Children's mental health and well-being during the Covid-19

Bangladesh, like many other countries across the globe, is facing an unprecedented challenge brought about by the Covid-19 pandemic. This coronavirus pandemic has hit the Bangladesh society and economy hard, across all walks of life. In a bid to contain the spread of this novel coronavirus, the Government of Bangladesh has taken unprecedented measures to mandate the practice of wearing masks in public and 'social distancing' leading to closure of all educational institutions, including schools, colleges, and universities from March 17, 2020 till date. Educational institutions have had to undertake a big shift from their existing ways of teaching-as teachers are now delivering lessons online. This means that students had to hastily adapt to this home-based learning model-a stark contrast to the classroom environment they were used to. The pandemic has brought an abrupt end to children's face-to-face interaction with their peers, their recreation-the initial closure of parks and entertainment venues had decreased their opportunities for physical activity, and creative exploration outdoors. The situation is compounded by the fact that parks are not common in Dhaka's neighbourhoods and children's playtime as well as interaction with their peers are often limited to their time spent on school premises. As a result, children being compelled to stay indoors for extended periods of time are having a profound, often inimical, effect on their mental health-such as anxiety, stress, depression, sleep difficulties, psychological trauma, as well as issues with cognitive development and self-confidence. This is because adapting and adjusting to such abrupt changes-remote learning as well as the inability to see peers and go outdoors-is immensely stressful for children. The fear that surrounds the virus itself-i.e. the risk of getting infected-may also be adding to their anxiety.

In Bangladesh, mental health has historically been given little importance-more so for children due to the demographic group generally being less vocal about their concerns. Furthermore, the Bangladeshi society often casts aside concerns about children's mental health and well-being, expecting them to "grow out of it"-i.e. Boro hole shob thik hoye jabe. According to the World Health Organisation Assessment Instrument for Mental Health Systems (WHO-AIMS) report from 2007, mental health expenditures from government health departments are very insignificant and are less than 0.5 per cent of the healthcare outlay. In its National Children Policy of 2011, the government formulated policies to address a host of issues faced by the children. Unfortunately, mental health was not included among those issues. As a common thread, children's mental health issues arising from Covid-19's onset have, regrettably, not received the attention they deserve, in Bangladesh.

Children's mental health can be (adversely) affected by a variety of factors, in addition to the Covid-19 pandemic. These include the location and condition of their residence, parental educational background and financial conditions, and working status of both parents. Households where both parents work tend to have less quality interactions-both in terms of frequency and duration-between parents and children. Often these working parents cannot interact with their children for as long as required for a healthy upbringing. For children aged between 1 and 5 years, less quality time spent with parents often results in severe mental health issues as young adults. The (mental) stress that parents bring from their work can also affect their child rearing activities, the home environment, and eventually the children's mental health. This issue has been worsened in the wake of the pandemic as many working parents have lost their jobs or are under a constant fear of losing their job. This is leading to an increase in anxiety around the home, as interaction between mentally stressed parents and the children can exacerbate the situation. In other words, mental stress (and trauma) can be hereditary: passed on from parents to children.

The children of low-income Bangladeshi families are at a greater risk as they are often deprived of education and employed in dangerous jobs-ranging from construction, agriculture, parts of the garment sector, waste disposal/management, transportation etc., to help the family finances. Children from such households are employed informally-usually on verbal contracts-for miniscule and incommensurate remuneration, and are often abused physically, mentally, and sometimes sexually. According to the ILO National Child Labor Survey 2015, the prevalence of child labour is widespread in both rural and urban areas in Bangladesh, with almost 1.2 million children aged between 5 and 14 engaged in the workforce. Many of these child labourers often end up homeless and live/sleep on unsafe and high-traffic public locations-including the streets, bus stops, parks, rail stations etc.,-making them more vulnerable to Covid-19 infection. The Covid-19 pandemic is expected to have a severe impact on the daily life, physical and mental health of this vulnerable demographic, as the children, as well as their families, rely primarily on their daily incomes. The loss of income worsens the plight of this vulnerable group and may lead to the child labourers being pushed into more dangerous and illegal jobs, including prostitution and pornography.

Various government agencies have taken initiatives to offer help with children's mental issues during this Coronavirus pandemic. The Ministry of Women and Children Affairs, the Department of Psychology at the University of Dhaka, and the Social Workers Association have opened their helplines for free services. In addition, the WHO has illustrated parenting tips to cope with the current situation (see Figure 1). The organisation encourages parents to talk about the pandemic with their children. A typical conversation can be twenty minutes or longer. An additional tip is to encourage children by using positive reinforcement-whereby good behaviour is praised/rewarded-more often than punishment of bad behaviour. Constructive interaction with children, instituting a daily routine, avoiding bad behaviour, managing stress, and talking about Covid-19 can help children cope better with this novel and ongoing phenomenon.

