Pregnancy and young child feeding in South Sudan during the COVID-19 pandemic

Author(s): Compiled by the Editorial Team

Pregnancy and young child feeding in South Sudan during the COVID-19 pandemic

The SSMJ Editorial team

Guidelines on preventing COVID-19 are constantly being updated. The information below was prepared in April 2020 and is based on guidelines given in the materials listed below[1,2, 3].Check them for updates.

Pregnancy

Based on available information, pregnancy does not seem to alter the risk of getting sick from COVID-19. However, pregnant girls and women have had a higher risk of severe illness when infected with viruses from the same family as COVID-19 and other viral respiratory infections, such as influenza. So, it is important that pregnant women know how to avoid COVID-19 – see Figure 1.

Mother-to-child transmission of coronavirus during pregnancy and birth is probable and after birth a new-born is susceptible to person-to-person spread. A very small number of babies have tested positive for the virus shortly after birth, but so far all have remained well. It is unknown if these babies got the virus before or after birth since all had been delivered by Caesarean Section. More evidence is needed to establish if and when Caesarean Sections should be recommended for women with COVID-19.[4]

To date (30 April 2020):

  • The virus has not, so far, been detected in amniotic fluid, breastmilk, or other maternal samples.
  • As this is a very new virus, we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage, and it is considered unlikely that the virus would cause problems with the baby’s development.
  • Emerging evidence suggests that in China, some babies have been born prematurely to women with symptoms of coronavirus. It is unclear whether coronavirus caused these premature births, or whether it was recommended that the baby was born early for the benefit of the women’s health.[5]

Pregnant girls and women should follow the national guidelines for antenatal care and for avoiding COVID-19.[6,7]

 

Infant feeding

More details are given in Infant and Young Child Feeding.

Programmes and services to protect, promote and support optimal breastfeeding and age-appropriate and safe complementary feeding practices should continue during the COVID-19 pandemic. This should be accompanied by a very strong focus on public health education e.g. proper hygiene and safe channels for communications and social distancing in addition to the country’s COVID-19 guidelines.

 

Figure 1. PAHO Communication materials

Breastfeeding

  • Health staff should continue to provide breastfeeding counselling and practical feeding support to all pregnant women and mothers with infants and young children, whether or not they or their children have suspected, probable or confirmed COVID-19.
  • Breastmilk is still the best protection of the immune systems of infant and young children. Where infectious co-morbidities are common, any risk of transmission of COVID-19 through breastfeeding is outweighed by the known risks associated with replacement feeding.
  • So, it is important to follow national infant feeding guidelines emphasising on appropriate respiratory hygiene during feeding, and share the following with mothers/carers:
    • There is no need to wash your breasts (biology likely does that – but note that WHO is further researching).
    • Wash your hands often with soap and water especially before feeding and after cleaning a baby. Make sure anyone caring for the baby washes their hands often.
    • Routinely clean surfaces, with which you are in contact, using soap and water.
  • As with all probable, confirmed or suspected COVID-19 cases, symptomatic mothers who are breastfeeding or practicing skin-to-skin contact or Kangaroo Mother Care should take extra care to practice respiratory hygiene, including during feeding (see above).If the mother has flu-like symptoms, she should wear a mask/face covering when near a child. See Figure 2.
  • When severe illness in a mother with COVID-19 or other health complications, prevents her from caring for her infant or prevents her from continuing direct breastfeeding, encourage and support her to express milk, and safely provide breastmilk to the infant using a small cup or small spoon while applying appropriate hygiene measures.Consider asking someone who is well to feed the expressed breast milk.
  • Advise mothers to continue breastfeeding if the child becomes sick with suspected, probable, or confirmed COVID-19 or any other illness. 

Complementary feeding

  • Continue to follow the national guidelines on complementary feeding emphasizing respiratory hygiene, and social distancing where possible.
  • Share practical, local suggestions for maintaining healthy diets (including fresh fruits and vegetables) and resisting low-nutrient commercial foods and drinks.

Figure 2. UNICEF/USAID For symptomatic mothers Take precautions when breastfeeding, day and night 

Feeding older children

School closures are threatening the delivery of essential nutrition interventions to school-age children, especially the most vulnerable ones. For interim guidance to ensure that the nutritional needs of school children are fulfilled, both where schools are closed and where schools are open. See Mitigating the effects of the COVID-19 pandemic on food and nutrition of school children.

Also

  • Be alert to breastmilk substitute manufacturers exploiting the crisis to offer free samples of their products.
  • Be careful not to spread myths about COVID-19 (see p 43)
  • Use digital, broadcast and social media, including cell phones, to share reliable messages on infant feeding.
  • Follow the latest advice for immunization and Vitamin A supplementation activities. See here 

Acknowledgements: Thanks to Mayom Biar Atem and members of the SSMJ Editorial team who helped to prepare this article.

References

  1. WHO’s Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected, Interim Guidance, 13 March 2020 WHO adapted byUNICEF for the African region. See UNICEF and African News
  2. Clinical management of severe acute respiratory infection when COVID-19 is suspected Interim guidance 13 March 2020
  3. PAHO/WHO Social Media cards: Pregnancy and breastfeeding (COVID-19)
  4. Management of pregnant women infected with COVID-19
  5. Coronavirus infection and pregnancy: Information for pregnant women and their families
  6. CDC. COVID-19 Pregnancy and breastfeeding
  7. Royal College of Obstetrician and Gynaecologists. Coronavirus (COVID-19) infection and pregnancy RCOG Pregnancy and RCOG

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