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The changing face of COVID-19: a live tracker of its impact on children

While children may not be the face of the coronavirus pandemic, they could be its biggest victims. We keep track of the latest evidence and research on the potential socio-economic impacts of the pandemic on children and their rights to survive, learn and be protected.

There is real and present danger that the 2020s will become a ‘lost decade’ with unprecedented reversals in development progress. And while children seem to be less susceptible to the direct consequences of the coronavirus (although emerging evidence suggests COVID-19 poses a health threat to them as well), they are becoming the biggest victims of its social and economic impacts.

In this live tracker we are summarising what we believe to be the pandemic’s most severe consequences on children living in low- and middle-income countries. We will regularly update this tracker whenever new evidence emerges.

Latest update from 8th September, which saw the live tracker being migrated to a new platform and included country-specific results for all thematic areas.

  

Child Poverty

The scale and depth of financial hardship among families threatens to roll back years of progress in reducing child poverty and to leave children deprived of essential services.

The economic fallout brought about by COVID-19 will likely reverse this trend and turn back the clock by decades, pushing children into poverty or increasing the depth for children already living in poverty – both if measured monetarily or multidimensionally. Basing on economic projections by the World Bank and the IMF, our joint analysis with UNICEF estimates that, without urgent action to protect families, the number of children living in monetary poor households could soar between 90 to 117 million in 2020 (with poverty measured based on national poverty lines). For the first time, we are also able to look ahead to 2021, and while this comes with significant uncertainty, analysis suggests that the spike in poverty is unlikely to subside in 2021.

Across all age groups, the World Bank expects 71-100 million people being pushed into extreme poverty (as measured by those living below $1.90 PPP per day) due to the pandemic. A large share of the new extreme poor will be concentrated in countries that are already struggling with high poverty rates and numbers of poor, with almost half of the new poor being in South Asia and a third in Sub-Saharan Africa. Before the pandemic, children made up more than half of the world’s extreme poor.

Survive

Disruptions to essential health services and food supply due to the pandemic could lead to hundreds of thousands of additional child deaths and contribute to soaring levels of child malnutrition.

While children seem to make up less than 2% of diagnosed COVID-19 cases, we have reasons to be concerned by the secondary effects of the crisis on children: there is evidence for increasing child mortality either due to weakened or disrupted health services or due to reduced utilisations of routine services. Research by Johns Hopkins University covering 118 low- and middle-income countries and modelling for these effects estimates excess under five mortality basing on the severity and length of disruptions to essential health services. Depending on the scenario, under five mortality could increase by between 10 and 45%, resulting in 250,000 to 1.2 million additional under five deaths. 

More broadly, there are fears that the COVID-19 response will come at the expense of treating other diseases, especially in lower-income settings. For instance, UNAIDS estimates that in Sub-Saharan Africa alone a six-month disruption of antiretroviral therapy could lead to 500,000 additional AIDS-related deaths in 2020-21. Similarly, the WHO models that suspension in campaigns and loss of access to treatment for malaria could increase malaria deaths by 50% (with scenarios ranging from 7% to 99%), with children being disproportionally affected.

Children in emergency/conflict settings face a heightened risk of indirect health effects because they likely live in countries plagued by poor infrastructureweakened health systems ill-equipped to respond and eroded capacity for service provision, where distrust in institutions drives reluctance to follow public health directives and delivery of relief material by external actors might be impeded.

The economic shock which families are facing, coupled with mitigation measures which risk disrupting food supply chains, pose a significant risk of food insecurity, with nefarious consequences for children. 

A recent analysis published by the Lancet estimates that COVID-19 will lead 6.7 million children under 5 to suffer from moderate to acute wasting in 2020 (a 14.3% increase), with 57% of cases in South Asia and 22% in sub-Saharan Africa. Combined with an average of 25% reduction in coverage of nutrition and health services, this would lead to between 111,000 and 178,000 under-five deaths, more than half in Sub-Saharan Africa alone. This happens at a time when, at the height of the lockdown, school closures meant that 368.5 million children globally who rely on school meals might have lost access to a reliable source of food.

