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Children under five bear brunt of Covid disruption

By Evelyn Makena
Monday, August 31st, 2020
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Evelyn Makena @evemake_g

With sweat streaming down her face, Leila Ajigo frantically peeled off her daughter’s clothes.

The heat from the baby’s body was intense. Her hands shook and her whole body trembled. Leila was terrified.

For hours, doctors and nurses dashed in and out of the room to check on the child’s condition without uttering a word.

Their countenance and silence to her constant cries for answers sent chills down her spine.  

It was a chilly June morning. Leila had taken her nine-month daughter for a measles vaccination. 

“I was also hoping to get medication for flu and cough that my daughter had come down with,” she recalls.

But what was meant to be a simple immunisation visit at a health facility in Nairobi’s Kiambiu slums, had thrown the mother of four into a panic.

In line with the Covid-19 guidelines, Leila and her daughter underwent a mandatory temperature check at the facility’s entrance. Leila’s temperature was normal, but her daughter’s was abnormally high.  

“Without any explanation, my daughter and I were whisked into a room within the facility and put in isolation,” she says.

Demand and supply 

With a fever of 41 degrees Celsius, her daughter was suspected to have contracted Covid-19.

Mother and daughter were immediately placed in isolation to minimise contact with the other patients.

For more than four hours, the two were treated as if they had deadly plague. They stayed in isolation until her temperature gradually dropped to 36 degrees. 

“No tests were conducted to show whether she had Covid-19 or not. When her temperature dropped, we were allowed to access the immunisation services. I was at the hospital from 9am to 3pm,” she says. 

This encounter has been traumatising for Leila. She is completely discouraged from going to the hospital for subsequent vaccinations.

The stigma and treatment of those suspected to be Covid-19 positive is keeping many frightened mothers away from hospitals. 

The 30-year old mother is scheduled to return to the hospital when the child is one and half years old, but she is too petrified to venture anywhere near a health facility in case she goes through similar experience.  

Amid the Covid-19 public health crisis, essential health interventions for children under five, such as vaccinations, have been disrupted.

The United Nations (UN) warns there could be as many as 6,000 child deaths every day globally, due to preventable causes, if the pandemic persists for the next six months.

The deaths will be a consequence of disruption of routine health services and decreased access to food occasioned by the coronavirus.

An analysis by Johns Hopkins Bloomberg School of Public Health, published in the Lancet Global Health Journal, shows that there could be an additional 1.2 million deaths of children under five in the most severe scenario of Covid-19 over the next six months.

The increase in mortality will be as a result of wasting due to disruption in access to food; pneumonia and sepsis due to reduced coverage of antibiotics; and diarrhea owing to low access to oral rehydration solution.

Dr Lynn Kanyuuru, Head of Health and Nutrition, Save the Children, says the disruptions in health services have occurred on both the demand and supply sides.

On the demand side, comprising those seeking health services, there is greater difficulty in accessing care due to restrictions of movement.

Difficulty in accessing health services is also perpetuated by lack of money since incomes and livelihoods have been lost during this pandemic.

This is difficult especially for people paying for health services out of pocket.

“Care givers are also afraid to go to health facilities for fear of contracting the virus.

In this case, mothers only go to the hospital for serious health concerns, hence services like immunisation may be overlooked as caregivers minimise visits to health facilities,” says Dr Lynn.

On the supply side, that being the health facilities, the cost of providing medical care has gone up due to the extra investment in personal protective gear and modifications in patients flow to minimise risk of coronavirus infections.

Dr Lynn notes that with most resources shifting to fight coronavirus, some crucial areas are likely to be overlooked causing challenges such as medicine supplies stock-outs.

Similarly, infant initiatives such as Kangaroo Mother Care and trainings to mothers on integrated management of childhood diseases are likely to take a backseat during this pandemic. 

“Exclusive breastfeeding could be affected due to fear, since some mothers are shying away from breastfeeding when they get a cough for fear that they will transmit the virus to their children,” she adds.

Before the onset of the outbreak in March, Save the Children, a children’s non-governmental organisation present in seven counties, was supporting the government to scale up Kangaroo Mother Care Services, a method of care for preterm babies on a national level.

But with the shift of resources to Covid-19, fewer children are likely to benefit from these services.

Pinket Andati, 18, from Kiambiu slums, has been navigating motherhood with great difficulty.

Prior to the pandemic, the first time mother of a seven-month-old, would maximise on monthly clinic visits to learn about childcare. 

“From the clinics, I learnt how to feed my baby and keep him warm during the cold weather,” says the Form Three student.

But with the severity of Covid19 increasing, Pinket has shied away from any health facility. She instead buys medication over the counter whenever the child comes down with flu.

This delay in seeking medical care, Lynn notes, will lead to worse outcomes for childhood illnesses since mothers and caregivers may be forced to medicate their children without a doctor’s prescription. 

Outcomes for children under five include death, longer period of illnesses and other medical conditions. 

Experts predict there will be a spike in vaccine preventable diseases such as measles and tetanus due to missed immunisation.  

Awour Opee, a paediatric critical care nurse at Kenyatta National Hospital (KNH), observes that there was about a 75 per cent drop in the number of outpatient visits for the paediatric section.  

“In KNH, where on average 400 children visit the paediatrics outpatient per day, the numbers went as low as 100 in the initial days of the outbreak,” she says. 

The poor health seeking behaviors, Awour notes, have led to a slight increase in children brought in while critically ill increasing the chances of mortality.

She argues that there has been an increase in cases of Covid-19 among children under five, owing to community transmission. 

“Children rely on a caregiver to feed, bath, cloth and take care of them. This makes them vulnerable. Besides, children are quite clumsy and nose breathers and, therefore may not be able to consistently wear a mask as a preventative measure thus an increase in the rate of infections,” she says.  

Even though there are no concrete statistics on the same, Dr Lynn observes that there has also been an increase in stillbirths and neonatal deaths (children under 28 days), during this period of the outbreak.

The trend, Dr Lynn says, could be a consequence of the quality of care a mother receives during pregnancy and delivery.

Community health workers

Several initiatives have been established to counter the disruptions caused by the pandemic and ensure provision of health services to mothers and children.

One of these initiatives is Wheels for Life, an emergency transport service rolled out to help expectant mothers and children get to the hospital during the curfew hours. 

Through the toll-free number 1196, mothers can access the services of the initiative by the Ministry of Health in collaboration with other service providers such as AMREF and cab hailing service, Bolt.

Lynn postulates that engagement of community health volunteers has been successful in ensuring reduced hospital visits and in eliminating the fear of contracting the virus.

Community health volunteers are taking services closer to the people and ensuring continuity of health services during the coronavirus outbreak.

Despite the encouraging initiatives, Leila shakes her head in silence. She highly doubts if she can master the courage and energy to enter another health facility as long as the corona virus hangs over our heads.

She prays that God will preserve and protect her daughter and keep her safe and healthy.