December 18th, 2021 

By Rehan Piracha


An usually high child mortality rate of 14 percent in children with COVID reported in a recent study is not consistent with 0.19% fatality rate in infected children up to age of 18 years across the country compiled by the National Command and Operation Centre.

According to a World Health Organization-sponsored multi-centre study in Pakistan, one in seven children in Pakistan, 14 per cent, who contract moderate to severe COVID-19 lose their lives to the virus, a mortality rate that is many times higher than countries in the West.

However, the representatives from the Pakistan Pediatric Association pointed out that the study’s data on death of children aged between newborns up to 18 years is not consistent with the country’s overall child mortality rate compiled by the National Command Operation Centre (NCOC). The findings of the study were shared at a seminar in Islamabad on December 10.

Researchers from the WHO-sponsored study covered over 1,100 children in three hospitals- Karachi’s National Institute of Cardiovascular Diseases and National Institute of Child Health; Children’s Hospital, Lahore; and Benazir Bhutto Hospital in Rawalpindi- to the study who tested positive for the virus and had been admitted to the hospital for treatment. Data was collected on newborns, infants, babies and adolescents up to 18 years old between March 2020 and December 2021.

The study found that children with underlying health conditions such as malnutrition, cancer or cardiovascular disease were at a higher risk of dying from COVID-19 with findings showing that one in five young patients with comorbidities, or 19.5 per cent, lost their lives. Even children with a previously clean bill of health were at risk with one in eight children in Pakistan dying after contracting the virus.

According to the findings, the child mortality rate from COVID is many times higher than western countries where similar studies from have found it to be under one percent.

Researchers had reported 154 child deaths from COVID in the three hospitals between March 2020 and December 2021.

The NCOC data has reported over 100,000 cases of COVID in children up to 18 years since the start of the pandemic in the country.

Dr Khalid Shafi, Secretary General of Sindh chapter of the PPA, told that there were problems with the data used in the WHO-sponsored study led by doctors from the Aga Khan University. The study based its findings on hospital populations of COVID child patients while the NCOC figures are based on general population, he explained.

According to the NCOC pediatric data from start of the pandemic till 19th Dec 2021, the total number of children up to 18 years of age with confirmed COVID positive are 1,00,148, he said. “The NCOC has reported total child deaths (of newborns to up to 18 years age) of 192 in the period,” Dr Shafi said. The mortality rate for children is reported to 0.19% as compared with the overall case fatality rate of 2.2% in Pakistan, according to statistics from the NCOC.

The NCOC data shows that children under 18 years are relatively less affected and mortality is low in this age group as compared to other age groups, Dr Shafi pointed out. He said there was problems with the NCOC data too as it did not include cases of children infected with COVID who were neither tested or taken to hospitals in the country.

Early findings from the WHO-sponsored study show the main cause of death from COVID was multi-system inflammatory syndrome (MIS-C), which typically occurs a few weeks after a child is infected with the virus. It causes vital organs such as the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs to become inflamed.

Respiratory ailments were another major cause of deadly complications from the virus. Further insights into all causes of death in the study and the most important factors that enabled children to survive are currently being compiled, the researchers told participants at the seminar.

Researchers noted that most deaths in the study occurred in 2021 rather than 2020 which suggests that later strains of the virus may be more deadly compared to the strain at the start of the outbreak in Pakistan.

 “While overall mortality from COVID-19 in children is low compared to adults, it is now clear that COVID-19 is not a benign disease in children. The virus is continuously evolving and the medical community should follow the updated treatment guidelines,” said AKU’s Dr Qalab Abbas, Dr Fyezah Jehan and Dr Shazia Mohsin, the study’s principal investigators in Pakistan.

“Paediatricians around the country are now suggesting three potentially life-saving changes to treatment guidelines for critically-ill children.”

The World Health Organization is yet to recommend vaccinating children under the age of 12. However, speakers pointed out that this study’s results add to the body of evidence recommending vaccines for younger children with comorbidities.

 “The majority of child deaths in our study took place between the ages of 1 and 9,” said Dr Abbas, Dr Mohsin and Dr Jehan. “As we conduct further analysis from our data and compare it to our partner sites in India, Ethiopia and South Africa, we will be able to provide more specific guidelines on how vaccination policies could be amended.”

The World Health Organization-sponsored study collected data from over 5,000 children across Pakistan, India, Ethiopia and South Africa.


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