Many Non-Governmental Organisations (NGO) in Bangladesh-such as BRAC, ICDDRB, Moner Bondhu, and Bot Tola-have taken internet-based initiatives supporting child mental health. A handful of online healthcare providers, like Hello Doctor, Moner Daktar, Athena, Pulse healthcare, and Olwel have started online video consultation services by specialist doctors. Awareness and advocacy activities are running simultaneously. Many templates and guidelines have been created and made available on the websites of relevant government agencies and NGOs. The Bangladesh Association for Children and Adolescent Mental Health (BACAMH) has created some guidelines for parents, especially for children with special needs. The guidelines prepared by the WHO and International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) have also been translated into Bangla. In addition, the UNICEF has translated a storybook on Covid-19 for children. The Directorate General of Health Services (DGHS) has adopted these resources, which are now available on their website. A range of online resources are, thus, available to Bangladeshi parents on taking care of children and confronting their mental health issues during the pandemic.

While these (largely) online resources are helpful for parents-especially those with small children, they pose the fundamental question of digital divide into the fray. Accessing online healthcare requires costly hardware (i.e., personal computer or smartphone) and high-speed internet services (wired broadband or mobile internet connection). A 2018 report by the international ICT thinktank LIRNEasia revealed that less than 1 in 5 (18 per cent) Bangladeshis aged 15 to 65 owned a smartphone-the statistics is expected to be much worse for children. Despite the situation improving between 2005 and 2010, a huge gap persists between the urban and rural populations regarding ICT facility utilisation (see Table 1). Those who are unable to afford the hardware and internet services-i.e., the low income and/or rural parents-are at a considerable disadvantage in accessing help.

The situation is exacerbated by many parents losing their jobs and/or income sources due to the economic slowdown in the pandemic's aftermath. The Bangladesh Economic Association (BEA) estimated that some 36 million people lost their jobs because of closure of economic activities due to the general holidays, restrictions on movements of people, and other measures adopted by the government to contain the Coronavirus spread. Moreover, an analysis by the Centre for Policy Dialogue (CPD) found that the Covid-19 pandemic proliferated the poverty rate in Bangladesh-from 24.3 per cent in 2016 to some 35 per cent in 2020. The GDP growth projections for Fiscal Years 2019-20, as well as 2020-21, have been drastically revised down by various agencies including the World Bank, International Monetary Fund, Asian Development Bank, CPD, inter alia.

All these happenings will, unfortunately, worsen the digital divide in Bangladesh, preventing disadvantaged parents from seeking online medical attention for their children's mental health issues. This is compounded by the decline in availability of expert medical help in person, owing to government health directives for containing Covid-19. The burgeoning digital divide is an added detriment to children from low income and/or rural backgrounds, who may have their education-and future earnings potentials-disrupted due to lack of access to hardware and internet services. These children may suffer from further mental anguish as they fall behind their peers.

For the Bangladeshi society, it is extremely important to pay close attention to children's mental health issues. The pandemic's untoward impact on children's mental health and cognitive development may lead to both short-and long-term effects on their physical and mental health. The short-term effects may include childhood obesity and diabetes, depression and mood swings, sleep disorder, psychological trauma etc., which can lead to behavioural problems, declining educational performance, and the need for healthcare and psychotherapy. The long-term effects on these children growing into adulthood may include inattentiveness, poor educational outcomes (i.e., dropping out), severe behavioural and sociability problems (due to extended isolation and lack of interaction with peers), chronic depression and anxiety, among others. The repercussions of these long-term mental health problems may include post-traumatic stress disorder, inability to collaborate in professional teamwork, poor decision making and life-choices, involvement in heinous crime and self-harm etc. The long hours spent online-including lessons and entertainment-may also result in both short-and long-term impact on children. These include addiction to the internet, accessing inappropriate material online, and/or deviant behaviour.

Eventually, these short-and long-term effects of the Covid-19 pandemic on children may adversely affect the future of the Bangladesh economy and its development. This is because an entire generation, growing into adulthood, may suffer from mental (and physical) health issues, affecting them personally as professionally and encumbering their future lifestyle and earning potentials. The future of our nation living and working below their potential will have significant ramifications for the economy, its global competitiveness, growth and development, as well as government revenue and its ability to provide essential services.

The Bangladesh society needs to realise that children disadvantaged during their formative years may just not be able to "grow out of it". A proactive, rather than a reactive, response is required to help our children overcome the extraordinary challenges brought upon them by the pandemic.

Ms. Nigharin Aresfin is Head of Curriculum, Pingu's English Bangladesh, and an Early Childhood Development Specialist.

Dr. Muhammad Shafiullah is an

Assistant Professor of Economics at the

University of Nottingham Malaysia. [email protected]