Children and COVID-19 Research Library

The Care, Coping and Connection under COVID-19 report presents findings from a phone survey with 500 couples in Rwanda, examining the impact of the pandemic on stress, caregiving, and family relationships. The study builds on a randomized controlled trial of the Bandebereho intervention to examine the longer-term (five-year) impact of the intervention on participating families. The data suggest that while the pandemic has been hard on many families, Bandebereho participants have tended to fare better than those in the control group, suggesting long-lasting impacts of the intervention on key outcomes related to men’s engagement in care work and on couple and family relations.

Despite some cases of severe or critical manifestations of the coronavirus disease 2019 (COVID-19) described among children, the prevalence of this infection in the pediatric population is quite low worldwide, particularly in sub-Saharan Africa. Current data suggest indeed that, independent of the population considered overall, severe and critical cases of COVID-19 are rare among children. This observation prompted the discussion of the possible hypotheses which could explain the low prevalence of COVID-19 among children; amongst others, immunomodulation by the Bacillus Calmette–Guerin vaccine or by some parasitic infections such as malaria, schistosomiasis, and helminthiasis and cross immunization with other coronaviruses commonly found in the sub-Saharan African setting are discussed.

To better understand the socio-economic impact of COVID-19 on the lives of vulnerable children in Asia and to make evidence-based policy and programming decisions, World Vision conducted a Rapid Assessment in May 2020. The assessment found that COVID-19 had grossly heightened the vulnerabilities of children in Asia. Families had been experiencing devastating loss of livelihood which led to limited access to food, essential medicines, and basic healthcare. The resulting strain on families increased incidences of physical abuse, early marriage, and the entry of children into exploitative work. The assessment recommended, for the next immediate period, that Asian governments scale-up social protection interventions, increase investment in public works programmes,  target the most vulnerable through government social assistance schemes, provide support to micro, small and medium enterprises, and scale up and provide skill-building for community health workers.

In an updated review of how the COVID-19 pandemic has been affecting women’s and girls’ health in low- and middle-income contexts, this study examined 247 studies between January and March 2021 (peer-reviewed papers, pre-prints, and working papers that met specific search terms, and contained empirical analyses and findings). This collection of evidence largely reinforces previous findings that in many areas, women are bearing the greatest burdens of the crisis. Evidence continues to mount that there has been disruption of access to and utilization of maternal health services and contraceptive services, disproportionately worse mental health for women versus men, as well as worsened mental health for pregnant women during the pandemic. This review also identifies new research indicating mixed evidence on COVID-19- related knowledge and behaviors and COVID-19 morbidity and mortality by gender. Gaps remain on several health issues (e.g., non-communicable diseases, infectious diseases other than HIV). Existing research also focuses primarily on describing and quantifying the burden of these gendered health impacts, rather than sharing effective mitigation strategies.

The COVID-19 pandemic is significantly impacting the provision of vital health, nutrition, education, child protection, and water, sanitation and hygiene (WASH) services to women and children. UNICEF is conducting quarterly surveys to better understand the level of disruption to essential services for women and children, the reasons for these disruptions, and government response measures. This brochure provides an overview of the findings from the past three survey rounds and reveals that all countries – not only those with ongoing humanitarian response – continue to face some severe service disruptions due to the COVID-19 pandemic and response.

COVID-19 lockdowns have significantly disrupted the daily lives of children and adolescents, with increased time at home, online learning and limited physical social interaction. This report seeks to understand the immediate effects on their mental health. Covering more than 130,000 children and adolescents across 22 countries, the evidence shows increased stress, anxiety and depressive symptoms, as well as increased alcohol and substance use, and  externalizing behavioural problems. Children and adolescents also reported positive coping strategies, resilience, social connectedness through digital media, more family time, and relief from academic stress. Factors such as demographics, relationships and pre-existing conditions are critical.  To ensure children and adolescents are supported, the report recommends building the evidence on the longer-term impact of the pandemic on child and adolescent mental health in low- and middle-income countries, including vulnerable populations.

Children’s vaccination is a major goal in health-care systems worldwide; nevertheless, disparities in vaccination coverage expose socio-demographic accessibility gaps, unawareness, physicians’ disapproval and parents’ incomplete adherence reflecting insufficient public-provider trust. This study aimed to analyze parents’ attitude toward children’s vaccination in correlation with trust among stakeholders. A total of 1031 parents replied to a “snowball” questionnaire; 72% reported high trust in their physician, 42% trusted the authorities, 11% trusted internet groups. Among minorities, parents who fully vaccinate their children were younger, live in urban areas, eat all kinds of foods and trust the authorities, similar to the general population. Low adherence to children’s vaccination was correlated with trusting internet groups.

