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International Red Cross members provide health care prevention advice to contain COVID-19, in the Protea informal settlement in Soweto, on March 23, 2020.

LUCA SOLA/AFP/Getty Images

More than a million children and thousands of mothers living in low- and middle-income countries could die from preventable causes over the next six months as the COVID-19 pandemic weakens health care systems and disrupts services, new research shows.

A team of researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore modelled three scenarios in 118 low- and middle-income countries based on the reduction of essential maternal and child health services and the increase of child wasting, meaning low weight for height.

The researchers found that in the least severe scenario, where health coverage is reduced by 9.8 per cent to 18.5 per cent, and a wasting increase of 10 per cent, 253,500 additional children younger than 5 and 12,200 mothers could die in six months. In the worst-case scenario, where health coverage is reduced by 39.3 per cent to 51.9 per cent and with a wasting increase of 50 per cent, 1,157,000 children younger than 5 and 56,700 mothers could die in six months.

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maternal and child mortality in low-

and middle-income countries

Maternal deaths per month

40,000

Baseline deaths

Additional deaths

35,000

30,000

25,000

20,000

15,000

10,000

5,000

0

Baseline

Scenario 1

Scenario 2

Scenario 3

Child deaths per month

Baseline deaths

700,000

Additional deaths due to

reduced interventions coverage

600,000

Additional deaths due to wasting

500,000

400,000

300,000

200,000

100,000

0

Baseline

Scenario 1

Scenario 2

Scenario 3

Scenario 1: Assumes small reductions in the avail-

ability of health workers and supplies due to the

reallocation of resources to the pandemic response

Scenario 2: Assumes greater disruptions to health

systems due to work force and supply chain issues

Scenario 3: Assumes that governments impose

strict movement restrictions, forcing families and

non-essential workers to stay home

JOHN SOPINSKI/THE GLOBE AND MAIL

SOURCE: the lancet

maternal and child mortality in low-income

and middle-income countries

Maternal deaths per month

40,000

Baseline deaths

Additional deaths

35,000

30,000

25,000

20,000

15,000

10,000

5,000

0

Baseline

Scenario 1

Scenario 2

Scenario 3

Child deaths per month

Baseline deaths

700,000

Additional deaths due to

reduced interventions coverage

600,000

Additional deaths due to wasting

500,000

400,000

300,000

200,000

100,000

0

Baseline

Scenario 1

Scenario 2

Scenario 3

Scenario 1: Assumes small reductions in the availability of

health workers and supplies due to the reallocation of

resources to the pandemic response

Scenario 2: Assumes greater disruptions to health systems

due to work force and supply chain issues

Scenario 3: Assumes that governments impose strict move

ment restrictions, forcing families and non-essential work-

ers to stay home

JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: the lancet

maternal and child mortality in low-income

and middle-income countries

Maternal deaths per month

40,000

Baseline deaths

Additional deaths

35,000

30,000

25,000

20,000

15,000

10,000

5,000

0

Baseline

Scenario 1

Scenario 2

Scenario 3

Child deaths per month

Baseline deaths

700,000

Additional deaths due to

reduced interventions coverage

600,000

Additional deaths due to wasting

500,000

400,000

300,000

200,000

100,000

0

Baseline

Scenario 1

Scenario 2

Scenario 3

Scenario 1: Assumes small reductions in the availability of health workers and supplies

due to the reallocation of resources to the pandemic response

Scenario 2: Assumes greater disruptions to health systems due to work force and supply

chain issues

Scenario 3: Assumes that governments impose strict movement restrictions, forcing fami-

lies and non-essential workers to stay home

JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: the lancet

The research, published in The Lancet journal Wednesday, says the 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.”

Tim Roberton, the lead researcher of the study, said the models are based on two main factors. The first is children and pregnant women not accessing health services, such as treatment or preventative services. For example, he said, if a child has pneumonia and would normally be treated with antibiotics, their chance of dying is higher if they can’t access drugs. If pregnant women can’t access a health facility because of pandemic-related disruptions and have a complication, that also leads to more deaths, he said. Secondly, children who are not getting proper nutrients are more susceptible to die from an infectious disease if they get the disease.

“We often think about the secondary effects of the pandemic, so in Canada and the U.S., it’s the impact on businesses, on the economy, and that kind of thing. I think we forget sometimes that the secondary effects could also be public-health related as well,” Mr. Roberton said.

Mr. Roberton said the research is there to provide policy makers some context to help weigh the trade-offs, adding that they are not criticizing pandemic mitigation strategies, but rather pointing out that tensions exist.

He said that while they chose three scenarios based on low-, medium- and worst-case outcomes, they’ve learned from conversations with stakeholders that their worst-case scenario “was not unrealistic.”

However, he emphasized that the research is not meant to predict what will happen, but rather set up hypothetical scenarios and show what they may lead to depending on how the pandemic unfolds, such as how governments respond, public behaviour and if health systems and food markets get disrupted.

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“My main message is that if disruptions occur for whatever reason, the health system or access to care, if disruptions occur then that will lead to an increase in the number of women and children dying from otherwise preventable diseases and complications,” he said.

“The paper also points out that if certain interventions or certain health services were to stop, you would get more additional deaths … but everything is very country specific and context specific.”

The chief executive officer of Unicef Canada, the United Nations agency that supports children, said that while few children have died from COVID-19 so far, that does not mean it’s not a crisis for children.

“We’ve been working with ministries of health around the world to train and empower front-line community health workers and they made a profound difference in the number of children under the age of five who die. That rate has been going down consistently for the last 60 years since we started, and what we see is the pandemic risks reversing it,” David Morley said.

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