Epidemics, Lockdown Measures and Vulnerable Populations: A Mixed-Methods Systematic Review of the Evidence of Impacts on Mother and Child Health in Low-and Lower-Middle-Income Countries.

BACKGROUND: The aim of this research was to synthetise the existing evidence on the impact of epidemic-related lockdown measures on women and children's health in low- and lower-middle-income countries (LLMICs). METHODS: A mixed-methods systematic review was conducted of qualitative, quantitative and mixed-methods evidence. Between 1st and 10th of November 2021, seven scientific databases were searched. The inclusion criteria were that the paper provided evidence on the impact of lockdown and related measures, focused on LLMICs, addressed impacts on women and child's health, addressed epidemics from 2000-2020, was peer-reviewed, provided original evidence, and was published in English. The Joanne Briggs Institute's critical appraisal tools were used to assess the quality of the studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. The evidence from the papers was grouped by type of lockdown measure and categories of impact, using a narrative data-based convergent synthesis design. RESULTS: The review process identified 46 papers meeting the inclusion criteria from 17 countries that focussed on the coronavirus disease 2019 (COVID-19) and Ebola epidemics. The evidence on the decrease of utilisation of health services showed plummeting immunisation rates and faltering use of maternal and perinatal services, which was linked to a growth of premature deaths. Impacts on the mental health of children and women were convincingly established, with lockdowns associated with surges in depression, anxiety and low life satisfaction. Vulnerability may be compounded by lockdowns, as livelihoods were disrupted, and poverty levels increased. CONCLUSION: Limitations included that searches were conducted in late-2020 as new research was being published, and that some evidence not published in English may have been excluded. Epidemic-related lockdown measures carry consequences for the health of women and children in lower-income settings. Governments will need to weigh the trade-offs of introducing such measures and consider policies to mitigate their impacts on the most vulnerable.

Public Health in a Federation: Lessons from the Spanish Influenza in Australia.

Public health policy has been identified by scholars as a principal means by which the state has expanded its control over human populations. Yet, as the COVID-19 pandemic has shown, public health responses do not necessarily reinforce the authority and prestige of the state, even while governments employ strict measures such as lockdowns and border closures. This article examines arguments about the nation-making effects of public health measures through an examination of the Spanish influenza outbreak in the recently federated Australian nation during 1919. It examines the effort of the central government to co-ordinate quarantine and other public health measures in the face of serious tensions within the Australian federation. In doing so, the article suggests a need to think more subtly about the role of 'bio-political' events such as public health crises in consolidating state control and fostering exclusionary forms of nationalism. These lessons apply particularly to federal nation-states.