Nicole Minckas1, Melissa M Medvedev2,3, Ebunoluwa A Adejuyigbe4, Helen Brotherton3,5, Harish Chellani6, Abiy Seifu Estifanos7, Chinyere Ezeaka8, Abebe G Gobezayehu9, Grace Irimu10,11, Kondwani Kawaza12, Vishwajeet Kumar13, Augustine Massawe14, Sarmila Mazumder15, Ivan Mambule16, Araya Abrha Medhanyie17, Elizabeth M Molyneux12, Sam Newton18, Nahya Salim14,19, Henok Tadele20, Cally J Tann3,16,21, Sachiyo Yoshida1, Rajiv Bahl1, Suman P N Rao1,22, Joy E Lawn3. 1. Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organisation, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. 2. Department of Pediatrics, University of California San Francisco, 550 16th Street, Box 1224, San Francisco, CA 94158, United States. 3. Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London WC1E 7HT, United Kingdom. 4. Department of Paediatrics and Child Health, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria. 5. Medical Research Council Unit The Gambia at LSHTM, Atlantic Road, Fajara, The Gambia. 6. Department of Paediatrics, Vardhaman Mahavir Medical College and Safdarjung Hospital, Ansari Nagar, New Delhi 110029, India. 7. Department of Reproductive, Family and Population Health, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia. 8. Department of Paediatrics, University of Lagos College of Medicine and Lagos University Teaching Hospital, P.M.B. 12003, Lagos, Nigeria. 9. Maternal and Newborn Health in Ethiopia Partnership, Emory Ethiopia, P.O. Box 793, Addis Ababa, Ethiopia. 10. Department of Paediatrics and Child Health, University of Nairobi and Kenyatta National Hospital, P.O. Box 19676-00202, Nairobi, Kenya. 11. Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya. 12. Department of Paediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, P.B. 360, Chichiri, Blantyre 3, Malawi. 13. Community Empowerment Lab, 26/11 Wazir Hasan Road, Lucknow 226001, India. 14. Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. 15. Centre for Health Research and Development, Society for Applied Studies, 45 Kalu Sarai, New Delhi 110016, India. 16. Medical Research Council/Uganda Virus Research Institute and LSHTM Uganda Research Unit, P.O. Box 49, Entebbe, Uganda. 17. School of Public Health, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia. 18. School of Public Health, Kwame Nkrumah University of Science and Technology, P.M.B. SPH-KNUST, Kumasi 00233, Ghana. 19. Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, P.O. Box 78 373, Dar es Salaam, Tanzania. 20. Department of Pediatrics and Child Health, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia. 21. Department of Neonatal Medicine, University College London Hospital, 235 Euston Road, London NW1 2BU, United Kingdom. 22. Department of Neonatology, St John's Medical College Hospital, Sarjapur Road, Bangalore 560034, India.
Abstract
BACKGROUND: COVID-19 is disrupting health services for mothers and newborns, particularly in low- and middle-income countries (LMIC). Preterm newborns are particularly vulnerable. We undertook analyses of the benefits of kangaroo mother care (KMC) on survival among neonates weighing ≤2000 g compared with the risk of SARS-CoV-2 acquired from infected mothers/caregivers. METHODS: We modelled two scenarios over 12 months. Scenario 1 compared the survival benefits of KMC with universal coverage (99%) and mortality risk due to COVID-19. Scenario 2 estimated incremental deaths from reduced coverage and complete disruption of KMC. Projections were based on the most recent data for 127 LMICs (~90% of global births), with results aggregated into five regions. FINDINGS: Our worst-case scenario (100% transmission) could result in 1,950 neonatal deaths from COVID-19. Conversely, 125,680 neonatal lives could be saved with universal KMC coverage. Hence, the benefit of KMC is 65-fold higher than the mortality risk of COVID-19. If recent evidence of 10% transmission was applied, the ratio would be 630-fold. We estimated a 50% reduction in KMC coverage could result in 12,570 incremental deaths and full disruption could result in 25,140 incremental deaths, representing a 2·3-4·6% increase in neonatal mortality across the 127 countries. INTERPRETATION: The survival benefit of KMC far outweighs the small risk of death due to COVID-19. Preterm newborns are at risk, especially in LMICs where the consequences of disruptions are substantial. Policymakers and healthcare professionals need to protect services and ensure clearer messaging to keep mothers and newborns together, even if the mother is SARS-CoV-2-positive. FUNDING: Eunice Kennedy Shriver National Institute of Child Health & Human Development; Bill & Melinda Gates Foundation; Elma Philanthropies; Wellcome Trust; and Joint Global Health Trials scheme of Department of Health and Social Care, Department for International Development, Medical Research Council, and Wellcome Trust.
BACKGROUND: COVID-19 is disrupting health services for mothers and newborns, particularly in low- and middle-income countries (LMIC). Preterm newborns are particularly vulnerable. We undertook analyses of the benefits of kangaroo mother care (KMC) on survival among neonates weighing ≤2000 g compared with the risk of SARS-CoV-2 acquired from infected mothers/caregivers. METHODS: We modelled two scenarios over 12 months. Scenario 1 compared the survival benefits of KMC with universal coverage (99%) and mortality risk due to COVID-19. Scenario 2 estimated incremental deaths from reduced coverage and complete disruption of KMC. Projections were based on the most recent data for 127 LMICs (~90% of global births), with results aggregated into five regions. FINDINGS: Our worst-case scenario (100% transmission) could result in 1,950 neonatal deaths from COVID-19. Conversely, 125,680 neonatal lives could be saved with universal KMC coverage. Hence, the benefit of KMC is 65-fold higher than the mortality risk of COVID-19. If recent evidence of 10% transmission was applied, the ratio would be 630-fold. We estimated a 50% reduction in KMC coverage could result in 12,570 incremental deaths and full disruption could result in 25,140 incremental deaths, representing a 2·3-4·6% increase in neonatal mortality across the 127 countries. INTERPRETATION: The survival benefit of KMC far outweighs the small risk of death due to COVID-19. Preterm newborns are at risk, especially in LMICs where the consequences of disruptions are substantial. Policymakers and healthcare professionals need to protect services and ensure clearer messaging to keep mothers and newborns together, even if the mother is SARS-CoV-2-positive. FUNDING: Eunice Kennedy Shriver National Institute of Child Health & Human Development; Bill & Melinda Gates Foundation; Elma Philanthropies; Wellcome Trust; and Joint Global Health Trials scheme of Department of Health and Social Care, Department for International Development, Medical Research Council, and Wellcome Trust.
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