COVID-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition

ABSTRACT Coronavirus disease 2019 (COVID-19) continues to ravage health and economic metrics globally, including progress in maternal and child nutrition. Although there has been focus on rising rates of childhood wasting in the short term, maternal and child undernutrition rates are also likely to increase as a consequence of COVID-19 and its impacts on poverty, coverage of essential interventions, and access to appropriate nutritious foods. Key sectors at particular risk of collapse or reduced efficiency in the wake of COVID-19 include food systems, incomes, and social protection, health care services for women and children, and services and access to clean water and sanitation. This review highlights key areas of concern for maternal and child nutrition during and in the aftermath of COVID-19 while providing strategic guidance for countries in their efforts to reduce maternal and child undernutrition. Rooted in learnings from the exemplars in Global Health's Stunting Reduction Exemplars project, we provide a set of recommendations that span investments in sectors that have sustained direct and indirect impact on nutrition. These include interventions to strengthen the food-supply chain and reducing food insecurity to assist those at immediate risk of food shortages. Other strategies could include targeted social safety net programs, payment deferrals, or tax breaks as well as suitable cash-support programs for the most vulnerable. Targeting the most marginalized households in rural populations and urban slums could be achieved through deploying community health workers and supporting women and community members. Community-led sanitation programs could be key to ensuring healthy household environments and reducing undernutrition. Additionally, several COVID-19 response measures such as contact tracing and self-isolation could also be exploited for nutrition protection. Global health and improvements in undernutrition will require governments, donors, and development partners to restrategize and reprioritize investments for the COVID-19 era, and will necessitate data-driven decision making, political will and commitment, and international unity.

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Social protection for all ages? Impacts of Ethiopia’s Productive Safety Net Program on child nutrition

Social Science & Medicine ◽

10.1016/j.socscimed.2016.05.001 ◽

2016 ◽

Vol 159 ◽

pp. 92-99 ◽

Cited By ~ 18

Author(s):

Catherine Porter ◽

Radhika Goyal

Keyword(s):

Child Nutrition ◽

Social Protection ◽

Safety Net

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The Novel Coronavirus and Undocumented Farmworkers in the United States

NEW SOLUTIONS A Journal of Environmental and Occupational Health Policy ◽

10.1177/1048291121989000 ◽

2021 ◽

pp. 104829112198900

Author(s):

Olayemi O. Matthew ◽

Paul F. Monaghan ◽

John S. Luque

Keyword(s):

Legal Status ◽

Risk Mitigation ◽

Healthcare Services ◽

Safety Net ◽

The United States ◽

Mitigation Strategies ◽

Contact Tracing ◽

Precautionary Measures ◽

Novel Coronavirus ◽

Working And Living Conditions

The Covid-19 pandemic has greatly impacted frontline workers’ health in 2020. The objective of this commentary is to evaluate some of the challenges faced by undocumented farmworkers in the context of the current global pandemic and possible risk mitigation strategies. Undocumented farmworkers make considerable contributions to the U.S. economy and food production, but they are at an elevated risk for contracting Covid-19. Their risk is compounded by their employment and legal status, as well as their poor working and living conditions which makes it difficult for them to observe Covid-19 precautionary measures. U.S. immigration policy disincentivizes undocumented farmworkers from seeking healthcare services. Contact tracing challenges could be overcome by gaining trust with subsequent increased testing and care. Extending eligibility of safety net programs for undocumented farmworkers will help to ease the burden of Covid-19, thereby improving their overall health and productivity.

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Food Security and COVID-19 in Africa: Implications and Recommendations

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-1590 ◽

2021 ◽

Author(s):

Esraa Mahadi Ali Mohamed ◽

Samar Mohammed Alhaj Abdallah ◽

Attaullah Ahmadi ◽

Don Eliseo Lucero-Prisno

Keyword(s):

Food Security ◽

Food Systems ◽

Social Protection ◽

Distribution Networks ◽

Safety Net ◽

African Countries ◽

Economic Implications ◽

Supply And Distribution ◽

Food Commodities

Before the COVID-19 pandemic ravaged Africa, a large percentage of Africans were already affected by poverty and food insecurity. The pandemic wreaked havoc on their already unfavorable situation. The direct and indirect impacts of COVID-19 included but not limited to illness and deaths of food systems’ workers, interruption of food supply chains, unemployment, depreciation of currency value, and disruption of social protection programs. COVID-19 will lead to further economic fallout. Thus, the situation needs careful observation and timely intervention to safeguard the vulnerable African communities. Although Africa has sought ways to lessen the dire impact of the pandemic on food security, short-term solutions should include and enhance social and economic relief initiatives such as monetary intervention and social safety net. Considering a balance between health benefits of COVID-19 restrictions and their economic implications, the African countries, at the regional level, must preserve open and efficient social protection programs and cross-border supply and distribution networks for agricultural inputs. Africa’s medium- and long-term strategies for improving food security should include improving and diversifying its agricultural productivity and production of key food commodities. This will reduce Africa’s dependence on importation of these key commodities, and will help the continent address underlying economic vulnerabilities and better manage food, pandemic, and/or health-related crises affecting food security in the long term.

