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More than 50 million people in India do not have access to effective handwashing, putting them at a greater risk of acquiring and transmitting the novel coronavirus, according to a study.

Researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US found that without access to soap and clean water, over 2 billion people in low- and middle-income nations -- a quarter of the world's population -- have a greater likelihood of transmitting the coronavirus than those in wealthy countries.

According to the study, published in the journal Environmental Health Perspectives, more than 50 per cent of the people in sub-Saharan Africa and Oceania lacked access to effective handwashing.

"Handwashing is one of the key measures to prevent COVID transmission, yet it is distressing that access is unavailable in many countries that also have limited health care capacity," said Michael Brauer, a professor at IHME.

The study found that in 46 countries, more than half of people lacked access to soap and clean water.

In India, Pakistan, China, Bangladesh, Nigeria, Ethiopia, Democratic Republic of the Congo, and Indonesia, more than 50 million persons in each country were estimated to be without handwashing access, according to the study.

"Temporary fixes, such as hand sanitizer or water trucks, are just that -- temporary fixes," Brauer said.

"But implementing long-term solutions is needed to protect against COVID and the more than 700,000 deaths each year due to poor handwashing access," Brauer said.

He noted that even with 25 per cent of the world's population lacking access to effective handwashing facilities, there have been "substantial improvements in many countries" between 1990 and 2019.

Those countries include Saudi Arabia, Morocco, Nepal, and Tanzania, which have improved their nations' sanitation, the researchers said.

The study does not estimate access to handwashing facilities in non-household settings such as schools, workplaces, health care facilities, and other public locations such as markets.

Earlier this month, the World Health Organization predicted 190,000 people in Africa could die of COVID-19 in the first year of the pandemic, and that upward of 44 million of the continent's 1.3 billion people could be infected with the coronavirus, the researchers said. 

May 7: India is projected to record the highest number of births in the 9 months since COVID-19 was declared a pandemic in March, with more than 20 million babies expected to be born in the country between March and December, according to top UN body.

The United Nations Children's Fund (UNICEF) warned that pregnant mothers and babies born during the pandemic across the world were threatened by strained health systems and disruptions in services.

An estimated 116 million babies will be born under the shadow of COVID-19 pandemic, UNICEF said on Wednesday, ahead of Mother's Day, observed on May 10.

These babies are projected to be born up to 40 weeks after COVID-19 was recognised as a pandemic on March 11.

The highest numbers of births in the 9 months since the pandemic was declared are expected to occur in India, where 20.1 million babies are projected to be born between March 11 and December 16. Other countries with the expected highest numbers of births during this period are China (13.5 million), Nigeria (6.4 million), Pakistan (5 million) and Indonesia (4 million), it said.

"Most of these countries had high neonatal mortality rates even before the pandemic and may see these levels increase with COVID-19 conditions," UNICEF said.

It is estimated that there will be 24.1 million births in India for the January-December 2020 period.

UNICEF warned that COVID-19 containment measures can disrupt life-saving health services such as childbirth care, putting millions of pregnant mothers and their babies at great risk.

Even wealthier countries are affected by this crisis. In the US, the sixth-highest country in terms of the expected number of births, over 3.3 million babies are projected to be born between March 11 and December 16.

"New mothers and newborns will be greeted by harsh realities," UNICEF said, adding they include global containment measures such as lockdowns and curfews; health centres overwhelmed with response efforts; supply and equipment shortages; and a lack of sufficient skilled birth attendants as health workers, including midwives, are redeployed to treat COVID-19 patients.

"Millions of mothers all over the world embarked on a journey of parenthood in the world as it was. They now must prepare to bring a life into the world as it has become – a world where expecting mothers are afraid to go to health centres for fear of getting infected, or missing out on emergency care due to strained health services and lockdowns," UNICEF Executive Director Henrietta Fore said.

"It is hard to imagine how much the coronavirus pandemic has recast motherhood" Fore said.

UNICEF said its analysis was based on data from World Population Prospects 2019 of the UN Population Division.

An average full-term pregnancy typically lasts a complete 9 months, or 39 to 40 weeks. For the purposes of this estimate, the number of births for a 40-week period in 2020 was calculated.

The 40-week period of March 11 to December 16 is used in this estimate based upon the WHO's March 11 assessment that COVID-19 can be characterised as a pandemic.

UNICEF warned that although evidence suggests that pregnant mothers are not more affected by COVID-19 than others, countries need to ensure they still have access to antenatal, delivery and postnatal services.

Similarly, sick newborns need emergency services as they are at high risk of death. New families require support to start breastfeeding, and to get medicines, vaccines and nutrition to keep their babies healthy, it said.

"This is a particularly poignant Mother's Day, as many families have been forced apart during the coronavirus pandemic, but it is also a time for unity, a time to bring everyone together in solidarity. We can help save lives by making sure that every pregnant mother receives the support she needs to give birth safely in the months to come," Fore said.

Issuing an urgent appeal to governments and health care providers to save lives in the coming months, UNICEF said efforts must be made to help pregnant women receive antenatal checkups, skilled delivery care, postnatal care services, and care related to COVID-19 as needed.

Ensure health workers are provided with the necessary personal protective equipment and get priority testing and vaccination once a COVID-19 vaccine becomes available so that can deliver high quality care to all pregnant women and newborn babies during the pandemic, it said.

While it is not yet known whether the virus is transmitted from a mother to her baby during pregnancy and delivery, UNICEF advised all pregnant women to follow precautions to protect themselves from exposure to the virus.

Closely monitor themselves for symptoms of COVID-19 and seek advice from the nearest designated facility if they have concerns or experience symptoms. Pregnant women should also take the same precautions to avoid COVID -19 infection as other people: practice physical distancing, avoid physical gatherings and use online health services, it said.

UNICEF said even before COVID-19 pandemic, an estimated 2.8 million pregnant women and newborns died every year, or 1 every 11 seconds, mostly of preventable causes.

The agency called for immediate investment in health workers with the right training, who are equipped with the right medicines to ensure every mother and newborn is cared for by a safe pair of hands to prevent and treat complications during pregnancy, delivery and birth.