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
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
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DOI：
10.1016/s2214-109x(20)30229-1
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发表时间：
2020-07-01
影响因子：
34.3
通讯作者：
Walker, Neff
中科院分区：
文献类型：
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作者：
Roberton, Timothy;Carter, Emily D.;Walker, Neff
虽然COVID-19大流行将增加因该病毒导致的死亡率，但它也可能间接增加死亡率。在本研究中，我们估计了由于卫生系统的潜在中断和食物获取减少而导致的额外孕产妇和5岁以下儿童死亡。方法我们模拟了三种情景，其中基本妇幼保健干预措施的覆盖率减少了9.8-51.9%，消瘦率增加了10-50%。尽管我们的情景是假设的，但鉴于新出现的关于大流行的供给侧和需求侧影响的报告，我们力求反映现实世界的可能性。我们使用“拯救生命工具”估算了118个低收入和中等收入国家在每种情况下的额外孕产妇和5岁以下儿童死亡人数。我们估计了一个月的额外死亡人数，并推断了3个月、6个月和12个月的额外死亡人数。研究结果：在6个月内，最不严重的情况（覆盖率下降9.8-18.5%，浪费增加10%）将导致253 500名额外的儿童死亡和12 200名额外的孕产妇死亡。我们最严重的情况（覆盖率减少39.3-51.9%，浪费增加50%）在6个月内将导致额外的1 157 000名儿童死亡和额外的56 700名产妇死亡。在118个国家中，这些额外的死亡人数将意味着每月5岁以下儿童死亡人数增加9.8-44.7%，每月孕产妇死亡人数增加8.3-38.6%。在我们的三种情况下，四种分娩干预措施（子宫强直剂、抗生素和抗惊厥药的静脉注射，以及清洁的分娩环境）的覆盖范围减少，将导致约60%的额外产妇死亡。消瘦流行率的增加将占新增儿童死亡人数的18-23%，治疗肺炎和新生儿败血症的抗生素和治疗腹泻的口服补液覆盖率的减少将合计占新增儿童死亡人数的41%左右。我们的估计是基于暂定的假设，代表了广泛的结果。尽管如此，它们表明，如果常规卫生保健中断并减少获得食物的机会（由于不可避免的冲击、卫生系统崩溃或在应对大流行时故意做出的选择），儿童和孕产妇死亡人数的增加将是毁灭性的。我们希望这些数字能够为政策制定者在未来几天和几个月内制定指导方针和分配资源提供背景。
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.