Health and Healthcare Systems

COVID-19 poses some unique challenges for Africa's children

Children wearing face masks stand listening to their friends outside their shelters, amid the spread of the coronavirus disease (COVID-19), in Liberte 6 Baraka district of Dakar, Senegal May 2, 2020.

Children wearing masks in Dakar, Senegal, May 2020 Image: REUTERS/Zohra Bensemra

Juliette M. Tuakli
Chair, UWW Board of Trustees, and CEO, Family, Child & Associates, Ghana
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  • COVID-19 symptoms in children can be similar to those of other common diseases in Africa.
  • Malaria and sickle cell anaemia, in particular, can be hard to differentiate from COVID-19 and must be tested for.
  • Constraints on availability mean few children in Africa are being tested for the virus, however.

The COVID 19 pandemic is ravaging the world indiscriminately - but a combination of medical, political and societal factors means the coronavirus presents a particular set of complications for children in West Africa.

In general, children who catch COVID-19 display milder symptoms - as an investigation carried out into the case reports of 2,135 children infected with the disease in and around Wuhan has confirmed. Some children show no symptoms at all.

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Nine out of 10 children will display mild symptoms such as fever, cough, fatigue, vomiting, nausea and diarrhoea. Some form of reactive airways symptomatology (such as wheezing and shortness of breath) is seen in about half of affected children. In most cases, pneumonia is a sign that the disease is increasing in severity and as such should be observed closely in ill children.

In Wuhan, only one in 20 children had severe symptoms such as pneumonia, although upper respiratory symptoms might have been present in those patients at the onset of the illness. What is crucial to note, however, is that the symptoms were almost identical to those seen in cases of malaria in African children. A simple blood test can clearly differentiate the two illnesses; the blood count in COVID-19 patients is quite different from malarial patients, and displays evidence of severe inflammation in the body. The total white blood cell counts in COVID-19 patients, meanwhile, tend to be normal or low. Chest X-rays demonstrate marked changes in severe cases.

As with adults, children with chronic illnesses or conditions who go on to contract COVID-19 tend to fare worse. One major concern in Africa is sickle cell anaemia (SCA). Africa is home to around 75% of all SCA cases, with the majority found in the Democratic Republic of Congo and Nigeria. A major problem for family and medical personnel alike is that SCA affects the same organs of the body as COVID-19. Again, it is of paramount importance that laboratory testing is performed to differentiate between the two. More biomedical research and data collection will show whether African children with SCA are affected disproportionately by COVID-19.

Confirmed COVID-19 cases in Africa by country, as of 26 May
Confirmed COVID-19 cases in Africa by country, as of 26 May Image: WHO

Likewise, in endemic areas, malaria affects similar organs of the body as COVID-19.

From personal experience and anecdotal evidence, children may be higher transmitters of the COVID-19 virus than previously thought, despite exhibiting fewer symptoms. In addition, children are generally tested far less than adults; this is possibly because in many countries, testing is limited to those admitted to hospital with COVID-19 symptoms - and as my personal experience suggests, while many children will contract COVID-19, very few manifest severe symptoms. Some have even presented with only a viral rash. Constraints on the numbers of tests available in some countries also helps ensure that few children will be tested in other parts of Africa as well.

This may be a particularly important consideration for governments, given that a high number of mothers on the continent engage in high-contact forms of income generation such as street hawking or selling food in open markets. Childhood exposure would therefore be expected to be higher than average, although the same may pertain to much of China.

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We know that other illnesses can exacerbate the severity of COVID-19. These include heart, liver or kidney disease, diabetes, obesity and chronic lung disease, as well as in patients with a weakened immune system. Symptomatic medical treatment for two to four weeks is usually adequate; many parents, however, are worried and are asking for information on what prevention and treatment modalities are available in Ghana and the rest of Africa.

There is some evidence that other human coronaviruses have demonstrated "marked winter seasonality"; some as-yet-unpublished research, meanwhile, has found that the spread of the novel coronavirus may be constrained in tropical regions. Only further biomedical research can quantify how much. There is also evidence that relatively high levels of childhood immunizations may help to protect children against COVID-19; this should certainly encourage African governments and parents to maintain updated routine childhood vaccine regimes as part of their community strategy against COVID-19.

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