The food grain supply and monetary assistance to the large underserved population had a role to play.
WASHINGTON DC
The disruption of essential services and social welfare measures during Covid-19 lockdown had adversely affected child health worldwide, including in India, which recorded the second-highest number of Covid-19 cases and the third-highest deaths worldwide during the peak second phase in 2021 and later. Child health outcomes during the Covid-19 lockdowns were most likely to be affected by disruptions in health services, and were reported extensively then in Indian media and worldwide. However, if a recently published population health article from Harvard University is to be believed, India has something to cheer about when it comes to child health outcomes during the Covid-19 health crisis.
The study titled, “Patterns in Child Health Outcomes Before and After the Covid-19 Outbreak in India” has been done by Harvard University’s Professor in Population Health and Geography, Dr S.V. Subramanian, and two health care experts and scholars from South Korea, Dr Rockli Kim and Soohyeon Ko. The study had used the National Family Health Survey (NFHS) in India from 2019 to 2021 to examine the systematic differences in various child health outcomes before versus after the outbreak. It used 26 indicators related to pregnancy and child health and health care, feeding and nutrition, anthropometric failures, and vaccination to analyze the findings of this study on child health outcomes during and after the Covid-19 outbreak in India.
Compared with before-Covid-19 data, the after-Covid-19 data showed small but significant deterioration in neonatal mortality, feeding and nutrition and anthropometric failures like underweight. The study’s striking findings, and something to further analyze and adopt effectively, suggested that the adverse consequences of Covid-19 and national lockdown were countered, to some extent, by emergency relief programs. The Indian government had launched the Pradhan Mantri Garib Kalyan Ann Yojana in 2020 to distribute 5 kg of food grains and 1 kg of pulses per month to approximately 800 million individuals (approximately two-thirds of India’s population).
The food grain supply and monetary assistance through direct benefit transfers that were executed without delay and any bureaucratic red-tape to the large underserved population, have a role to play in these findings. The study says that this social welfare measure initiated by the Indian government may explain the relatively constant or minimally worsened patterns in child nutrition status before and after the outbreak. It also underscored the need to sustain relief programs in non-pandemic times to promote children’s health. The second most striking finding says that improvements in child health outcomes, such as diarrhea and acute respiratory infection rates, may be credited to the wider promotion of interpersonal hygiene during the pandemic.
The study, however, pointed out that vaccination for children suffered a hit with 7.74 percentage points and 6.51 percentage points reduction in first dose of DPT (diphtheria, pertussis, tetanus) and polio, respectively.
Talking about the study findings, Dr Subramanian told The Sunday Guardian: “Our findings revealed mixed results on child health outcomes before and during the Covid-19 outbreak. For instance, most child health outcomes remained constant or had marginal difference except for vaccination indicators. Despite the widespread expectation that the Covid-19 pandemic and subsequent national lockdowns would disrupt access to basic services and significantly harm children’s health, our findings were mixed or insignificant.” Dr Subramanian runs a tracker at Harvard Center for Population and Development Studies at Harvard University on Indian Parliament constituencies on policy indicators and have been publishing extensively on India’s health, social welfare and population issues.
He elaborated his point by saying, “These findings indicate that the adverse effects of Covid-19 may have been offset, to some extent, by emergency relief programs, such as Pradhan Mantri Garib Kalyan Ann Yojana in India. Thus, our study highlights the need for continued efforts in child healthcare and emphasises the importance of maintaining relief programs even during non-pandemic periods to support child health in India.”
However, Dr Subramanian added, “We must clarify that our study did not assess trends but merely compared two time periods—pre vs post Covid-19 outbreak. For this reason, while the findings indicate some positive outcomes for child health during the Covid-19 period, it is crucial to interpret them cautiously. The small but significant deterioration in specific child health indicators, particularly in vaccination, raises concerns about potential long-term consequences. Our findings should be interpreted together with evidence from other studies that have evaluated the potential long-term health impacts of Covid-19 outbreak and subsequent national lockdowns.’’
The study’s co-authors, Dr Kim and Ko, are from Korea, and were key to concept, design, and data collection and interpretation. The Harvard study took a large sample size of about 125,812 children, and of this, boys comprised 52%, while girls were about 48%.
The findings are a learning for Indian health sector policymakers, says Dr Subramanian: “This study demonstrates that even in the face of a pandemic and disruptions to healthcare services, targeted welfare programs and emergency relief initiatives can somewhat mitigate adverse child health outcomes. Our finding emphasises the need for proactive policy measures to mitigate the pandemic’s harmful effects on children’s health and well-being, even in resource-limited settings. Policymakers should prioritize sustaining relief programs beyond pandemic periods and strengthening health infrastructure to ensure that children and mothers have continuous and equitable access to healthcare services.”
The study, however, pointed out that this is not the final as the impact of many indicators are yet to be assessed. “Some positive outcomes for child health during Covid-19, this should not be over-interpreted. Emergency relief programs, widespread promotion of interpersonal hygiene, and continued essential services provided by the healthcare system and health workers may have contributed to the prevention of significant worsening of the child health outcomes. However, our analysis did not specifically assess the impact of these factors,” Dr Subramanian told The Sunday Guardian.
The Harvard professor prescribes a comprehensive approach to strengthen India’s immunization infrastructure and expand programs to reach underserved populations. Citing the study’s results about the downward trend in immunization numbers, which got greatly affected during the lockdown, Dr Subramanian said: “Utilizing technology and timely data for tracking and monitoring vaccine coverage can help identify and target areas with low immunization rates.”
The study credits sanitation measures that were in place during the lockdown and the strong regulatory measures, including safe distancing guidelines as contributing closely to child health outcomes, especially for diarrhea and acute respiratory infection rates. “Improvements in child health outcomes, such as diarrhea and acute respiratory infection rates, may be attributed to the wider promotion of interpersonal hygiene during the pandemic. The more comprehensive promotion of interpersonal hygiene practices during the Covid-19 outbreak may have somewhat improved those outcomes. However, once again, it is crucial to interpret these findings cautiously since the improvement was marginal at best,’’ added Dr Subramanian.