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Mapping the effects of drought on child stunting

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1905228116 ◽

2019 ◽

Vol 116 (35) ◽

pp. 17219-17224 ◽

Cited By ~ 11

Author(s):

Matthew W. Cooper ◽

Molly E. Brown ◽

Stefan Hochrainer-Stigler ◽

Georg Pflug ◽

Ian McCallum ◽

...

Keyword(s):

Climate Change ◽

Food Systems ◽

Child Nutrition ◽

Local Food Systems ◽

Precipitation Extremes ◽

Child Stunting ◽

Child Undernutrition ◽

Adverse Impacts ◽

Effects Of Drought ◽

Climate Shocks

As climate change continues, it is expected to have increasingly adverse impacts on child nutrition outcomes, and these impacts will be moderated by a variety of governmental, economic, infrastructural, and environmental factors. To date, attempts to map the vulnerability of food systems to climate change and drought have focused on mapping these factors but have not incorporated observations of historic climate shocks and nutrition outcomes. We significantly improve on these approaches by using over 580,000 observations of children from 53 countries to examine how precipitation extremes since 1990 have affected nutrition outcomes. We show that precipitation extremes and drought in particular are associated with worse child nutrition. We further show that the effects of drought on child undernutrition are mitigated or amplified by a variety of factors that affect both the adaptive capacity and sensitivity of local food systems with respect to shocks. Finally, we estimate a model drawing on historical observations of drought, geographic conditions, and nutrition outcomes to make a global map of where child stunting would be expected to increase under drought based on current conditions. As climate change makes drought more commonplace and more severe, these results will aid policymakers by highlighting which areas are most vulnerable as well as which factors contribute the most to creating resilient food systems.

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“PHONE-CONNECT” - A Pilot Program Prescribing Phones to Address Digital Health Equity Needs in the COVID-19 Era (Preprint)

10.2196/preprints.23914 ◽

2020 ◽

Author(s):

Gill Kazevman ◽

Marck Mercado ◽

Jennifer Hulme ◽

Andrea Somers

Keyword(s):

Public Health ◽

Health Care ◽

Social Services ◽

Access To Health Care ◽

Health Care Services ◽

Point Of Care ◽

Digital Health ◽

Contact Tracing ◽

Health Care Intervention ◽

Care Intervention

UNSTRUCTURED Vulnerable populations have been identified as having higher infection rates and poorer COVID-19 related outcomes, likely due to their inability to readily access primary care, follow public health directives and adhere to self-isolation guidelines. As a response to the COVID-19 pandemic, many health care services have adopted new digital solutions, relying on phone and internet connectivity. Yet, persons who are digitally inaccessible, such as those struggling with poverty or homelessness, are often unable to utilize these services. In response to this newly highlighted social disparity known as “digital health inequity”, emergency physicians at the University Health Network, Toronto, initiated a program called “PHONE CONNECT”. This novel approach attempts to improve patients’ access to health care, information and social services, as well as improve their ability to adhere to public health directives (social isolation and contact tracing). While similar programs addressing the same emerging issues have been recently described in the media, this is the first time phones are provided as a health care intervention in an emergency department. This innovative ED point-of-care intervention may have a significant impact on improving the health outcomes for vulnerable people during the COVID-19 pandemic, and even beyond it.

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Cash transfers and child nutritional outcomes: a systematic review and meta-analysis

BMJ Global Health ◽

10.1136/bmjgh-2020-003621 ◽

2020 ◽

Vol 5 (12) ◽

pp. e003621

Author(s):

James Manley ◽

Yarlini Balarajan ◽

Shahira Malm ◽

Luke Harman ◽

Jessica Owens ◽

...

