Is the effect of COVID‐19 on children underestimated in low‐ and middle‐ income countries?

• DOI: 10.1111/apa.15419
• Publication Date: 2020-06-19T03:06:31Z
• Authors: Justus Simba; Ian Sinha; Patrick Mburugu; Ambrose Agweyu; Caren Emadau; Sam Akech; Rosemary Kithuci; Laura Oyiengo; Mike English
• Keywords: 2019-20 coronavirus outbreak; Pandemic; Betacoronavirus; Coronavirus Infections

The COVID-19 pandemic has had a huge impact on health and society, worldwide. While most high-income countries are felt to be reaching their peak, low- middle-income (LMICs), particularly sub-Saharan countries, anticipating an exponential growth of cases.1 Overall it been documented that children less affected.2 However, in this commentary we describe how Kenya, LMIC Africa, is likely have far-reaching direct indirect implications children. Of all confirmed cases COVID-19, only around 1%-5% children.2 In the first case was diagnosed 13th March 2020; one month later, six aged between 15 years (2.7% out 216 total cases) with infection according Ministry Health Daily Situation Report as at April 2020. Although mild illness, there reported death child underlying comorbidity. As testing for very limited, being excluded from mass testing, difficult confident numbers. Collecting nasopharyngeal or oropharyngeal swabs requires patient cooperative, which achieve young children, well acute respiratory infections (ARIs), so common index suspicion low, these pose unique challenges It therefore imperative other methods estimating burden LMICs may utilised including syndromic surveillance modelling data. led different predictions depending assumptions made.3 tell path will follow reality. Children risk developing dying severe preventable causes mortality diarrhoea, malaria neonatal causes. Particular factors include malnutrition immunodeficiency HIV, low uptake immunisation services (particularly rural settings urban slums), variable housing quality, indoor air pollution, poor care seeking behaviour barriers access affordable high-quality services.4 National local initiatives aligned global survival strategies gone some way improving modifiable factors, tangible improvements outcome, but resources directed towards gains eroded witnessed Ebola epidemic west Africa.5 government-mandated lockdown affect mobility healthcare workers, patients families, hindering such efforts further. currently guidelines resumptions follow-up chronic conditions, hitherto suspension paediatric outpatient clinics,6 addition closure monitoring/ well-child notable reduction immunisations, medical conditions suffer. illnesses known sickle cell disease, rickets, HIV asthma, lack increase morbidity COVID-19. We do acknowledge evidence whether poorly controlled asthma substantial number get become clearer. Social distancing measures schools Kenya. absence formal government-led facilitation alternative learning arrangements, adopted technology online interaction welcome, may, fact, worsen inequalities, backgrounds not resources.7 Worse still, available special needs. mental emotional well-being already threatened by social isolation friends relatives, continuous exposure bad news about risks death.7, 8 Schools peer-group can provide protective effect times uncertainty, lose opportunity. effects closed should evaluated against backdrop that, effective method controlling coronavirus transmission. economic also catastrophic large sections population. About 80% labour force Kenya works informal sector.9 Current restrictions uncertainty reduced opportunities dwindling family income. This families most, those living settlements home worsening financial hardship quality nutrition, housing, education mobility, time rapid physiological psychological development, described.8 short term, levels decreasing food security negatively further outcomes appear adults mainly. Children, however, vulnerable wider consequences. hope predominance asymptomatic illness countries2 applies LMICs. without adequate weak systems, rates diagnosis disease uncertain.10 What clear, societal detrimental great need immediate, country-led multi-sectoral sustain hard-earned health. national policy discussions ensure protected must start now continue long-term Continuation interventions shown reducing services, delivery under skilled birth attendants, prevention early treatment malaria, Integrated Management Neonatal Childhood Illness (IMNCI) priority. Further, tapping into emerging brought strengthening system through related response reduce untold effects. Such use telemedicine where applicable, enhanced practices facilities increased oxygen capabilities. Lastly, equitable opportunities, provision directly cash transfers orphaned vulnerable, explored mitigation afore mentioned Without efforts, generational far higher than estimated. authors declare no conflict interest.