A few weeks ago, during the ward round on the maternity unit, I saw a lady who was 8 months pregnant and in hospital for an unrelated problem. She was ready to go home, and before discharging her, I asked whether she was having antenatal care. This particular lady told us that she tried to visit the midwife in her village, but that the antenatal clinic was not running at present, due to Coronavirus. She had therefore received no pregnancy-related healthcare.
We made arrangements to see her in our antenatal clinic before she left the hospital and advised her to return to HVMM for further antenatal care. But this encounter left me somewhat anxious – how many pregnant women in our district were currently unable to access routine but essential care? And what might be the consequences?
The WHO recommends that all pregnant women have at least four antenatal visits to ensure that mother and baby remain healthy and to prevent and treat any complications. Data show that in even before COVID-19, only half of women in Madagascar received this level of antenatal care, and that many who access antenatal care do not receive basic interventions such as iron and folic acid supplements or treatment to prevent malaria.
The following week, the team on the medical ward were caring for a one-week old baby admitted with tetanus. In newborn babies, tetanus causes severe painful spasms and often death. This particular little boy was very severely affected. As doctors, we were fearful he would die, but by God’s grace, he turned the corner and was eventually discharged about 3 weeks after admission. The whole team praised God for his grace.
We see several babies each year at the hospital affected by tetanus, despite the fact that it is entirely preventable through vaccination of women during pregnancy. The current pandemic has interrupted essential vaccination and healthcare services. Even as we rejoiced with the family of the baby boy who recovered, I was left wondering how many more sick children we might see as a result of this disruption.
A team from John Hopkins University modelled the potential impact worldwide of this disruption to maternal and child health services, including vaccination, treatment for diseases such as pneumonia, diarrhoea and malaria, nutrition programs, and antenatal, birth and postnatal care. They looked at different scenarios, and even in their “least severe” scenario they predicted more than 250,000 additional deaths of under fives over 6 months across the world. This number rose to nearly 1.2 million – around 6000 per day – in the scenario where health coverage was severely affected.
Whatever the exact numbers, and these are only estimates based on mathematical models, it is likely that children in poor countries such as Madagascar will be severely affected by the COVID-19 pandemic. The economic impact of COVID will hit vulnerable children hard and further exacerbate malnutrition and lack of access to healthcare and education, especially in a country like Madagascar where three quarters of the population live on less than $1.25 per day.
How can we pray in the face of such an overwhelming situation?
Thankfully we have a God who cares about every man, woman and child affected by this pandemic and whose heart is for the vulnerable and the oppressed. We can continue to plead with him to halt the spread and limit the impact of COVID-19.