Child malnutrition and COVID-19: the time to act is now

Abstract

www.thelancet.com Vol 396 August 22, 2020 517 The COVID-19 pandemic is undermining nutrition across the world, particularly in low-income and middle-income countries (LMICs). The worst consequences are borne by young children. Some of the strategies to respond to COVID-19—including physical distancing, school closures, trade restrictions, and country lock downs—are impacting food systems by disrupting the production, transportation, and sale of nutritious, fresh, and affordable foods, forcing millions of families to rely on nutrient-poor alternatives. Strained health systems and interruptions in humanitarian response are eroding access to essential and often life-saving nutrition services. Social protection systems in many LMICs are overloaded as vulnerable families struggle to access the food and services they need in the context of an economic downturn. Malnutrition could exacerbate the effects of COVID-19 in mothers and children. At the same time, more children are becoming malnourished due to the deteriorating quality of their diets, interruptions in nutrition and other essential services, and the socioeconomic shocks created by the pandemic in LMICs. New estimates by Derek Headey and colleagues in an accompanying Comment in The Lancet suggest that without timely action, the global prevalence of child wasting could rise by a shocking 14·3%. With an estimated 47 million children younger than 5 years affected by wasting globally before the COVID-19 pandemic, this would translate to an estimated additional 6·7 million children with wasting during the first 12 months of the pandemic—80% of them in sub-Saharan Africa and south Asia—and more than 10 000 additional child deaths per month during this same period. With services for the prevention and treatment of wasting to a large extent up-ended in LMICs, millions of children are at risk of not receiving the care they need to survive and thrive. UNICEF reports from the early months of the COVID-19 pandemic suggest a 30% reduction in the coverage of essential nutrition services in LMICs and declines of 75–100% under lockdown contexts. Our agencies estimate that a minimum of US$2·4 billion is needed immediately to protect these children, prevent and treat malnutrition, and avoid human loss. This $2·4 billion estimate includes an essential package of four life-saving inter ventions: prevention of wasting in children at risk; treatment for children who are wasted; biannual vitamin A supplementation for children aged 6–59 months (90% coverage); and mass communication for the protection, promotion, and support of breast feeding that focuses on caregivers or families of children aged 0–23 months. Child malnutrition and COVID-19: the time to act is now The study by Nicolas Bréchot and colleagues examined the use of a highly specialised intervention (ECMO) for a rare presentation (cardiogenic shock) of a common illness (sepsis). Few clinicians will need to apply the results of this study in clinical practice but, for those who do, it will probably save lives.