How will COVID-19 affect children in low to middle-income countries?

Global experience to date suggests that the COVID-19 mortality rate for children will be low, even in low to middle-income countries. However, modelling published this month in the Lancet indicates that there will be a considerable indirect impact. COVID-19 will weaken, and in some cases overwhelm, health systems which will lead to a reduction in the coverage of health services. Children will be disproportionately effected by this indirect impact of COVID-19.

It is now accepted that diarrhoea-related deaths in children are directly affected by coverage rates of ORS and Zinc. As the availability and use of ORS and Zinc increases the mortality rate and rates of stunting fall.

Lancet modelling framework May-20The Lancet modelling looked at the potential effect of COVID-19 on the coverage rates of health services overall using the framework in Figure 1. They included 118 countries in the model. These countries account for 97.7% of global deaths of children under 5.

Using very detailed assumptions they created three potential impact scenarios on the coverage of health services: Low; Moderate; Large. The study then broke down the overall effect into its key components, including coverage of ORS and Zinc. The additional monthly deaths attributed to a fall in coverage of ORS and Zinc were between 3,640 and 15,940.

Impact on coverage
of ORS and Zinc
          Additional monthly deaths
Low 3,640
Moderate 6,290
Large 15,940


To put this into context, pre-COVID-19, monthly under 5 diarrhoea deaths were in the region of 44,480. What the Lancet modelling indicates is that the indirect effects of COVID-19 on child mortality will be considerable even though the direct effects, based on global experience so far, will be low.

This indirect impact will reverse the progress made in reducing diarrhoea deaths in recent years. Coming out of COVID-19, health systems will continue to be under pressure and there will be a need for an increased focus on the cost effectiveness of treatments. The most cost-effective way to deliver the globally recommended treatment for diarrhoea is co-packaged ORS and Zinc. This will be our message as we continue to focus our attention on accelerating the uptake by national governments of the new WHO recommendation on co-packaging.