Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality

Abstract

The unprecedented global social and economic crisis triggered by the COVID-19 pandemic poses grave risks to the nutritional status and survival of young children in low-income and middle-income countries (LMICs). Of particular concern is an expected increase in child malnutrition, including wasting, due to steep declines in household incomes, changes in the availability and affordability of nutritious foods, and interruptions to health, nutrition, and social protection services. One in ten deaths among children younger than 5 years in LMICs is attributable to severe wasting because wasted children are at increased risk of mortality from infectious diseases. Before the COVID-19 pandemic, an estimated 47 million children younger than 5 years were moderately or severely wasted, most living in sub-Saharan Africa and south Asia. The economic, food, and health systems disruptions resulting from the COVID-19 pandemic are expected to continue to exacerbate all forms of malnutrition. Estimates from the International Food Policy Research Institute suggest that because of the pandemic an additional 140 million people will be thrown into living in extreme poverty on less than US$1·90 per day in 2020. According to the World Food Programme, the number of people in LMICs facing acute food insecurity will nearly double to 265 million by the end of 2020. Sharp declines are expected in access to child health and nutrition services, similar to those seen during the 2014–16 outbreak of Ebola virus disease in sub-Saharan Africa. Early in the COVID-19 pandemic, UNICEF estimated a 30% overall reduction in essential nutrition services coverage, reaching 75–100% in lockdown contexts, including in fragile countries where there are humanitarian crises. The accompanying call to action on child malnutrition and COVID-19 from leaders of four UN agencies in The Lancet is an important first step for the international community. Alongside these efforts, the Standing Together for Nutrition consortium, a multidisciplinary consortium of nutrition, economics, food, and health systems researchers, is working to estimate the scale and reach of nutrition challenges related to COVID-19. These efforts link three approaches to model the combined economic and health systems impacts from COVID-19 on malnutrition and mortality: MIRAGRODEP’s macroeconomic projections of impacts on per capita gross national income (GNI); microeconomic estimates of how predicted GNI shocks impact child wasting using data on 1·26 million children from 177 Demographic Health Surveys (DHS) conducted in 52 LMICs between 1990–2018; and the Lives Saved Tool (LiST), which links country-specific health services disruptions and predicted increases in wasting to child mortality. What do our initial analyses and estimates suggest? First, the MIRAGRODEP projections suggest that even fairly short lockdown measures, combined with severe mobility disruptions and comparatively moderate food systems disruptions, result in most LMICs having an estimated average 7·9% (SD 2·4%) decrease in GNI per capita relative to pre-COVID-19 projections. Second, the microeconomic model projections indicate that decreases in GNI per capita are associated with large increases in child wasting. Our own analyses, based on these estimates applied to 118 LMICs, suggest there could be a 14·3% increase in the prevalence of moderate or severe wasting among children younger than 5 years due to COVID-19-related predicted countryspecific losses in GNI per capita. We estimate this would translate to an additional estimated 6·7 million children with wasting in 2020 compared with projections for Published Online July 27, 2020 https://doi.org/10.1016/ S0140-6736(20)31647-0