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Children and COVID-19 Research Library

UNDER DEVELOPMENT UNICEF Innocenti's curated library of COVID-19 + Children research

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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

AUTHOR(S)
Timothy Robertson; Emily Carter; Victoria Chou; et al.

Published: July 2020   The Lancet Global Health
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. 
Challenges of COVID-19 in children in low- and middle-income countries

AUTHOR(S)
Heather J. Zar; Jeanette Dawa; Gilberto B. Fischer

Published: June 2020   Paediatric Respiratory Reviews
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.
Beyond handwashing: Water insecurity undermines COVID-19 response in developing areas

AUTHOR(S)
Justin Stoler; Wendy Jepson; Amber Wutich

Published: May 2020   Journal of Global Health
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. 
Protecting children in low-income and middle-income countries from COVID-19

AUTHOR(S)
Salahuddin Ahmed; Tisungane Mvalo; Samuel Akech; et al.

Published: May 2020   BMJ
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.
A wake-up call: COVID-19 and its impact on children's health and wellbeing.

AUTHOR(S)
Henrietta H. Fore

Published: May 2020   The Lancet Global Health
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.
The Impact of COVID-19 on children
Published: April 2020  

The UN Secretary-General has launched a policy brief on the impact of COVID-19 on children. The brief lays out the ways in which the virus will impact children.  Whilst they appear largely to be spared the worst symptoms of the disease, they may well be among the biggest victims of the crisis in the long run because their education, nutrition, safety and health will be significantly undermined by the socioeconomic impact and by unintended consequences of the pandemic response. The harmful effects of this pandemic will not be distributed equally. They are expected to be most damaging for children in the poorest countries, and in the poorest neighbourhoods, and for those in already disadvantaged or vulnerable situations. This policy brief provides a deeper analysis of these effects. It identifies also a series of immediate and sustained actions for the attention of governments and policymakers.

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UNICEF Innocenti's Children and COVID-19 Library is a database collecting research from around the world on COVID-19 and its impacts on children and adolescents. Learn more.

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COVID-19 & Children: Rapid Research Response

UNICEF Innocenti is mobilizing a rapid research response in line with UNICEF’s global response to the COVID-19 crisis. The initiatives we’ve begun will provide the broad range of evidence needed to inform our work to scale up rapid assessment, develop urgent mitigating strategies in programming and advocacy, and preparation of interventions to respond to the medium and longer-term consequences of the COVID-19 crisis. The research projects cover a rapid review of evidence, education analysis, and social and economic policies.