Assessing the hidden burden and costs of COVID-19 pandemic in South Asia: Implications for health and well-being of women, children and adolescents

The study analysed administrative health information systems data from Afghanistan, Bangladesh, Nepal, India, Pakistan, and Sri Lanka to assess disruptions in essential maternal and child health service coverage between January 2020 and June 2021, compared to the same calendar months in 2019. Coverage of key interventions, including antenatal care and immunizations, decreased by up to 60%, with the largest disruptions between April and June 2020 and a reversal of recovery gains in April/May 2021 during the delta variant surge. Using the Lives Saved Tool, the authors estimated that these disruptions potentially resulted in an additional 19,000 maternal and 317,000 child deaths. The study also modelled the impact of prolonged school closures, estimating that more than nine million children likely dropped out permanently, with 40% from the poorest households. Limitations include reliance on proxy estimates for some Sri Lanka indicators, lack of confidence bounds due to incomplete health management information system data, and school dropout rates modelled from Indonesia's 1997 financial crisis assumptions. Implications centre on the need for continued investment in health systems and targeted policies to mitigate long-term, potentially intergenerational effects on the most vulnerable populations.