For all age groups, estimates vary. The Food and Agriculture Organization (FAO) estimates that the economic downturn following the pandemic might lead to an extra 14-80 million malnourished people. The World Food Programme (WFP) has issued a warning that unless swift action is taken the number of people suffering from acute food insecurity could double, jumping from 135 to 270 million. Oxfam warns that this might mean up to 12,000 people every day dying of starvation by the end of the year, more daily deaths than the coronavirus alone would cause.

Some regions will likely be more harshly hit than others. Sub-Saharan Africa is particularly affected, with 50% of the global food insecure population located on the continent even before the pandemic started. More than 50 million would suffer from hunger in West Africa alone, and the number of food insecure people could more than double in East Africa, jumping to 43 million.

As a direct consequence of COVID-19, immunisation campaigns have been suspended, despite research suggesting that the benefits of continuing immunisation are substantial, even when taking into account the risk of coronavirus infections, and that children who are losing out on life-saving vaccines might face negative long-term effects. According to the UN, at least 80 million children under 1 in almost 70 countries were likely affected in May; the Measles and Rubella Initiative predicts that 178 million people are at risk of missing measles shots in 2020; and World Vision expects reductions in DPT3 immunisation coverage of 30% in some of the poorest countries. The dire consequences of halted vaccinations campaigns are starting to emerge: 18 out of the 29 countries that have currently suspended measles campaigns because of the pandemic are reporting outbreaks; a mutated strain of poliovirus has been reported in more than 30 countries; and diphtheria and cholera are appearing in South Asia and Sub-Saharan Africa. 

Lockdown restrictions are restraining access to maternal health services, with devastating consequences for some mothers in labourJohns Hopkins estimates increases in maternal mortality ranging from 8% to 39% depending on the severity and duration of disruptions to routine health care. Measures contravening WHO recommendations are damaging maternal and child health alike; for instance, pregnant women have been denied beds in hospitals, and separation from a primary caregiver at birth increases a baby’s risk of death and contracting infections. The pandemic has also pushed a drop in the utilisation of maternal health services. 

More generally, an analysis of six Save the Children’s health projects in five countries shows heavy essential service disruption across continents, with varying degrees of intensity by region and type of service. 

While mostly negative, COVID-19 and its economic consequences also have positive effects on a limited set of child health issues. For instance, a temporary drop in pollution is estimated to result in 6000 fewer cases of asthma in children in Europe and 4000 fewer under five deaths in China. Also, greater emphasis on hygiene measures and broader awareness might have contributed to lowering the incidence of infectious diseases and sexually transmitted infections.

The Center for Global Development has built an online and frequently updated inventory capturing many of the indirect health effects of COVID-19 due to disrupted and suspended health services across communicable and non-communicable diseases, immunisation, and child and maternal health.

In Burkina Faso, a survey finds that almost 1 in 10 (8,4%) respondents or their family members had to delay or skip health care visits due to the lockdown, while 1 in 4 respondents had to limit either the number of size of their meals in the past week - with poorer respondents more likely to report being affected by food security issues.

A survey carried out in Colombia suggests that 43% of respondents had to delay or skip essential healthcare during the lockdown and that around half of them had to reduce the size (50%) or number (40%) of their meals at least once in the week preceding the survey. Despite a higher likelihood of receiving new government support over the month before the survey, households with schoolchildren reported being disproportionately affected by food security issues.

A survey conducted in Côte d'Ivoire finds that 14% of respondents skipped or delayed healthcare visits and 45% had to limit the number and/or size of their meals over the past week.

According to a survey conducted in Ghana, 10% of respondents say someone in their household delayed or skipped needed healthcare visits since mid-March. Almost 1 in 2 respondents reported reducing meal size and/or number over the week previous to the survey, with families with age-school children being more likely to be unable to afford food due to income drops.

In Kenya, daily deliveries in a large regional hospital dropped by 33%.

