A new analysis projects that further reduction in health services in Bangladesh could cause the death of over 28,000 children under the age of five in the next six months as an indirect result of coronavirus pandemic in the worst case scenario, UNICEF said Wednesday.
Wasting, a severe form of malnutrition, would be a significant contributory factor to such under-five deaths, it said.
An additional 6,000 children could die worldwide every day from preventable causes over the next six months as the COVID-19 pandemic continues to weaken health systems and disrupt routine services, UNICEF said.
In Bangladesh, the uptake of critical health services for under-five children has decreased significantly due to the COVID-19 pandemic.
The service utilisation for children under five in March 2020 was down 25 percent compared to March 2019.
“A large number of children could die from preventable and treatable conditions if the pandemic leads to substantial reductions in health service coverage. UNICEF is working closely with the Government of Bangladesh to help ensure that lifesaving care for children and mothers is available, safe and accessible,” said Tomoo Hozumi, UNICEF Country Representative in Bangladesh.
The uptake of maternal and newborn health services has also decreased, approximately by 19 percent.
In addition, key maternal health services such as antenatal care visits and postnatal checkups in health facilities have decreased substantially, and deliveries in facilities have decreased by 21 percent for the period of January to March 2020 compared to October-December 2019.
Due to the pandemic, Bangladesh had to postpone a measles and rubella immunisation campaign targeting 34 million children aged 9 months to 9 years. Though routine immunisation sessions continue, many outreach sessions have been suspended and the transportation of vaccines remains challenging.
While the health system has had to give much of its attention to coronavirus pandemic response, UNICEF is also working with the Ministry of Health and Family Welfare to maintain routine essential maternal, newborn and child health services which have equally important consequences for children and women.
The ministry has recruited an additional 2,000 doctors and 5,000 nurses to help overcome the challenges. Additional investments in health are needed now more than ever to strengthen the health system in Bangladesh.
The above-mentioned mortality estimates are based on an analysis by researchers from the Johns Hopkins Bloomberg School of Public Health, newly published in The Lancet Global Health journal.
1.2mn Deaths In 118 Countries
Based on the worst of three scenarios in 118 low- and middle-income countries, the analysis estimates that an additional 1.2 million under-five deaths could occur in just six months, due to reduction in routine health service coverage levels and an increase in child wasting.
These potential child deaths will be in addition to the 2.5 million children who already die before their 5th birthday every six months in the 118 countries included in the study, threatening to reverse nearly a decade of progress on ending preventable under-five mortality.
Some 56,700 more maternal deaths could also occur in just six months, in addition to the 144,000 deaths that already take place in the same countries over a six-month period.
“Under a worst-case scenario, the global number of children dying before their fifth birthdays could increase for the first time in decades,” said UNICEF Executive Director Henrietta Fore.
“We must not let mothers and children become collateral damage in the fight against the virus. And we must not let decades of progress on reducing preventable child and maternal deaths be lost.”
In countries with already weak health systems, COVID-19 is causing disruptions in medical supply chains and straining financial and human resources. Visits to health care centres are declining due to lockdowns, curfews and transport disruptions, and as communities remain fearful of infection.
In a commentary to the Lancet report, UNICEF warns these disruptions could result in potentially devastating increases in maternal and child deaths. The paper analyses three scenarios for the impact of reductions in lifesaving interventions due to the crisis on child and maternal deaths.
It warns that in the least severe scenario, where coverage is reduced around 15 percent, there would be a 9.8 percent increase in under-five child deaths, or an estimated 1,400 a day, and an 8.3 percent increase in maternal deaths.
In the worst-case scenario, where health interventions are reduced by around 45 percent, there could be as much as a 44.7 percent increase in under-five child deaths and 38.6 percent increase in maternal deaths per month.
These interventions range from family planning, antenatal and postnatal care, child delivery, vaccinations and preventive and curative services.
The estimates show that if, for whatever reason, routine healthcare is disrupted and access to food is decreased, the increase in child and maternal deaths will be devastating.
The greatest number of additional child deaths will be due to an increase in wasting prevalence among children, which includes the potential impact beyond the health system, and reduction in treatment of neonatal sepsis and pneumonia.
According to the modelling, and assuming reductions in coverage in the worst-case scenario, the 10 countries that could potentially have the largest number of additional child deaths are: Bangladesh, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Uganda and United Republic of Tanzania.
The 10 countries that are most likely to witness the highest excess child mortality rates under the worst-case scenario are: Djibouti, Eswatini, Lesotho, Liberia, Mali, Malawi, Nigeria, Pakistan, Sierra Leone and Somalia.
Continued provision of life-saving services is critical in these countries, UNICEF said.
In addition to the estimated potential rise in under-five and maternal deaths described in the Lancet Global Health Journal analysis, UNICEF is deeply alarmed by the other knock-on effects of the pandemic on children.
An estimated 77 percent of children under the age of 18 worldwide – 1.8 billion out of 2.35 billion – were living in one of the 132 countries with stay-at-home policies, as of early May.
Nearly 1.3 billion students – over 72 percent – are out of school as a result of nationwide school closures in 177 countries.
Forty percent of the world’s population are not able to wash their hands with soap and water at home.
Nearly 370 million children across 143 countries who normally rely on school meals for a reliable source of daily nutrition must now look to other sources as schools are shuttered.
As of April 14, over 117 million children in 37 countries may miss out on their measles vaccination as the pandemic causes immunisation campaigns to stop to reduce the risk of spreading the virus.
This week, UNICEF is launching #Reimagine, a global campaign to prevent the COVID-19 pandemic from becoming a lasting crisis for children, especially the most vulnerable children – such as those affected by poverty, exclusion or family violence.
Through the campaign, UNICEF is issuing an urgent appeal to governments, the public, donors and the private sector to join UNICEF as they seek to respond, recover and reimagine a world currently besieged by the coronavirus.
“The COVID-19 crisis is a child rights crisis. We need an immediate-, medium- and long-term response that not only addresses the challenges created by the pandemic and its secondary impacts on children, but also outlines a clear version for building back a better world when the crisis finally recedes. For that, we need everyone’s ideas, resources, creativity and heart,” said Fore.
“It is our shared responsibility today to reimagine what the world will look like tomorrow.”