Children and COVID-19 Research Library

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. 

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.

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.

The aim of this article is to advocate perspectives to strengthen existing healthcare systems to prioritize maternal health services amidst and beyond the COVID-19 pandemic in low- and middle income countries. COVID-19 directly affects pregnant women causing more severe disease and adverse pregnancy outcomes. The indirect effects due to the monumental COVID-19 response are much worse, increasing maternal and neonatal mortality.

Across diverse contexts, emerging evidence suggests that the COVID-19 pandemic is increasing levels of anxiety and stress. In calling for greater attention to people’s psychosocial and emotional well-being, global actors have paid insufcient attention to the realities of the pandemic in low- and middle-income countries, where millions of people are already exposed to intersecting vulnerabilities. Chronic poverty, protracted violence, confict and displacement, coupled with weak health, education and protection systems, provide the backdrop of many adolescents’ lives. Drawing on qualitative in-country telephone interviews with over 500 adolescents in Ethiopia, Côte d’Ivoire and Lebanon, this article unpacks the age and gendered dimensions of COVID-19 and its response.

Currently, as COVID-19 spreads across the world, an unprecedented 76.7 million people are living as refugees, or have been displaced inside their countries. Some 131 of the countries affected by COVID-19 have sizeable refugee populations and more than 80% of refugees are hosted in low- and middle-income countries including Uganda, Sudan, Pakistan and Turkey, with health systems that are ill-equipped to manage significant outbreaks. Refugee and IDP camps are mostly chronically overcrowded and measures to avoid community transmission of the virus, such as physical distancing and frequent handwashing, are difficult to implement. The absence of basic amenities, such as clean running water and soap, insufficient medical personnel, and poor access to health information, let alone access to masks, will make avoiding infection virtually impossible. Also, in many host countries, refugees’ entitlement to healthcare and social protection systems are restricted or non-existent, which increases their vulnerability even further.

This discussion paper sets forth the lessons on urban vulnerability and safety, relevant to the security sector, emerging from coronavirus (Covid-19) and its related socioeconomic impacts on urban societies in low- and middle-income countries.

Although substantial progress has been made in many aspects of child health in the past two decades, the COVID-19 pandemic and its wide-ranging effects are threatening some of these hard-won gains. Public health measures such as lockdown, school closures, and restrictions in population movement—while necessary to halt virus transmission—are causing prolonged disruption to societal functioning and exacerbating inequalities worldwide. The global Human Development Index (HDI) is projected to decline this year for the first time since 1990, effectively erasing all progress in human development made in the past 6 years.With resources diverted to tackle the pandemic, many clinical and community health services for children have reduced in capacity. A modelling study by Timothy Roberton and colleagues in The Lancet Global Health estimated that a 9·8–18·5% reduction in coverage of essential maternal and child health services and a 10% increase in child wasting prevalence would lead to 42 240 additional child deaths per month across 118 low-income and middle-income countries.

While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. This study estimates the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Estimates 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 substantial. 

As the coronavirus pandemic extends to low and middle income countries (LMICs), there are growing concerns about the risk of coronavirus disease (COVID-19) in populations with high prevalence of comorbidities, the impact on health and economies more broadly and the capacity of existing health systems to manage the additional burden of COVID-19. The direct effects of COVID are less of a concern in children, who seem to be largely asymptomatic or to develop mild illness as occurs in high income countries; however children in LMICs constitute a high proportion of the population and may have a high prevalence of risk factors for severe lower respiratory infection such as HIV or malnutrition. Further diversion of resources from child health to address the pandemic among adults may further impact on care for children. Poor living conditions in LMICs including lack of sanitation, running water and overcrowding may facilitate transmission of SARS-CoV-2. The indirect effects of the pandemic on child health are of considerable concern, including increasing poverty levels, disrupted schooling, lack of access to school feeding schemes, reduced access to health facilities and interruptions in vaccination and other child health programs. Further challenges in LMICs include the inability to implement effective public health measures such as social distancing, hand hygiene, timely identification of infected people with self-isolation and universal use of masks. Lack of adequate personal protective equipment, especially N95 masks is a key concern for health care worker protection. While continued schooling is crucial for children in LMICs, provision of safe environments is especially challenging in overcrowded resource constrained schools. The current crisis is a harsh reminder of the global inequity in health in LMICs. The pandemic highlights key challenges to the provision of health in LMICs, but also provides opportunities to strengthen child health broadly in such settings.

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. Henrietta Fore, Executive Director of UNICEF, highlights the risks for maternal and child health in low- and middle-income countries if essential health services are disrupted as a result of COVID-19.

A saving grace of the COVID-19 pandemic in high-income and upper middle-income countries has been the relative sparing of children. As the disease spreads across low-income and middle-income countries (LMICs), long-standing system vulnerabilities may tragically manifest, and we worry that children will be increasingly impacted, both directly and indirectly. Drawing on our shared child pneumonia experience globally, we highlight these potential impacts on children in LMICs and propose actions for a collective response.

Water, sanitation, and hygiene (WASH) inequities are long-recognized as important contributors to the global burden of disease that inhibit sustainable development. Inadequate water quantity poses additional challenges for maintaining clean environments and sanitizing physical surfaces where COVID-19 can survive. But the problems associated with water insecurity extend well beyond issues of quantity and hygiene.
Social distancing can cause significant disruptions in people’s access to their most basic necessity. One of the most underappreciated coping strategies for dealing with water insecurity is water sharing between households. The ubiquitous, but often invisible, practice of household water sharing occurs in a variety of socio-cultural settings, and may serve as a transmission pathway for many communicable diseases. 
Water insecurity also complicates people’s ability to participate in social distancing if they have to fetch their own water. About a billion people globally collect their own water from sources outside of their home such as public standpipes, wells, or surface water bodies, and often at great distances. Water fetching in groups contributes to building social capital among women and children, while offering a mechanism of protection from physical dangers like injuries, accidents, harassment, and assaults. Thus, when social distancing measures are in place, vulnerable groups (especially women and girls) experience greater risks by having to fetch water alone. 
Under-resourced regions that already suffer economic losses from lack of adequate water supplies are on the verge of an enormous additional burden from COVID-19.