Results from a Mexico survey find that 1 in 3 people had to delay or skip essential health care and 20-25% had to limit the size and/or number of meals over the week prior.

A study conducted in Nepal comparing key metrics before and during the lockdown finds that restrictive measures led to a 52.4% decrease in institutional childbirth, 50% increase in the stillbirth rate, and a 200% increase in neonatal mortality.

A survey from the Philippines finds that around 1 in 4 respondents had to reduce their meal size and/or number over the week preceding the survey. Poorer households report being disproportionately affected, while families with school-age children reported greater difficulties buying food because of income drops.

Evidence from a survey conducted in Rwanda finds that 13% of respondents delayed or skipped needed healthcare visits and more than 50% of households say they have had to reduce food consumption in the past week, with rural respondents reporting greater difficulties accessing food.

According to a survey conducted in Sierra Leone, 5% of respondents had to delay or skip necessary healthcare visits and more than 40%had to limit portion sizes at meal times or reduce the number of meals they eat.

In South Africa lockdown measures have reduced deaths from non-natural causes such as road accidents and homicides, where road injuries are the second biggest cause of death for children age 5 to 14.

In Syria, food prices suffered a +200% increase in under a year, adding a hunger crisis on top of a humanitarian one.

Results from a survey in Zambia find that around 1 in 10 respondents delayed or skipped needed healthcare visits since the onset of the lockdown, and around 40% had to limit portion sizes at meal times or reduce the number of meals at least once in the past week. 

Learn

The pandemic is going to exacerbate the global learning crisis many low- and middle-income countries were already facing before and pose a real risk that some children will drop out indefinitely.

Remote learning will likely deepen education inequalities and learning gaps because of the digital divide and different loss of learning by socio-economic group. Worldwide, 50% of the students out of the classroom do not have access to a computer, and 40% lack internet access at home; with those figures as high as 90% and 82% in Sub-Saharan Africa, respectively. Household wealth is the biggest determinant of internet access, with the overwhelming majority of students living in the poorest households being excluded from accessing online services and therefore many remote learning opportunities. The divide extends beyond internet access: UNICEF research finds that in 40 of the 88 countries for which data is available, urban households are more than twice as lively to own a TV than rural households. Connectivity is an issue not only for households, but for schools too: in low-income countries, only 20% of schools are connected.

Finally, online education might disadvantage girls and children with disabilities. Globally, 25% fewer women have access to the internet than men, and in Sub-Saharan Africa women are 50% less likely to use the internet than men. Furthermore, evidence suggests children with disabilities are least likely to benefit from remote learning

Prolonged school closures could worsen learning outcomes in the long-term and widening existing inequalities, with an increasing number of children falling below minimum proficiency standards. Summer loss literature could give an indication in terms of potential effects and equity impacts: when schools are closed during the summer breaks, learning for children from more disadvantaged socio-economic backgrounds flattens, while children from privileged socio-economic backgrounds continue to gain new skills. In short, more privileged children continue to learn at home, while more disadvantaged children fall further behind as schools are closed. 

Estimates by Save the Children suggest that an additional 90-117 million children living in poverty could lead to between 7.0 and 9.7 million more children dropping out of school. The World Bank estimates that the pandemic will result in 7 million dropouts in primary and secondary school, decrease individual LAYS (Learning-Adjusted Years of Schooling) by 0.3-0.9 down to 7-7.6, and cost $10 trillion in future earnings if schools are shut down for 5 months. UNDP predicts that even in a conservative scenario, the effective out-of-school rate for primary education in 2020 will spike to 20%, with the highest setback suffered by the lowest human development countries. 

COVID-19 is having a devastating impact on early education, too: research by UNICEF estimates that at least 40 million children have missed out on early education in their pre-school year because of COVID-19. 

A survey in Burkina Faso finds that only in 50% of households do all children devote time to remote learning during school closures, and almost 4 in 10 respondents cannot say with certainty that children in the family will go back to school. Richer households are more likely to report that all of their primary-school-aged children are devoting time to home learning, and are also more likely to have a member of the household doing home-schooling.

