Zero to 19 year-old children in sub-Saharan Africa bear a disproportionate proportion of the global burden of communicable and non-communicable diseases. Significant public health gains have been made in the fight against these diseases, however, factors such as underequipped health systems, disease outbreaks, conflict, and political instability continue to challenge prevention and control. The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) introduces new challenges to public health programs in sub-Saharan Africa. Of particular concern are programs targeting major conditions among children, such as undernutrition, vaccine-preventable pneumonia and diarrhea, malaria, tuberculosis, HIV, and sickle cell disease. This article focuses on the impact of the COVID-19 pandemic on child health in sub-Saharan Africa. We review the epidemiology of major pediatric diseases and, referencing modeling projections, discuss the short- and long-term impact of the pandemic on major disease control. We deliberate on potential complications of SARS-CoV-2 co-infections/co-morbidities and identify critical social and ethical issues. Furthermore, we highlight the paucity of COVID-19 data and clinical trials in this region and the lack of child participants in ongoing studies. Lastly, approaches and interventions to mitigate the pandemic’s impact on child health outcomes are discussed.
Impact
Children in sub-Saharan Africa bear a disproportionate burden of communicable and non-communicable diseases globally; this remains true even as the COVID-19 pandemic persists.
Amidst the fast-expanding COVID-19 literature, there is little comprehensive coverage of the pandemic’s indirect impact on child health in sub-Saharan Africa.
This article comprehensively outlines the threat that the pandemic poses to major disease prevention and control for children in sub-Saharan Africa. It discusses the potential impact of SARS-CoV-2 co-infections/co-morbidities, highlights research gaps, and advocates for data and action to mitigate the ripple effects of the pandemic on this population.
In addition to advancing the body of knowledge and response to COVID-19 in children, the indirect effects of the pandemic must be identified and concurrently addressed. For children in SSA, it will be important to optimize case detection and prompt management of highly prevalent diseases, such as malaria, HIV, and TB, and minimize interruptions for those on long-term treatment.Other infectious disease prevention through established national immunization programs must be sustained, while scaling up access to accurate diagnostics and care for SARS-CoV-2 and other causes of undifferentiated febrile illness.High-risk children with NCDs such as undernutrition and SCD must be targeted for sustained immunization and access to other critical interventions. The WHO’s Action Plan on Child Wasting and African Union’s Nutrition Strategy supports strengthening of national food, health, and social protection programs. However, this emergency pandemic situation requires promptly implemented palliatives of food and financial support that prioritize the most vulnerable children and families. Pandemic-responsive plans are being rolled out to minimize the negative impact of COVID-19 on targets set for HIV, TB, and malaria in SSA countries. Donor agencies have instituted measures to mitigate the effect of the pandemic on major diseases, especially in resource limited in settings. The Global Fund to Fight AIDS, Tuberculosis and Malaria has created a new funding mechanism that dedicates at least $500 million to fighting COVID-19 in hard-hit countries and is also reallocating portions of previously disbursed funds for the COVID-19 response, including epidemic preparedness assessment, laboratory testing, surveillance infrastructure, infection control in health facilities, and information campaigns.The Global Fund also provides regularly updated online information on how COVID-19 is affecting the global response to HIV, TB, and malaria. The US President’s Emergency Plan for AIDS Relief is decentralizing HIV services nearer to patient homes during movement restrictions, through strategies like community drug delivery.To reduce HIV-infected or -affected children’s exposure to COVID-19, caregivers have been advised to access facility-based services without their wards. Remote case management and support is to be prioritized for vulnerable children, including those with treatment failure and particularly severe psychosocial challenges.Implementing partners have been sensitized to potential spikes in gender-based violence and sexual exposure to HIV and are strengthening programming for prevention and survivor care. Furthermore, where feasible, key primary services and ancillary care such as adolescent support groups and adherence counseling are being migrated to social media applications.
Telehealth (also known as telemedicine) allows for continued but remote healthcare delivery during movement restrictions and isolation.Telehealth infrastructure in SSA is relatively undeveloped; however, social media and mobile health applications are being leveraged to facilitate interactive provider–patient consultations during the pandemic.South Africa is one of the few SSA countries to have telehealth guidelines, and these 2014 guidelines have been updated specifically for COVID-19.Much is left to be addressed for telehealth in SSA, such as accessibility and affordability for healthcare facilities, providers and patients, documentation and billing, patient privacy, and other regulatory issues.
Public health responses to the pandemic in SSA countries are evolving; however, attention to social determinants of health is sadly inadequate. Measures such as expanded access to courts, legal protection, and housing to address the needs of vulnerable children should be instituted by governments as an ethical imperative.Furthermore, civil society organizations, health personnel, researchers, and other relevant stakeholders need to collectively ensure the safety and protection of children, especially during this pandemic.
Studies from outside Africa have highlighted the disproportionate impact of COVID-19 on different subpopulations, including people of color. In order to alleviate immediate and long-term harmful effects, we need evidence on the extent to which social determinants of health such as poverty, physical environment, gender, and racial/ethnic discrimination are affecting children in SSA due to the pandemic.
While pediatric numbers for COVID-19 may be assumed small, the dearth of data in SSA countries limits meaningful study for an appropriate public health response for children. The under-inclusion of SSA children in clinical trials further limits the safe and efficacious use of new and/or repurposed drugs and vaccines for COVID-19 for this population. There is also sub-optimal understanding on the role of children in community transmission of SARS-CoV-2 in SSA. So far, tracing and testing in SSA is largely focused on adults.
Conflict and post-conflict areas will be more likely to face data gaps, and more extensively so. Countries experiencing intense conflict and forced displacement (e.g., Central African Republic, the Democratic Republic of the Congo, Nigeria, Somalia, South Sudan, and Sudan) are expected to be at particularly high risk for COVID-19 transmission and deaths.Due to additional safety concerns and health service disruptions, these countries are likely to experience greater strains in their testing/reporting capacity and thus may have significant undercounting of cases secondary to limited disease surveillance.Poor COVID-19 data can be strengthened through strategic sentinel surveillance to inform tailored responses for conflict/post-conflict settings.
Conclusion The COVID-19 pandemic is threatening efforts to prevent and control the major causes of child morbidity and mortality in SSA. As long as this pandemic persists, and even in its aftermath, its ripple effects will impact on children’s health, whether or not they are ever infected by SARS-CoV-2. These effects will take an especially heavy toll on children in SSA. However, this pandemic presents an opportunity to accelerate both targeted (testing laboratories and infectious disease treatment centers) and comprehensive/cross-cutting action (e.g., social support, policy changes, and new funding streams). The changes should focus not only on what can or should be done but also on how to do things differently for sustainable impact in these rapidly changing circumstances. Even as the COVID-19 pandemic continues, things should not fall apart for children in SSA.
Reference & SOurce information: https://www.nature.com/
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