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COVID-19 and child health

COVID-19 and child health
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SUNEETHA KADIYALA: Hello, everyone. My name is Suneetha Kadiyala, and I’m going to talk about COVID-19 and the food systems and implications for nutrition. We all want healthy babies to be growing up to their fullest potential to be as children and adolescents, and healthy adults who will, in turn, give birth, if they choose to, to children that are healthy and well-nourished throughout their life. This is only possible with a lot of things in place. For example, good health care, correct information, wash, education, and being there for each other through collective action throughout the lifecycle. One of the key inputs into nutrition is healthy and nutritious diets.
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These diets come from no other place than our food systems, which incorporates agriculture production, markets and trade systems, food transformation, and consumer demand, and therefore the consumer themselves. Together, these processes determine our diet quality, which includes dietary diversity, dietary adequacy, as well as safety. Before COVID, about 40% to 70% of the labour force in low- and middle-income countries was employed in agriculture. What we find after COVID since March of this year, is that there’s been an estimated one-third decrease in livelihoods, and then one-third decrease in incomes of people. Therefore, there has been a 20% increase in poverty in sub-Saharan Africa and in Asia, on South Asia on average.
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Low- and middle-income countries have always faces– especially for perishable nutrient-dense food such as the animal source foods, fruits and vegetables– a weak supply chains. And because of lockdowns and because of infections and disruption of formal and informal markets and production itself, countries have seen food price fluctuations, making nutritious diets rather difficult. As we all know, there has been a rapid increase in ultra processed food consumption across the globe. But there is some emerging evidence that this might be worsening due to COVID. Before COVID, there were 135 million people food insecure, according to WFP, the World Food Programme.
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And now, there at about 260 million people who are food insecure, therefore attracting the diet quality of these people and therefore potential for better improving their nutrition outcomes. So given that, there has been a disruption just not to one system, but every possible system that we can think of. The hard-earned gains in improvements in maternal and child nutrition are indeed under jeopardy. Recent estimates show that there has been a 14% increase in child wasting. This is, of course, not a surprise, given disruptions to food supplies and therefore access– physical and economic access to foods, the 30% reduction in essential nutrition services, as well as a lot of misinformation, and on COVID, and on COVID and nutrition also.
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In the recent article in the Lancet, the UN heads, some of the agencies, have put forward nutritious, safe, and affordable diets as one of the most important COVID responses. They also point to the need for accurate information. What are some of the research questions therefore? Well, what are the COVID impacts on maternal and child nutrition diets? We think, according to estimates, this is bad, but we really do not know the range of or the extent of these impacts. And this is, of course, difficult to get understandably so when data collection itself is difficult. Once we know the impacts, how do we mitigate these impacts? Well, we are trying this out at the school, especially with our research group in nutrition.
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And the couple of groups that I lead is on trying to understand how nutrition-sensitive agriculture, which we know can improve diets, can be redesigned and repurposed to deliver interventions at scale to build resilience, especially among vulnerable populations to the impacts of COVID-19 on food systems and therefore nutrition. We’ll be trying this out as an add-on follow up study to one of the recent trials we ended in India. As I said, COVID is a multi-systemic shock. Therefore, there are cascading risks. And we want to try and understand, at the school probably, is about the cascading risks and risks transmission posed by COVID along the food system and implications for nutrition outcomes.
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Of course, we need to take into account the complexity, uncertainty, across systems and the interactions between these systems and data availability, as I said, which is even more challenging due to COVID-19, as we are all acutely feeling. But as this school, I think we’re all up for this task and this challenge. Thank you for giving me this opportunity.

What about children and COVID-19? While children seem to be less impacted by COVID-19 with possibly fewer infections and definitely fewer deaths, the main concern about child health is the potential collateral damage and indirect effects of COVID-19 on child health services. Some concerning highlights:

117 million children may miss measles vaccine as 23 countries suspended immunisation campaigns early in the pandemic. A model by LSHTM (Abbas et.al. LGH 2020) suggested that continuing routine immunisation programmes may lead to 8,300 additional COVID-19 deaths, while suspending such vaccination programmes to avoid excess COVID-19 deaths could lead to 702,000 child deaths from vaccine preventable diseases. After publication of this model, many countries reinstated immunisation programmes with an emphasis on infection control procedures and personal protective equipment.

There have also been projections of increased child wasting and malnutrition related mortality. Heady et.al. (Lancet 2020) estimated additional estimated 6·7 million children with wasting is combined with a projected 25% reduction in coverage of nutrition and health services, estimate 128 605 additional deaths in children younger than 5 years from malnutrition.

These impacts on child nutrition are based on impact of COVID-19 on poverty and food systems. The World Food Programme analysis shows that, due to the Coronavirus, an additional 130 million people could be pushed to the brink of starvation by the end of 2020. That’s a total of 265 million people.

This video presents a discussion on the threat to Food Systems globally due to COVID-19 and suggests some ways public health professionals can work on broader social determinants of health to mitigate these threats. COVID-19 has posed a global threat not only to health but also well-being, the economy and our communities. We must think beyond health systems to these wider systems to assure the health of children and families.

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