The unprecedented global social and economic crisis triggered by the COVID-19 pandemic poses grave risks to the nutritional status and survival of young children in low-income and middle-income countries (LMICs). Of particular concern is an expected increase in child malnutrition, including wasting, due to steep declines in household incomes, changes in the availability and affordability of nutritious foods, and interruptions to health, nutrition, and social protection services. The COVID-19 pandemic is expected to increase the risk of all forms of malnutrition. The wasting-focused estimates we present here are likely to be conservative, given that the duration of this crisis is unknown, and its full impacts on food, health, and social protection systems are yet to be realised. The disruption of other health services during lockdowns will further compromise maternal and child health and mortality, and with the deepening of economic and food systems crises, other forms of malnutrition, including child stunting, micronutrient malnutrition, and maternal nutrition, are expected to increase. The estimated increase in child wasting is only the tip of the iceberg.
One in ten deaths among children younger than 5 years in LMICs is attributable to severe wasting because wasted children are at increased risk of mortality from infectious diseases. Before the COVID-19 pandemic, an estimated 47 million children younger than 5 years were moderately or severely wasted, most living in sub-Saharan Africa and south Asia.
The COVID-19 pandemic is expected to continue to exacerbate all forms of malnutrition. Estimates from the International Food Policy Research Institute suggest that because of the pandemic an additional 140 million people will be thrown into living in extreme poverty on less than US$1·90 per day in 2020. According to the World Food Programme, the number of people in LMICs facing acute food insecurity will nearly double to 265 million by the end of 2020. Sharp declines are expected in access to child health and nutrition services, similar to those seen during the 2014–16 outbreak of Ebola virus disease in sub-Saharan Africa. Early in the COVID-19 pandemic, UNICEF estimated a 30% overall reduction in essential nutrition services coverage, reaching 75–100% in lockdown contexts, including in fragile countries where there are humanitarian crises.
Based on the microeconomic model projections which indicate that decreases in GNI per capita are associated with large increases in child wasting new analyses applied to 118 LMICs, suggest there could be a 14·3% increase in the prevalence of moderate or severe wasting among children younger than 5 years due to COVID-19-related predicted country-specific losses in GNI per capita. We estimate this would translate to an additional estimated 6·7 million children with wasting in 2020 compared with projections for 2020 without COVID-19; an estimated 57·6% of these children are in south Asia and an estimated 21·8% in sub-Saharan Africa.
The projected increase in wasting in each country is combined with a projected year average of 25% reduction in coverage of nutrition and health services, we estimate there would be 128,605 (ranging from 111,193 to 178,510 for best and worst case scenarios) additional deaths in children younger than 5 years during 2020, with an estimated 52% of these deaths in sub-Saharan Africa.