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Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment.  Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.

The best way to prevent and slow down transmission is to be well informed about the COVID-19 virus, the disease it causes and how it spreads. Protect yourself and others from infection by washing your hands or using an alcohol based rub frequently and not touching your face.

The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, so it’s important that you also practice respiratory etiquette (for example, by coughing into a flexed elbow).

Stay informed:

The mobile health team screens herders and their families for communicable and non-communicable diseases, signs of cholesterol and sugar in their blood and they offer ultrasounds for women. One month ago, through this service, Norov was diagnosed with gallbladder and kidney problems and was referred to the nearest local (sub-province or soum) health centre, where a specialist gave him the medicines he needed.

“Because of the mobile health screening, I was diagnosed early and received timely treatment. The health professionals advised me to cut down my salt and animal fat intake. I know that health is wealth and that I need to make healthy living choices now, irrespective of financial challenges,” said Norov.

With a vast land area, Mongolia faces many challenges in delivering health services to its citizens especially those living in disadvantaged and remote rural areas, including vulnerable and nomadic populations, migrants and unregistered people.

From 2016-2020, the government operated an initiative called: ‘Expanding use of mobile health technology in primary health care (PHC) towards universal health coverage in Mongolia’ or M-Health. It was supported by WHO, through the UHC Partnership and the Korea Foundation for International Health Care and Community Chest of Korea.

Mongolia is among the 115 countries and areas to which the UHC Partnership helps deliver WHO support and technical expertise in advancing universal health coverage (UHC). The Partnership is funded by the European Union (EU), the Grand Duchy of Luxembourg, Irish Aid, the Government of Japan, the French Ministry for Europe and Foreign Affairs, the United Kingdom – Foreign, Commonwealth & Development Office and Belgium.

Reaching remote groups through mobile health

The Mongolian State Policy on Health (2017-2026) identifies the “need to expand the use of mobile service and technologies at the primary health care level to better reach out to target groups such as people in remote areas and the poor and vulnerable populations”.

The M-Health initiative is now being implemented in 21 provinces across Mongolia and 9 districts in Ulaanbaatar City.

As part of the initiative, PHC providers conduct integrated health services through three types of service delivery: home visits, mobile health services combined with home visits and health centre services. All these include health examinations, screening and health promotion activities related to maternal and child health, communicable diseases and non-communicable diseases. Mobile health services, in combination with home visits, are mostly used to reach disadvantaged communities, including herders, migrants, and low-income groups.

The Government of Mongolia, along with local governments, recognized the value and cost-effectiveness of reaching remote and disadvantaged populations. As a result, since 2016, this initiative has been expanded to another 121 local areas supported mostly by local governments and a few of them supported by development partners and private companies. In 2021, in order to maintain essential health services during the COVID-19 pandemic and beyond, WHO has been continuously providing support in other 63 remote areas.

Primary health care and universal health coverage  

Many health issues, as well as COVID-19, have the gravest impact on people who are socially, economically or geographically disadvantaged. Addressing equity and reaching those most in need of health services requires a strong focus on PHC for UHC, as a response to current and future health challenges. The UHC Partnership will continue to support the government with the expansion of telemedicine, mobile services and mobile and portable technologies at the PHC level, including rapid COVID-19 tests as a cost-effective measure. The Partnership will also support the strengthening of multisectoral collaboration to address health for all policies.

New research from WHO and partners shows that the COVID-19 pandemic is severely affecting the quality of care given to small and sick newborns, resulting in unnecessary suffering and deaths.

A study published in the Lancet EclinicalMedicine highlights the critical importance of ensuring newborn babies have close contact with parents after birth, especially for those born too small (at low birthweight) or too soon (preterm). However, in many countries, if COVID-19 infections are confirmed or suspected, newborn babies are being routinely separated from their mothers, putting them at higher risk of death and lifelong health complications.

This is especially the case in the poorest countries where the greatest number of preterm births and infant deaths occur. According to the report, disruptions to kangaroo mother care – which involves close contact between a parent, usually a mother, and a newborn baby – will worsen these risks.

Up to 125 000 babies’ lives could be saved with full coverage of kangaroo mother care. For babies born preterm or at low birthweight, kangaroo mother care (early, prolonged skin-to-skin contact with a parent and exclusive breastfeeding) is particularly critical. Among infants born preterm or at low birthweight, kangaroo mother care has been shown to reduce infant deaths by as much as 40%, hypothermia by more than 70%, and severe infections by 65%.

“Disruptions to essential health services during COVID-19 have severely affected the quality of care provided to some of the most vulnerable babies, and this includes their right to the lifesaving contact they need with their parents,” said Dr Anshu Banerjee, Director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO. “Decades of progress in reducing child deaths will be jeopardized unless we act now to protect and improve quality care services for mothers and newborns, and expand coverage of lifesaving interventions like kangaroo mother care.”

WHO advises that mothers should continue to share a room with their babies from birth and be able to breastfeed and practice skin-to-skin contact – even when COVID-19 infections are suspected or confirmed – and should be supported to ensure appropriate infection prevention practices.

“Much more attention is needed to ensure health practitioners and policymakers globally are aware of the need to keep mothers and babies together in these critical early days, especially for babies born too small or too soon,” said Queen Dube, Director of Health at the Ministry of Health in Malawi, one of the report authors. “Kangaroo Mother Care is one of our most cost-effective ways to protect small and sick newborns. According to our analysis, these risks by far outweigh the small chance of a newborn baby getting severe disease from COVID-19.”

“Kangaroo mother care is among the best interventions to improve a premature or low birthweight baby’s chances of survival, especially in low-income countries,” she added.

Evidence suggests that disruptions to kangaroo mother care may already be worryingly widespread. A systematic review of 20 clinical guidelines from 17 countries during the COVID-19 pandemic found that one-third recommended separation of mothers and newborns if the mother has or may have COVID-19. In a global survey of thousands of neonatal healthcare providers, published today in a related paper in the British Medical Journal (BMJ) Global Health, two-thirds of health workers in 62 countries reported they do not allow mothers with confirmed or suspected COVID-19 to practice routine skin to skin contact, while nearly one-quarter did not allow breastfeeding, even by uninfected caregivers.

Studies have reported mainly no symptoms or mild disease from COVID-19 in infected newborns, with low risk of neonatal death. This new study estimates that the risk of newborns catching COVID-19 would result in fewer than 2000 deaths.

However, infection during pregnancy may result in increased risk of preterm birth, which means it is even more important to ensure the right care is given to support preterm babies and their parents during the COVID-19 pandemic.

According to the most recent estimates, 15 million babies are born preterm (before 37 weeks) each year and 21 million are born at low birthweight (under 2.5kg). These babies face significant health risks including disabilities, developmental delays and infections, while prematurity-related complications are the leading causes of death of newborns and children under 5.

About the study

WHO authors have contributed to the following paper: Preterm care during the COVID-19 pandemic: A comparative risk analysis of neonatal deaths averted by kangaroo mother care versus mortality due to SARS-CoV-2 infection in The Lancet Eclinical Medicine. A related study by the COVID-19 Small and Sick Newborn Care Collaborative Group was published today in the British Medical Journal, Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers’ voices and experiences. BMJ GH. DOI:10.1136/bmjgh-2020-004347

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