Systematic review of health and disease in Ukrainian children highlights poor child health and challenges for those treating refugees

Abstract

Aim Millions of Ukrainian children have been internally displaced or fled to other countries because of the Russian war. This systematic review focused on their health needs and future challenges for clinicians. Methods A systematic literature search of the Medline, Embase and MedRxiv databases from 1 January 2010 to 31 March 2022 identified 1628 papers on the health of Ukrainian children and 112 were relevant to this review. Results In 2019, under‐5 mortality was 8 per 1000 live births in Ukraine. Underweight and adverse childhood experiences, including child abuse, were frequent compared to other European countries, while childhood obesity seemed less common. Alcohol consumption was common in women of reproductive age, including during pregnancy, risking foetal alcohol syndrome. Neonatal screening programmes provided low coverage. Vaccine hesitancy was common and vaccination rates were low. Other concerns were measles, HIV, antibiotic resistance and multi‐resistant tuberculosis. Many children are expected to suffer from psychological and physical trauma due to the war. Other healthcare challenges include low COVID‐19 vaccination rates and a preference for secondary and tertiary care, rather than primary care. Many people cannot afford medication. Conclusion Ukrainian children often have poor health and host countries need to be aware of their needs.

Cascading Risks for Preventable Infectious Diseases in Children and Adolescents during the 2022 Invasion of Ukraine

“…In Ukraine, recorded COVID-19 cases peaked at 241,000 during the first week of February 2022 and declined to 111,000 cases one week prior to the Russian invasion [ 6 ]. According to World Health Organization (WHO) surveillance data, Ukraine was one of the most affected European countries, surpassing 5 million cumulative cases toward the end of April 2022 [ 7 , 8 ]. Following Russia’s assault, Ukraine’s COVID-19 surveillance reporting was severely disrupted.…”

“…Less than 2% of the Ukrainian population had received a third (“booster”) dose of vaccine, which confers a much higher level of protection against the highly transmissible Omicron variant and its still-more infectious BA.2 sub-lineage that was actively circulating [ 14 ]. Ukrainian children were largely unvaccinated for COVID-19 when hostilities began [ 8 ], and vaccines were never provided for children under 12. Although adolescents had finally become eligible for COVID-19 vaccination, the national campaign to vaccinate children over the age of 12, launched on 13 January 2022, lasted only six weeks before it was brought to a halt by the conflict [ 9 ].…”

“…Widespread vaccine hesitancy in Ukraine during the first decades of the 2000s contributed to very low childhood vaccination rates for the diphtheria-tetanus-pertussis (DTP) vaccine; the measles, mumps, and rubella (MMR) vaccine; and the oral polio vaccine [ 8 , 18 ]. In 2018, a 12,000 case measles outbreak erupted in Ukraine, triggering emergency vaccination [ 19 ].…”

“…As a context for HIV risk in war-affected children and adolescents, Ukraine currently ranks second in Eastern Europe in terms of the prevalence of HIV, with an estimated 260,000 cases and 3000 to 5000 deaths in adults and adolescents annually [ 8 ]. Intravenous drug use and heterosexual transmission are prominent HIV exposure risks for both adults and adolescents.…”

“…HIV cases in Ukraine rose almost 10% annually from 2007 to 2017. Yet only 40% of HIV positive adults and 54% of HIV-positive children were receiving anti-retroviral treatment before the war [ 8 ]. Anti-retroviral treatment was strongly recommended to prevent vertical transmission from infected mothers to children; however, the rapidly deteriorating situation in Ukraine dramatically limited the access to HIV therapy in pregnant women with the subsequent risk of HIV infection in their newborns.…”