Keyword(s):

Child Nutrition ◽

Social Protection ◽

Dietary Diversity ◽

Meta Analysis ◽

Cash Transfer ◽

Animal Source Foods ◽

Animal Source ◽

Z Scores ◽

Households With Children ◽

The Impact

BackgroundCash transfer (CT) programmes are implemented widely to alleviate poverty and provide safety nets to vulnerable households with children. However, evidence on the effects of CTs on child health and nutrition outcomes has been mixed. We systematically reviewed evidence of the impact of CTs on child nutritional status and selected proximate determinants.MethodsWe searched articles published between January 1997 and September 2018 using Agris, Econlit, Eldis, IBSS, IDEAS, IFPRI, Google Scholar, PubMed and World Bank databases. We included studies using quantitative impact evaluation methods of CTs with sample sizes over 300, targeted to households with children under 5 years old conducted in countries with gross domestic product per capita below US$10 000 at baseline. We conducted meta-analysis using random-effects models to assess the impact of CT programmes on selected child nutrition outcomes and meta-regression analysis to examine the association of programme characteristics with effect sizes.ResultsOut of 2862 articles identified, 74 articles were eligible for inclusion. We find that CTs have significant effects of 0.03±0.03 on height-for-age z-scores (p<0.03) and a decrease of 2.1% in stunting (95% CI −3.5% to −0.7%); consumption of animal-source foods (4.5%, 95% CI 2.9% to 6.0%); dietary diversity (0.73, 95% CI 0.28 to 1.19) and diarrhoea incidence (−2.7%, 95% CI −5.4% to −0.0%; p<0.05). The effects of CTs on weight-for-age z-scores and wasting were not significant (0.02, 95% CI −0.03 to 0.08; p<0.42) and (1.2%, 95% CI: −0.1% to 2.5%; p<0.07), respectively. We found that specific programme characteristics differentially modified the effect on the nutrition outcomes studied.ConclusionWe found that CT programmes targeted to households with young children improved linear growth and contributed to reduced stunting. We found that the likely pathways were through increased dietary diversity, including through the increased consumption of animal-source foods and reduced incidence of diarrhoea. With heightened interest in nutrition-responsive social protection programmes to improve child nutrition, we make recommendations to inform the design and implementation of future programmes.

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Harvesting Health Knowledge: Breast Cancer Perceptions in the South Florida Latinx Farmworker Community

Qualitative Health Research ◽

10.1177/10497323211003542 ◽

2021 ◽

pp. 104973232110035

Author(s):

Felicia Casanova ◽

Felicia M. Knaul ◽

Natalia M. Rodriguez

Keyword(s):

Breast Cancer ◽

Community Health ◽

Health Care Services ◽

Health Knowledge ◽

Health Workers ◽

Cancer Education ◽

Breast Cancer Diagnosis ◽

South Florida ◽

Theory Approach ◽

Depth Interviews

South Florida agricultural regions, home to Latinx immigrant farmworkers, report higher rates of late-stage breast cancer diagnosis than national, state, and county-level averages. We conducted a community-based qualitative study on the needs, health knowledge gaps, barriers to breast cancer screening, and the role of community health workers (CHWs) in supporting the community’s access to early detection services. We conducted three CHW focus groups (FGs) ( n = 25) and in-depth interviews ( n = 15), two FGs ( n = 18) and in-depth interviews ( n = 3) with farmworker community members, and informal interviews with cancer clinicians ( n = 7). Using a grounded theory approach, five core themes regarding the community’s barriers to accessing health care services emerged: (a) lack of information; (b) social and economic barriers; (c) cultural factors; (d) fears and mistrust; and (e) psychosocial concerns. Findings yield implications for community health practice, the potential impact of CHWs, and the production of breast cancer education to improve health equity along with the care continuum.

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Child Undernutrition in the States of India: An Analysis Based on Change in Composite Index of Anthropometric Failure from 2006 to 2016

Review of Development and Change ◽

10.1177/09722661211010376 ◽

2021 ◽

pp. 097226612110103

Author(s):

J. R. Jith ◽

Rajshree Bedamatta

Keyword(s):

Child Nutrition ◽

Composite Index ◽

Family Health ◽

Wealth Index ◽

Household Wealth ◽

Population Projections ◽

Indian Children ◽

Indian States ◽

Child Undernutrition ◽

Low Weight

Stunting, wasting and underweight—the three traditional indicators of undernourishment among children—provide mutually non-exclusive categories of anthropometric failures: low height for age, low weight for height and low weight for age. Although these indicators are essential for designing specific clinical and child nutrition policy interventions, they fall short of estimating the prevalence of overall anthropometric failure, which provides a sense of the scale of the nutrition problem. This article estimates the alternative, more comprehensive measure Composite Index of Anthropometric Failure (CIAF) for Indian states, based on data from the National Family Health surveys of 2006 and 2016, for children under five years (Ch–U5). The CIAF-based undernutrition estimates show significantly high anthropometric failure levels among Indian children compared to only stunting, wasting and underweight. Based on population projections for Ch–U5, we also show that a sizeable number of states may have seen an increase in child undernutrition between 2006 and 2016. We also correlated CIAF with household wealth index scores and found a positive relationship with children facing no anthropometric failure.

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