/ 4 May 2020

Covid-19 and African children: The untold story

Too many of SA’s children are stunted, wasted or obese
More than a quarter of children under five in South Africa are affected by stunting

The ongoing Covid-19 pandemic has caused global devastation surpassing 3.5-million confirmed cases worldwide and almost 250 000 deaths by May 4. Thankfully, as several studies indicate, children are rarely affected compared to adults. The global incidence of childhood infection ranges between 0.8% and 2.2% of all Covid-19 cases.

Still, manifestations of the disease in children range from asymptomatic infections to severe illness with mostly the respiratory and digestive systems being affected. In rare cases, severe manifestations may present as respiratory failure or even heart disease.

But the effects of the disease on children go beyond ill health. Sadly, the socioeconomic and psychological effects of this pandemic on African children largely remains an unexplored narrative.

Several reasons have been proposed to explain the lower health risk of Covid-19 in children. These include immunity from frequent viral infections, lower levels of the angiotensin-converting enzyme mechanism required for viral entry and a less exuberant immune reaction, et cetera.

In addition, children are less likely to be tested than adults. This could be because children are frequently asymptomatic. Children are also not prioritised for testing in many countries.

At the beginning of May, figures from the Nigeria Centre for Disease Control (NCDC) indicate more than 2 170 positive cases of Covid-19 in the country, with 68 deaths. However, there is no official data on the burden of the disease on the pediatric population in Nigeria. Data from the World Health Organisation (WHO) indicates that the same is true for most African countries. This needs to change.

Cases of Covid-19 are increasingly being reported in vulnerable African children. Many of them have no home or parents to isolate with. A case in point was the recent report of 14 new cases of Covid-19 among destitute “almajiri” children in northern Nigeria.

There is currently no vaccine to prevent Covid-19. Unfortunately, other respiratory vaccines, such as the pneumococcal and Haemophilus influenza type B vaccine, do not confer any form of protection against Covid-19. Although some people have suggested that the BCG vaccine against tuberculosis could be effective against Covid-19, the WHO recently debunked this myth.

As part of widespread efforts to curb community spread, school closures and other lockdown measures have been instituted in many African cities and countries. Although a few private schools have begun instituting virtual-learning programmes, many homes in Nigeria have poor access to electricity and internet services. Moreover, many schools in Nigeria are not equipped to use online platforms for learning.

In addition, many parents are finding it difficult to home-school their children or cope with their repeated requests to be allowed to participate in outdoor activities, such as playing with friends or visiting relatives. Episodes of tantrums and restlessness due to boredom have increased. Although this largely describes children in the middle and upper classes, those at the lower end of society are struggling with food insecurity and hunger. 

Poor families are typically large and unable to afford enough food to last through a prolonged lockdown. Recognising that nutrition is key to immunity, the United Nations Children’s Fund has warned of worsening malnutrition affecting thousands of children across Nigeria in the face of Covid-19.

As many countries consider easing lockdown measures to mitigate the economic consequences, children must be protected. Actions should be taken to prevent children from being infected by adults.

Data on Covid-19 should include the incidence and prevalence of the disease in children. Measures must be instituted to prevent transmission in daycare centres and schools. Our children may need to wear masks in addition to their uniforms. We must pay greater attention to frequent handwashing and reasonable class spacing.

The untold story of Covid-19’s effects on African children needs to be amplified and acted upon.

Itoro Akpan is a pediatrician at the University of Uyo Teaching Hospital. She is also a member of the West African College of Physicians. Akpabio Akpabio is a rheumatologist and internal medicine physician at the University of Uyo Teaching Hospital, Nigeria. He is certified by the European League Against Rheumatism and volunteers with the Global Image Foundation. Utibe Effiong is an internal medicine physician with MidMichigan Health and a clinical assistant professor of medicine with Central Michigan University. He is also a senior fellow of global health and development at the Aspen Institute.