TY - JOUR
T1 - Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries
T2 - a modelling study
AU - Roberton, Timothy
AU - Carter, Emily D.
AU - Chou, Victoria B.
AU - Stegmuller, Angela R.
AU - Jackson, Bianca D.
AU - Tam, Yvonne
AU - Sawadogo-Lewis, Talata
AU - Walker, Neff
N1 - Funding Information:
The Lives Saved Tool, on which all authors work, is funded by the Bill & Melinda Gates Foundation (Johns Hopkins University grant 90076234, award number OPP1172551), with additional support from Global Affairs Canada (Johns Hopkins University grant 90067950). We thank Theresa Diaz at WHO, Jennifer Requejo, Danzhen You, Lucia Hug, and Debra Jackson at UNICEF headquarters, and colleagues at the Bill & Melinda Gates Foundation for their comments on a draft version of this manuscript.
Funding Information:
The Lives Saved Tool, on which all authors work, is funded by the Bill & Melinda Gates Foundation (Johns Hopkins University grant 90076234 , award number OPP1172551), with additional support from Global Affairs Canada (Johns Hopkins University grant 90067950 ). We thank Theresa Diaz at WHO, Jennifer Requejo, Danzhen You, Lucia Hug, and Debra Jackson at UNICEF headquarters, and colleagues at the Bill & Melinda Gates Foundation for their comments on a draft version of this manuscript.
Publisher Copyright:
© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2020/7
Y1 - 2020/7
N2 - Background: While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods: We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings: Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation: Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they 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 devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding: Bill & Melinda Gates Foundation, Global Affairs Canada.
AB - Background: While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods: We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings: Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation: Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they 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 devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding: Bill & Melinda Gates Foundation, Global Affairs Canada.
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U2 - 10.1016/S2214-109X(20)30229-1
DO - 10.1016/S2214-109X(20)30229-1
M3 - Article
C2 - 32405459
AN - SCOPUS:85085347607
SN - 2214-109X
VL - 8
SP - e901-e908
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 7
ER -