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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

Our take —

This study used the Lives Saved Tool to estimate the number of excess deaths from COVID-19 due to indirect effects of interruption to reproductive, maternal, neonatal, and child health services in 118 low- and middle-income countries. Indirect effects of COVID-19 may be more burdensome in the long-term than direct and immediate health effects, and should be considered by decision-makers. This study was not meant to provide formal projections, but could be useful for future response and recovery planning.

Study design

Modeling/Simulation

Study population and setting

Authors estimated potential excess deaths in 118 low- and middle-income countries caused by reduced coverage of reproductive, maternal, newborn, and child health (RMNCH) services, and increased prevalence of wasting (low weight for height). Authors assumed no (0%), small (5%), moderate (10%), and large (25%) reductions in RMNCH service and relative increases in prevalence of wasting of 10%, 20%, and 50% among children. Using the Lives Saved Tool (LiST), which estimates changes in mortality due to changes in intervention coverage, authors projected excess deaths under three scenarios and for three time periods. These scenarios were based on a health systems framework developed by authors that included availability of health workers, availability of supplies, demand for services, and access to health. Excess deaths represent the increase in deaths compared to the counterfactual of no changes to intervention coverage or prevalence of risk factors (e.g., wasting).

Summary of Main Findings

The scenario representing the smallest reduction in coverage (5%) resulted in an estimated 2,030 excess maternal and 42,240 child deaths per month. The scenario representing the most severe reductions in coverage (25%) resulted in an estimated excess 9,450 maternal and 192,830 child deaths per month. Assuming increases in wasting and reductions in coverage of 5%, 10%, and 25%, this represents relative increases in monthly child deaths of 9.8%, 17.3%, and 44.7%, respectively.

Study Strengths

Authors considered 19 maternal and 29 child health services; authors included contributions of individual RMNCH interventions and assumed varying levels of reduction to individual services would result in greater overall reduced coverage. LiST is a standardized tool used for estimating mortality under different intervention coverage scenarios.

Limitations

Increases in childhood wasting accounted for a significant proportion of the excess deaths, which may or may not have been accurately represented in these simulations. This study presents only hypothetical estimates on the utilization of maternal and child health services under different assumed scenarios of COVID-19-related disruption. Furthermore, assumptions were held constant for all 118 low- and middle-income countries, and country-specific responses were not accounted for. Although the authors present country-specific results in supplemental materials, assumptions are not likely to hold across such a diverse group of countries, and results may be under or overestimated for some countries.

Value added

This study adds to the growing body of work regarding the burden of COVID-19 in low- and middle-income countries, and for the potential impact of interruptions to primary care and other essential health services. This study estimates the indirect effects of COVID-19 on maternal and child health, which builds on previous estimates and may be useful for planners and decision-makers.

This review was posted on: 17 June 2020