Although much of the world is focused on the “silver lining” that COVID-19 does not appear to severely impact children’s health, UNICEF is raising the alarm about the potential damage of the hidden impacts on children’s health as well as the indirect socio-economic effects of the fallout from the pandemic. In response, UNICEF Innocenti is generating evidence to assist and inform UNICEF’s COVID-19 work. This blog is about a research conducted by UNICEF on the impacts of pandemics and epidemics on child protection, including topics such as violence against children, child labour and child marriage.
How are children affected by health crises?
A key first step in this process is synthesising what we already know through a rapid review, which is a fast way of summarising what is known about a topic and highlights where there are gaps in our knowledge. COVID-19 affects numerous areas of children’s lives, including development and education. Child protection, including violence against children, child labour, and child marriage, is another key area impacted by the pandemic. Innocenti’s latest rapid review looks at how previous pandemics, epidemics (like Ebola and HIV/AIDS), and their control measures (such as social distancing and school closures) impact child protection. This is a particularly important issue because of the many hidden and understudied pathways between health crises and child protection areas. With the help of EPPI-Centre at University College London, over 6,000 studies were screened, of which 53 were included in the review.
The broad scope of ‘child protection’
Child protection is complex and includes many areas that cut across multiple aspects of children’s lives, including education and health. For this reason, the review has a very broad scope. While this means different policy needs are met, it makes completing a timely review challenging. The result is a ‘broad and shallow’ review, whereby the scope encompasses a range of areas, but the depth of analysis and specificity of policy recommendations are affected.
Balancing robustness and timeliness
Recent controversies point to the effects that poor quality studies and a rush to judgement can have on policy responses to COVID-19. It is generally understood, at least by the evidence synthesis community, that shortcuts and comprises on the standard systematic review template can be applied to produce something that is both policy-relevant and quick. The review is relatively comprehensive and transparent, with a publicly available methodology. However, the quality of evidence included was not assessed, which may affect the validity of the findings.
There has been an unprecedented global sharing of data, editorials, policy guidance, and research during the COVID-19 crisis. While this is beneficial for evidence-informed responses, much of this research is being undertaken in an uncoordinated fashion, making it almost impossible to keep on top of new and potentially relevant research. As a result, the review may have duplicated some existing work and may be missing key evidence.
For evidence synthesis to be most useful, it may be counter-productive to expect too much from one product, especially if is a rapid evidence synthesis. Rather than one all-encompassing review, it may make sense to complete several smaller rapid reviews, each with their own specific purpose and scope. There is also value to be had in getting a draft version of the report into the public domain quickly via an open access portal.
In the future, collaboration with emerging networks and initiatives will be prioritised to ensure that rigorous evidence for decision-making is made available in a timely and accessible manner. For example, the COVID-19 Evidence Network to support Decision-making helps decision makers find the best evidence available and coordinates evidence syntheses. Global organisations responsible for setting standards for evidence synthesis are fast-tracking editorial processes for COVID-19-relevant evidence reviews.
Responding quickly to a crisis
Despite the challenges encountered, UNICEF was able to respond quickly to the COVID-19 crisis for various reasons. Firstly, UNICEF was well-prepared to provide relevant evidence thanks to recent work on the use research to drive change for children. Secondly, UNICEF understood that COVID-19 had serious implications for children and adapted work plans to focus on this. Thirdly, diverse expertise from UNICEF’s Child Protection Section and the evidence community were combined in an integrated effort, using methods experts and technology to find and use research fast. This helped shape the review which will assist UNICEF and others to ensure no child is left behind, during and after the pandemic.