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International Health

May 15, 2020

Health Systems Disruptions Caused by COVID-19 Could Lead to Significant Increases in Maternal and Child Mortality in Low- And Middle- Income Countries, New Study Finds

Potential disruptions of health systems and decreased access to food caused by the COVID-19 pandemic could lead to as much as a 45% increase in mortality of children under 5 years old and a 38% increase in maternal mortality in low- and middle-income countries, according to new analysis led by researchers from the Johns Hopkins Bloomberg School of Public Health. These increases in mortality could result in 1.2 million additional child deaths from preventable causes over a six-month period, across 118 countries, and as many as 57,000 additional maternal deaths.

The study was published May 12, 2020, in The Lancet Global Health.

Evidence from previous disease outbreaks shows that health systems struggle to maintain routine services as resources are shifted to the crisis situation. Additionally, people may be less likely to seek medical care, or they may not be able to access health facilities as easily as usual. In some situations where households lose income or agricultural markets are disrupted, food may also become scarcer. These indirect effects of a crisis can result in significant death tolls on top of those caused by the disease itself. Researchers used the Lives Saved Tool to estimate potential increases in child and maternal mortality caused by the indirect effects of the COVID-19 pandemic. The Lives Saved Tool, a mathematical modeling software application developed and maintained by a research team at the Bloomberg School, has been used for over 17 years to estimate child and maternal mortality.

Researchers estimated the additional maternal and child deaths under three scenarios in 118 low-income and middle-income countries. In each scenario, the percentage of people who receive essential health care in each country was assumed to be lower than it was prior to the pandemic. The researchers also assumed that, because of increased food insecurity (with children not having access to sufficient, nutritious diets), there would be an increase in the prevalence of wasting (when children’s weight is low for their height, often due to recent and severe starvation). The researchers estimated additional deaths for a single month and extrapolated for six months.

Under the least severe scenario, where coverage of health services is reduced by around 15% and childhood wasting increases by 10%, over six months there would be 253,500 additional deaths of children under 5 years old and 12,200 additional maternal deaths. Under the most severe scenario, where coverage is reduced by 45% and wasting increases by 50%, over six months there would be 1.2 million additional child deaths and 56,700 additional maternal deaths.

The researchers point to two main reasons for the potential increase in mortality. First, children who would normally get health care for illnesses such as pneumonia, diarrhea, and malaria, would not be able to get this care if health systems are disrupted. Women who would normally deliver their babies at a facility may choose or be forced to deliver at home, without access to emergency obstetric treatment if they experience a complication. These women and children who are not treated would therefore be more likely to die. Secondly, countries will likely see more food insecurity. The economic disruptions will mean that households have less income to spend on food, and the food itself may not be available due to transportation issues, harvesting problems, or other market distortions. Children without adequate nutrition who experience severe weight loss, or wasting, are more likely to die from infectious diseases.

“The study shows that if the COVID-19 pandemic disrupts health systems and decreases access to food, many more woman and children will die from otherwise preventable diseases and obstetric complications,” says Tim Roberton, DrPH ’15, MPH, the lead author of the study and an assistant scientist in the Department of International Health at the Bloomberg School. “These estimates are based on hypothetical scenarios; they are not intended as a prediction. The results are intended to help understand the potential magnitude of the effect, not to offer exact or even approximate numbers.

Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study was written by Timothy Roberton, Emily D Carter, Victoria B Chou, Angela R Stegmuller, Bianca D Jackson, Yvonne Tam, Talata Sawadogo-Lewis, and Neff Walker

The study was funded by the Bill & Melinda Gates Foundation, Global Affairs Canada