The Indirect Impact of COVID-19 Pandemic on Maternal and Child Mortality in Ethiopia: A Modelling Study

Background: According to the Ethiopian Federal Ministry of Health daily pandemic report, COVID-19 has caused considerable morbidity and mortality directly due to the virus. The occurrence of COVID-19 has caused serious interruption to high impact essential health services in Ethiopia like in many other countries. However, the indirect impact of the pandemic due to the interruption of other essential health services on maternal and child mortality has not been examined. Therefore, this study aimed to estimate the indirect impact of COVID-19 pandemic on maternal and child mortality in Ethiopia. Methods: We used the Lives Saved Tool (LiST) to estimate the impact of COVID-19. By varying the coverage of essential Maternal and Child Health (MCH) services from the baseline, we build four plausible scenarios that represent possible service interruptions possibilities. Scenario-1 represents a 25% average decrement in MCH service for a year, scenario-2 represents a 35% average service coverage decrement for a year, scenario-3 represents a 50% average service coverage decrement for a year, and the scenario-4 represent a 35% service coverage decrement for a half year duration. Ethiopian Demographic and Health Survey 2016 (EDHS 2016), Ethiopia Mini Demographic and Health Survey 2019 (EMDHS 2019) and for those variable which were not included in EDHS 2016 and EMHDS 2019, multivariate analysis estimates conducted on population-level coverage were used to estimate the baseline coverage and the impact of MCH interventions. Results: Based on scenario-1, additional 10,252 child deaths, 379 maternal deaths, and 1,673 stillbirths would occur per year. Based on scenario-2, over a year, additional 26,307 child deaths, 2,197 maternal deaths and 7,876 stillbirths would occur. Based on scenario-3, additional 41,945 under-5 deaths, 4,038 maternal deaths, and 13,294 stillbirths would result in a year. Wasting was the most predominant factor contributing about 16% to 30% of the additional under-5 deaths.Conclusion: A significant number of additional maternal and child deaths would occur in Ethiopia if the essential health service interruption persists, as seen in the first few months of the pandemic. This is more than the mortality caused by the pandemic itself.