Indirect effects of COVID-19 estimated to lead to tens of thousands of additional maternal and child deaths

1. In three separate models, it was found that the combination of decreased health care access, food availability, and the economic impacts (both intentional and unintentional) of COVID-19 may lead to between 250,000 to 1,157,000 additional child deaths and 12,200 to 56,700 maternal deaths over 6 months globally.

Evidence Rating: 3 (Average)

Historically, decreased access to food, increased unemployment, redistribution and shortages of healthcare personnel and equipment, lower buying power, and lack of infrastructure for domestic development of medical and pharmaceutical supplies in low and middle income countries (LMICs) have led to decreases in reproductive, maternal, and child health (RMNCH) services. Subsequently, there has been evidence to suggest decreased access to these services during previous outbreaks, such as in the case of the Ebola Virus and SARS, leading to potentially increased mortality rates in affected populations. In this study, researchers estimated the additional maternal and under-5 child deaths in 118 LMICs resulting from COVID-19 caused by disruptions to healthcare coverage and reduced food access. The Lives Saved Tool (LiST), a tool historically used to estimate additional mortality was employed, and researchers used a framework that broke down healthcare coverage into 4 contributing parts: availability of healthcare workers, availability of supplies and equipment, demand for health services, and access to health services. The tool also took into account changes in food access and economic disruption, as modelled by proportion of children who are wasted (low weight for height). In the least severe scenario, modelled by small reductions in healthcare coverage (i.e., 9.8-18.5%) and a 10% increase in wasting, an estimated 253,500 additional child deaths and 12,200 additional maternal deaths was estimated over 6 months. Over 12 months, 417,000 additional child deaths and 24,400 maternal deaths were projected. Results were grimmer in models predicting severe disruption (39.3-51.9% healthcare coverage reduction, and wasting increase of 50%), with a staggering 1,786,400 child deaths and 113,400 maternal deaths over 12 months. These results emphasize the ability of diseases to cause great suffering beyond their immediate pathology, as even the conservative estimates of the study yield mortality rates comparative to that of the currently confirmed worldwide death toll. The findings of this study may serve to better inform future policy changes and healthcare behavior, and encourage proactive decision making in these sectors to mitigate these potential losses.

Click to read the study in Lancet Global Health

Image: PD

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