A survey carried out in Colombia suggests that the overwhelming majority (96%) of primary- and secondary-age schoolchildren are spending time learning from home while schools are closed.

A survey conducted in Côte d'Ivoire finds that 79% and 84% of primary- and secondary-school children spent time on education while schools were closed, but 20% of respondents did not expect schoolchildren in their households to go back to school once schools reopened.

Evidence from Ecuador shows that children with less access to remote learning are more than twice as likely not to do any schoolwork.

survey conducted in Ghana finds that 36% and 43% of primary and secondary school pupils respectively are not spending any time on education at home, and those who do spend less time than they did in school. Additionally, only one third of households reported receiving communication from their child’s school.

A nationally representative survey carried out in Kenya finds that over 80% of respondents are very worried that the pandemic will have long-term effects on their children’s education.

Results from a survey in Mexico find that over 90% of respondents report that all primary and secondary school children in their household are spending time on education while at home, and close to 9 in 10 (87%) say children in the families will most likely or definitely go back to school once these reopen.

In a survey from the Philippines only 60% of respondents indicate that children in their household have already enrolled in school and 20% report they will not enrol children if schools reopened in August.

Evidence from a survey conducted in Rwanda finds that 80% of primary- and secondary-school age children are devoting time to remote learning during school closures.

Results from a phone survey in Senegal suggest that the likelihood of a child’s engagement in learning activities during lockdown is negatively correlated with wealth and level of education of the respondent.

According to a survey conducted in Sierra Leone, most respondents report all children in primary (78%) and secondary (76%) school in their household are spending time on education at home, but only 55-60% are spending an average of more than two hours per day on education.

Results from a survey in Zambia find that only around 60% of respondents report that primary- and secondary-age schoolchildren in their households are spending time learning from home during school closures; however, the overwhelming majority (96%) say their children will most likely or definitely return to school after the lockdown. 

Be Protected

The mitigation policies for, and economic repercussions of, COVID-19 are likely to have devastating effects for many children’s rights, with girls and young women being particularly at risk.

The pandemic could cause 13 million additional child marriages by 2030 due to a combination of prevention programmes being paused and potential effects of increasing poverty on the prevalence of early marriage. 

Disruptions to health services and supply chains could lead to loss of access to contraception for 47 million women (of all age groups), which may result in 7 million unintended pregnancies. Most likely, the pandemic is undercutting access to contraceptives and SRHS around the world. 

UNFPA and partners project 2 million additional cases of female genital mutilation (FGM) and 200 million cases of gender-based violence as the consequence of the pandemic. While coherent data is still lacking, many countries do experience stark increases in the reports of domestic violence. Basing on reported increases in domestic violence and given the strong co-occurrence between child abuse and domestic violence, World Vision estimates that over the next three months COVID-19 will drive violence against children (physical, sexual, and emotional) up by 20-32%. 

There are concerns that COVID-19 will increase the prevalence of child labour, as families’ experience economic hardships, parental deaths and school closures. Basing on evidence from South AfricaVietnamEcuador and other countries, the ILO finds that a 1 percentage point rise in poverty leads to at least a 0.7 percentage point increase in child labour, with dramatic consequences considering the major recession the pandemic has caused. Additionally, children face increased risk of physical violence as unemployment of parents is increasing in countries across the world.

Children with disabilities – up to 10% of all children – are disproportional at risk of violence and are particular vulnerable due to their dependence from care givers and face-to-face-services

Unprecedented, unstructured, and sometimes unsupervised screen time during lockdown puts children at greater risk of harm, including cyberbullying, online sexual exploitation and abuse, and sextortion. 

