Mounting worries that COVID-19 could lead to increase in child malnutrition

For Ethiopian children, the most serious risks posed by the COVID-19 pandemic are not those of the disease itself, but the secondary impacts on their well-being, among which is the threat posed by severe acute malnutrition (SAM).

Due to the combined effects of desert locusts, climate change, and the secondary impacts of COVID-19, UNICEF and its nutrition partners anticipate that the number of children to be treated for SAM in 2020 will rise by 24 percent, from the 460,000 initially planned as a target for UNICEF action (which includes 16,000 refugee children), to 570,000 children (of whom 18,400 are refugee children). A rise of this magnitude could trigger a spike in child mortality, as children with SAM are more likely to die from infectious diseases such as measles and malaria, with malnutrition often an underlying cause.

The advent of COVID-19 has complicated an already challenging situation. The locust invasion which began last July has affected more than 50 percent of available pastures in the worst affected parts of Ethiopia, notably areas of Somali and Afar regions. In Oromia, the impact on cereal crops has been particularly severe, while cattle herders in both Somali and Afar have reported that they are forced to sell livestock not only to buy food, but also just to buy stock feed for their remaining animals. Many of these places are already food-insecure.

Already we are seeing evidence of rising malnutrition in the communities living in the areas stormed by the desert locusts. Hence, admissions of children with SAM in the six desert-locust-affected regions of Tigray, Afar, Amhara, Oromia, SNNPR and Somali rose by an average of 20 percent between January and February this year compared to the same period last year. Meanwhile, the closure of schools has deprived about one million children from the poorest families of school meals, which are a valuable source of nutrition. In Addis Ababa alone, there were more than half a million children receiving school meals and they are no longer receiving this support.

The disruption wrought by the pandemic and associated lockdown measures will affect child nutrition in some obvious ways: through lost incomes and reduced livelihoods; higher food prices as supply chains are stretched; and increased poverty levels. But there are other less direct ways in which the COVID-19 crisis is expected to contribute to a sharp increase in child malnutrition.

Critically, the workload on healthcare workers - as a large part of the workforce is deployed on the COVID-19 frontline - coupled with a scarcity of medical supplies in the case of a surge in COVID-19 infections, could seriously jeopardize the delivery of essential health services. This means more children suffering from infectious diseases like malaria and cholera are unlikely to receive the treatment they need. The first tangible evidence that COVID-19 can disrupt health services is the postponement of the measles and polio campaigns from the planned March dates. This is particularly worrying when we consider that even before the pandemic, Ethiopia had one of the largest cohorts of unimmunized children in the world – about 1.2 million children. The Johns Hopkins University estimates that immunization averts over 62,000 child deaths every year.

COVID-19 could also affect demand for health services. March 2020 data from the Ministry of Health shows that there was a nine percent decrease in the number of children treated for pneumonia compared with the previous eight-month average, suggesting mothers and caregivers are choosing to stay home rather than visit health facilities for fear of catching the virus.

Moreover, health facilities in Ethiopia provide key micronutrient support for children and pregnant and breastfeeding women, such as vitamin A and iron folic acid supplementation. Vitamin A reduces child mortality by at least 23 per cent and iron folic acid reduces anemia among pregnant women by 27 per cent.

It is critical that early initiation of breastfeeding, which prevents 20 per cent of newborn deaths, and exclusive breastfeeding for the first 6 months of life, which prevents 13 per cent of under-five deaths, continue during COVID-19. Although expert advice is for mothers to continue breastfeeding their babies during COVID-19, not many are aware and they may stop breastfeeding for fear of transmitting the virus to their babies. They may also be less likely to give meat to their children if they believe - as some do – that it can transmit COVID-19.

UNICEF and other partners play a vital role in helping the Ministry of Health to meet these challenges. UNICEF is the sole purchaser of SAM treatment commodities in the country which we provide to 20,000 health facilities, including some in the remotest parts of the country. As part of our COVID-19 response strategy, we aim to treat the increasing number of malnourished children with Ready-to-Use Therapeutic Food at a cost of US$ 38 million, secured to a large extent with generous support from our partners, albeit there is a current funding gap of US$4.3 million.

At the same time, we are supporting messages on radio and television encouraging mothers to continue breastfeeding and providing complementary food to their children.

Although many of our programme activities are slowed down by COVID-19 - for example, we are unable to carry out face-to-face training of healthcare workers - we are finding ways to adapt. Currently, we are in the process of developing CD-based training for health workers, a step towards providing institutionalized online learning.

The projected increase in severe acute malnutrition is worrisome. However, a catastrophe can be averted if we ensured that every caregiver had the right information to prevent malnutrition, that vulnerable families were supported with cash transfers to enable them to buy food, and that treatment programmes were scaled up to reach every child in need of treatment. This undertaking is ongoing, with the government in the lead and UNICEF and other partners providing the necessary support.