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2020 ; 8
(7
): e901-e908
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gab.com Text
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English Wikipedia
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
#MMPMID32405459
Roberton T
; Carter ED
; Chou VB
; Stegmuller AR
; Jackson BD
; Tam Y
; Sawadogo-Lewis T
; Walker N
Lancet Glob Health
2020[Jul]; 8
(7
): e901-e908
PMID32405459
show ga
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.
|*Child Mortality
[MESH]
|*Maternal Mortality
[MESH]
|*Pandemics
[MESH]
|COVID-19
[MESH]
|Child, Preschool
[MESH]
|Coronavirus Infections/*epidemiology
[MESH]
|Delivery of Health Care/organization & administration
[MESH]
|Developing Countries/*statistics & numerical data
[MESH]