Infant and Neonatal Mortality During the Covid-19 Pandemic: An Interrupted Time Series Analysis From Five Low- and Middle-Income Countries.

The impact of the Covid-19 pandemic on infant and neonatal mortality in low- and middle-income countries (LMICs) is not well-understood. We searched PubMed using the terms "COVID" AND (("child" OR "infant" OR "neonatal") AND "mortality")) AND ("low- and middle-income countries" OR "developing countries") on May 10, 2023, without language restrictions. The existing evidence is mixed. Increased mortality rates have been documented in Ghana, Nigeria, Uganda, and Nepal while decreased rates documented in South Africa and Guinea. Prior analyses were mainly based on clinic and hospital administrative data and were often confined to a selection of facilities or geographic areas, hampering the generalizability of the existing evidence. We found no published article that leveraged nationally representative data sources to provide a general assessment of infant or neonatal mortality in LMICs following the start of the Covid-19 pandemic. To our knowledge, this study provides the most comprehensive and generalizable investigation of the impact of the Covid-19 pandemic on infant and neonatal mortality in LMICs to date. Using nationally representative survey data from five LMICs that were recently released, we estimated an increase of 9.9 and 6.7 deaths per 1,000 live births in infant and neonatal mortality, respectively, during the Covid-19 pandemic. We also found significant reductions in antenatal care use and facility deliveries, which could partly explain the changes in mortality we document. Our study highlights significant increases in infant and neonatal mortality rates in five LMICs following the start of the Covid-19 pandemic, which sets back about a decade's worth of progress. The decline in antenatal care services and facility births documented in our study suggests mortality increases were partly driven by disruptions in health service access induced by Covid-19 control measures. Helping to get reductions in neonatal and infant mortality back on track in LMICs should be a major global priority.