The COVID-19 pandemic has raised concerns about the mental health of a generation of children. But the pandemic may represent the tip of a mental health iceberg – an iceberg we have ignored for far too long. The State of the World’s Children 2021 examines child, adolescent and caregiver mental health. It focuses on risks and protective factors at critical moments in the life course and delves into the social determinants that shape mental health and well-being. It calls for commitment, communication and action as part of a comprehensive approach to promote good mental health for every child, protect vulnerable children and care for children facing the greatest challenges.

With interest, we read the commentary by Zhong et al. entitled, ”How can we best use COVID-19 vaccines in adolescents?” discussing the risk and benefits of vaccination for the adolescent age group and concluding that the risk-benefit ratio for vaccinating healthy adolescents was equivocal [1]. The authors noted in the first sentence of the article, “Mass vaccination of the world population is our ticket out of the COVID-19 pandemic.” This study posits that the adolescent age group, a significant proportion of the “world population,” is an important group to vaccinate to curb the spread of COVID-19 disease and to directly protect children and adolescents at risk of disease and disease complications.

The benefits of schools’ closure, used as a containment strategy by many European countries, must be carefully considered against the adverse effects of child wellbeing. This study assessed SARS-CoV-2 seroprevalence, which better estimates the real extent of the infection unraveling asymptomatic cases, among schoolchildren aged 3 to 18 in Milan, using dried blood spot, a safe and extremely viable methods for children, and then compared it between September 2020 and January 2021. Secondly, it evaluated the seroconversion rate and compared it between students attending schools in presence and those switched to distance-learning, using a logistic regression model, both as univariate and multivariate, adjusting for age and biological-sex.

Of 628 women, 11.8% (n = 74) were pregnant at the time of survey. Most of the pregnant women (89.2%, n = 66) had some degree of concerns about their unborn babies getting infected during delivery in the hospital. Among mothers of children under 10 years of age (n = 564), half (n = 282) reported change in their children’s behavior during the lockdown. Most mothers and pregnant women (94.9%, n = 569) had some degree of psychological distress. Mothers and pregnant women with a college degree had significantly lower psychological distress (β = -1.346; p = 0.014) than women with a high school education or less. Similarly, mothers and pregnant women with monthly family income ≥ US$ 1,333 had lower psychological distress than those with < US$ 1,333. Women with pre-existing chronic physical (β = 2.424; p < 0.001) or mental (β = 4.733; p < 0.001) conditions had higher psychological distress than those without these conditions. Having children in the house was a contributory factor for higher psychological distress. For example, mothers with one child (β = 2.602; p = 0.007) had significantly higher psychological distress compared to expectant mothers without children in the house.

The potential long-term impacts of natural or man-made disasters on children and adolescents have been the subject of numerous scientific research studies over the past decades. Since the rise of the COVID-19 pandemic, however, it has become even more important to continue these investigations in order to address the special needs of our youth. While the virus itself appears to cause less pathology in them compared to adults, the effects go beyond the disease itself. The pandemic has caused extremely high levels of stress for both the children and their families. As a result, special attention has to be given to the possible long-term impacts on their growth and development. It is very important for physicians and other healthcare providers to recognize the signs and symptoms of stress and monitor for physical and mental health inequities, and to be able to provide support when help is needed. Identifying culturally effective solutions and reaching out to community based organizations or partners for resources and programs with which families identify is an important part of this healing provision.

While there has been a global rush to generate rapid evidence on COVID-19 mental health impacts among adults, limited evidence exists on the potential impacts on children. This is the protocol for our rapid review that seeks to (i) understand the immediate impact of COVID-19’s first wave on the mental health of children and adolescents (0–19 years); and (ii) apply lessons learned from this pandemic to mitigate the impacts of future health crises.

COVID-19 is a crisis like no other in modern times. It has reached every population and community. While the evidence base is still nascent, this report looks at the impacts of disasters and past epidemics – such as Ebola, HIV, SARS/MERS and Zika – on child and adolescent mental health and psychosocial wellbeing, and examines how these insights can guide policies and progammes to support children, their families and communities during the current pandemic.