which constitutes an unacceptable data gap. Prevalence of anaemia in women remains high and unabated in many countries. Social inequalities are evident for many forms of undernutrition in women and children, suggesting a key role for poverty and low education, and reinforcing the need for multisectoral actions to accelerate progress. Despite little progress in some areas, maternal and child undernutrition remains a major global health concern, particularly as improvements since 2000 might be offset by the COVID-19 pandemic.

Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, it reviews the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, it assesses the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, it considers the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, this study presents a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders.

This study aims to assess competencies (knowledge, skills and attitudes) of midwifery care providers as well as their experiences and perceptions of in-service training in the four study countries; Benin, Malawi, Tanzania and Uganda as part of the Action Leveraging Evidence to Reduce perinatal mortality and morbidity in sub-Saharan Africa project (ALERT). While today more women in low- and middle-income countries give birth in health care facilities, reductions in maternal and neonatal mortality have been less than expected. This paradox may be explained by the standard and quality of intrapartum care provision which depends on several factors such as health workforce capacity and the readiness of the health system as well as access to care.