Profiles

The initial impression that paediatric SARS-CoV-2 infection is uncommon and generally mild has been replaced by a more nuanced understanding of infectious manifestations in children and adolescents across low-, middle-, and high-income countries and by demographic structure, with recognition of a widening disease spectrum. Critical knowledge gaps, especially in low- and middle-income countries remain, that have significant public policy and programme implications. Insufficient data disaggregated by age, geography and race/ethnicity are hindering efforts to fully assess prevalence of infection and disease in children and adolescents and their role in transmission. Potential biologic differences in susceptibility to infection and between children and adults need to be assessed. Determination of mother-to-child SARS-CoV-2 transmission during pregnancy or peripartum requires appropriate samples obtained with proper timing, lacking in most studies. Finally, predictors of disease progression, morbidity and mortality in children need to be determined particularly as the pandemic moves to low- and middle-income countries, where poor nutritional and health conditions and other vulnerabilities are more frequent among children than in higher-income settings. Countries, UN agencies, public health communities, donors and academia need to coordinate the efforts and work collectively to close the data and knowledge gaps in all countries (high-, middle- and low-income) for better evidence to guide policy and programme decision-making for children and COVID-19 disease.

It is commonly accepted, at least for now, that children and adolescents (0-19 years) have been largely spared the direct epidemiological effects of the COVID-19 crisis on their own health and survival. This narrative is based predominantly on early data from the first affected countries of the virus, notably from China (Wuhan Province) and Italy in early 2020, and also other high-income countries including the United States and some European nations.

It is commonly accepted, at least for now, that children and adolescents (0-19 years) have been largely spared the direct epidemiological effects of the COVID-19 crisis on their own health and survival. This narrative is based predominantly on early data from the first affected countries of the virus, notably from China (Wuhan Province) and Italy in early 2020, and also other high-income countries including the United States and some European nations.

While some countries are now moving to reopen schools, nearly 1.3 billion children are still out of school and dependent on remote learning, due to nationwide shutdowns. As national educational systems strive to meet this challenge, Multiple Indicator Cluster Survey (MICS) data offer some important insights into how we can ensure every child has an equal opportunity to learn remotely.

A total of 835,401 children and adolescents were out of school in Nepal in 2017, equivalent to 11.3 per cent of the primary and secondary school aged population (UNESCO – UIS, 2020). This rate varies across the country and population, as barriers related to poverty, social exclusion linked to caste and ethnicity, disability, social norms and gender biases, migration, child labor, mother tongue, and geographical location disproportionately keep children out of school (Nepal Ministry of Education School Sector Development Plan, 2016).

In some way, mental ill health has touched everyone. The statistics are alarming, and by some accounts constitute a public health emergency. Today, around 10-20 per cent of all children and adolescents suffer from some type of mental health disorder and mental health conditions account for around 16 per cent of