A health crisis like the one the world is experiencing is the perfect tsunami to add more deaths to those already caused by the new SARS-CoV-2 coronavirus. If the worst prognoses are fulfilled and in just six months, we would attend the death of up to 6,000 more children every day from preventable diseases. In half a year, about 1.2 million more child deaths from reduced coverage of routine medical services in at least 118 countries with fragile, low- and middle-income health systems. These potential infant deaths would add to the 2.5 million children who already die every six months in the world. Chilling figures that could defeat almost a decade of progress to end child mortality.

It is one of the conclusions reached by a new study by a group of researchers from the Johns Hopkins University School of Public Health, published this Wednesday in The Lancet Global Health. To carry out this report, the scientists have taken the current situation for covid-19 as a reference and have made a projection, with different variables, of one, three and even six months for 118 low and middle income countries.

There are two main reasons why this increase in deaths among children under the age of five could occur in the world, according to this study. “The first is that children who would normally receive medical attention for diseases such as pneumonia, diarrhea and malaria will not be able to receive it if health systems are affected; and if those who are already ill do not receive adequate treatment, they are more likely to die” , contextualizes Timothy Roberton, from the Department of Global Health at Johns Hopkins University, and the researcher who has led this study.

The Ebola crisis as a reference

B. Hernández

Since covid-19 spread across the globe, experts have turned their sights to draw conclusions and teachings from what was one of the deadliest epidemiological outbreaks in history: the Ebola crisis in West Africa in 2014. ” People who have other problems that are not directly related to the epidemic hardly receive medical service, “the WHO explained in a statement, cited in this study from the Johns Hopkins University School of Public Health.

A study carried out in 2014 shows how prenatal service was reduced by 22%, family planning and care after delivery by 6% by 13%. Other qualitative studies that analyzed this period suggest that this reduction in medical care was also due to the population’s fear of going to a medical center and that it could become infected, mistrust in the health system, as well as rumors about the origin of the epidemic, a reaction that can already be seen in some countries of the African continent by covid-19.

The second reason Roberton specifies is the food insecurity experienced by many households with less income and reduced access to food. “If they don’t get an adequate intake of macronutrients and become weak, they are more likely to die from infectious diseases,” he says. A report recently released by the UN World Food Program (WFP) warned that at least 135 million people experienced extreme food insecurity in 55 countries in 2019 and estimated that covid-19 could almost double the figure, up to 265 million in 2020. “Lack of food is one of the key elements and malnutrition is one of the most direct consequences that cause more lives to be lost,” adds Stefan Peterson, head of Health at Unicef.

In addition to this food insecurity, the other key factors that perpetuate the increase in infant mortality in the midst of the pandemic are poverty and weak health systems. Sub-Saharan Africa is the worst-positioned area, and of these 118 low- and middle-income countries are Djibouti, Eswatini, Lesotho, Liberia, Mali, Malawi, Sierra Leone, Somalia, Ethiopia, the Democratic Republic of the Congo, Tanzania, and Uganda. The other countries most likely to record the highest rates of excess infant mortality by population size are Brazil, Nigeria, Indonesia, India, and Pakistan.

The confinement measures, necessary to stop the spread of covid-19, have led to a setback, according to UNICEF’s Peterson, for many families in low- and middle-income countries, who had to choose between starvation or barely surviving to the pandemic. “It is not the same to live in an apartment in Madrid, with a refrigerator, Wi-Fi and have a job that allows you a fixed income, than to live in a shack with only one room, in an informal settlement in a large African city, where there is no easy access to soap and water and also not to a stable job. The measures of confinement and paralysis of medical routines should also take into account these factors “, contextualizes the Unicef ​​Health expert, who also regrets that the health personnel of many developing countries do not have enough information on the consequences of covid-19.

Increased maternal deaths

The covid-19 has caused that visits to medical centers are decreasing due to confinements, curfews and interruptions in transport, and also due to the fear that communities continue to get infected, as happened in the epidemic from Ebola 2014, one of the deadliest outbreaks in memory. As a result of the paralysis of family planning and childbirth monitoring programs, the study estimates that an additional 56,700 maternal deaths could occur in just six months, added to the 144,000 already taking place in the same countries in a similar period. “In Uganda, there has already been an increase in women who prefer to give birth at home, which in turn has increased the risk of dying from complications in childbirth. And one of the reasons why they do not go to a hospital and a center health is for fear of getting it, “says Peterson of Unicef.

“We cannot allow mothers and children to suffer the collateral damage of fighting the virus. And we cannot afford to miss decades of progress in reducing preventable deaths of mothers and children,” asks UNICEF Executive Director Henrietta Fore. , who in a comment on The Lancet report, warns that these disruptions could trigger potentially devastating increases in maternal and infant deaths. “We can prevent them if we act now.”

Recovering medical routines, key to saving lives

The results of this study, the researchers say, show how the side effects of the pandemic are not merely economic. Another of the conclusions reached by the report is that maintaining coverage of the most basic surgical interventions carried out in childbirth while the pandemic lasts in these 118 countries would save 60% of maternal deaths, while the administration of antibiotics for Neonatal sepsis and pneumonia, in addition to distributing oral rehydration solution for diarrhea to children under five, would reduce additional infant deaths by 41%. “Covid-19 is not a disease that has hitherto directly affected children, but they are and could be, in many countries, the direct victims of this pandemic in the long term,” says Peterson of Unicef.

The same report encourages countries and their governments to reestablish medical routines as soon as possible, warning that the longer it takes, the harder it will be to get back to square one. “We should not delay the restoration of health services if we want to minimize the lasting impact of temporary interruptions. The longer it takes, the more lives are lost along the way.” Warnings and advice to flatten that tsunami wave that this pandemic has become.

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