Evidence suggests that the pandemic and lockdown measures also jeopardise children’s mental health. Surveys conducted by Save the Children, the World Bank, and UNICEF in several countries consistently find that the pandemic and its consequences cause abnormal levels of distress in children. Additionally, there are fears that quarantined children “might be more susceptible to mental health problems because of their higher risk of infection, and the grief and fear caused by parental loss or separation;” similarly, previous research on the effect of health-related disasters on children’s psychological wellbeing finds that 30% of isolated or quarantined children met criteria for PTSD, a percentage four times higher than in non-quarantined peers. When it comes to teenagers, evidence suggests that social deprivation deriving from implementation of lockdown measures can be harmful at a time when social stimuli are key to adolescents’ development. 

A decline in facilities-based deliveries could cause birth registrations to plummet

Young women and girls are likely to suffer disproportionately from the crisis. First, they experience structural vulnerabilities, such as weaker safety nets to protect them from economic shocks. For instance, women and girls make up 60% of the world’s hungry, making them particularly vulnerable in emergencies. Second, the crisis might exacerbate existing inequalities, jeopardising or reversing hard-won gains towards gender equality. On a final sombre note, women and girls face specific challenges – such as gender-based violence (GBV), child marriage, and teenage pregnancy. As we laid out above, all of these are proven to rise during and in the aftermath of pandemics, with devastating effects for women and especially for adolescent girls.

Evidence from South and Southeast Asia finds that the pandemic is affecting women’s mental health more often than men’s, women are less likely to be covered by health insurance, and women’s unpaid domestic/care work has increased more often than for men. A rapid needs assessment conducted by UN Women in mid-April in 49 countries across 5 regions finds that 80% of the countries which provided data registered an increased in calls to helplines (by up to 400%). What is more, 70% of the countries reported a spike in cases reported by health centers – at a time when availability and access to services has plunged.

The Center for Global Development provides a useful overview of new studies researching the impact of the pandemic on violence against women and children (VAW/C). Findings suggest that effects are mixed depending by country, study, and type of violence; however, an apparent drop in VAW/C may well be due to a plunge in service availability and likelihood of reporting during lockdown. 

A survey in Burkina Faso finds that only in 50% of households do all children devote time to remote learning during school closures, and almost 4 in 10 respondents cannot say with certainty that children in the family will go back to school. Richer households are more likely to report that all of their primary-school-aged children are devoting time to home learning, and are also more likely to have a member of the household doing home-schooling.

A survey carried out in Colombia suggests that the overwhelming majority (96%) of primary- and secondary-age schoolchildren are spending time learning from home while schools are closed.

A survey conducted in Côte d'Ivoire finds that 79% and 84% of primary- and secondary-school children spent time on education while schools were closed, but 20% of respondents did not expect schoolchildren in their households to go back to school once schools reopened.

Evidence from Ecuador shows that children with less access to remote learning are more than twice as likely not to do any schoolwork.

survey conducted in Ghana finds that 36% and 43% of primary and secondary school pupils respectively are not spending any time on education at home, and those who do spend less time than they did in school. Additionally, only one third of households reported receiving communication from their child’s school.

A nationally representative survey carried out in Kenya finds that over 80% of respondents are very worried that the pandemic will have long-term effects on their children’s education.

Results from a survey in Mexico find that over 90% of respondents report that all primary and secondary school children in their household are spending time on education while at home, and close to 9 in 10 (87%) say children in the families will most likely or definitely go back to school once these reopen.

In a survey from the Philippines only 60% of respondents indicate that children in their household have already enrolled in school and 20% report they will not enrol children if schools reopened in August.

Evidence from a survey conducted in Rwanda finds that 80% of primary- and secondary-school age children are devoting time to remote learning during school closures.

Results from a phone survey in Senegal suggest that the likelihood of a child’s engagement in learning activities during lockdown is negatively correlated with wealth and level of education of the respondent.

According to a survey conducted in Sierra Leone, most respondents report all children in primary (78%) and secondary (76%) school in their household are spending time on education at home, but only 55-60% are spending an average of more than two hours per day on education.

Results from a survey in Zambia find that only around 60% of respondents report that primary- and secondary-age schoolchildren in their households are spending time learning from home during school closures; however, the overwhelming majority (96%) say their children will most likely or definitely return to school after the lockdown. 

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