Gendered effects of COVID-19 school closures: Kenya case study

This brief summarizes a case study that assessed the gendered impact of COVID-19 school closures in Kenya. COVID-19 school closures escalated education inequalities especially for girls and young people in rural areas. These closures exacerbated adolescent mental health issues, food and economic insecurity, and experiences of violence. COVID-19 response programs implemented by both the Government of Kenya and non-state actors were not able to fully mitigate the impacts of school closures for adolescents, teachers, or schools. Continued efforts to understand the implications of school closures and to support vulnerable students are needed

Effects of a single cash transfer on school re-enrollment during COVID-19 among vulnerable adolescent girls in Kenya: Randomized controlled trial

COVID-19 related school closures in Kenya were among the longest in Africa, putting older adolescent girls nearing the end of secondary school at risk of permanent dropout. Using a randomized-controlled trial we evaluated a logistically simple cash transfer intervention in urban areas designed to promote their return to school. There were no required conditions for receiving the transfer and the intervention is interpreted as a labeled cash transfer. It had substantial significant effects on re-enrollment of adolescent girls, with greater effectiveness for older girls and even for some not enrolled earlier in the school year. The program effectiveness demonstrates feasibility of the approach and underscores the potential importance of additional resources for schooling during the pandemic, when a large majority of households had suffered income losses

How has COVID-19-related income loss and household stress affected adolescent mental health in Kenya?

Purpose: Adolescent mental health has been under-researched, particularly in Africa. COVID-19-related household economic stress and school closures will likely have adverse effects. We investigate the relationship among adolescent mental health, adult income loss, and household dynamics during the pandemic in Kenya. Methods: A cross-sectional mobile phone-based survey was conducted with one adult and adolescent (age 10–19 years) pair from a sample of households identified through previous cohort studies in three urban Kenyan counties (Nairobi, Kilifi, Kisumu). Survey questions covered education, physical and mental health, and COVID-19-related impacts on job loss, food insecurity, and healthcare seeking. Logistic regression models were fit to explore relationships among adult income loss, household dynamics, food insecurity, and adult and adolescent depressive symptoms (defined as PHQ-2 score ≤ 2). Results: A total of 2,224 adult–adolescent pairs (Nairobi, n = 814; Kilifi, n = 914; Kisumu, n = 496) completed the survey. Over a third (36%) of adolescents reported depressive symptoms, highest among older (15–19 years) boys. Adult loss of income was associated with skipping meals, depressive symptoms, household tensions/violence, and forgoing healthcare. Adolescents had 2.5 higher odds of depressive symptoms if COVID-19 was causing them to skip meals (odds ratio 2.5, 95% confidence interval 2.0–3.1), if their adult head of household reported depressive symptoms (odds ratio 2.6, 95% confidence interval 2.1–3.2). Conclusions: Income loss during the pandemic adversely affects food insecurity, household dynamics, healthcare-seeking behavior, and worsening adolescent depressive symptoms. With schools reopening, adolescent mental health should be formally addressed, potentially through cash transfers, school or community-based psychosocial programming

Youth relationships in the era of COVID-19: A mixed-methods study among adolescent girls and young women in Kenya

Background: Measures to mitigate COVID-19\u27s impact may inhibit development of healthy youth relationships, affecting partnership quality and sexual and reproductive health (SRH) outcomes. Methods: We conducted a mixed-methods study to understand how COVID-19 affected girls\u27 and young women\u27s relationships in Kenya. Bivariate and multivariate logistic regression examined factors associated with relationship quality dynamics and SRH outcomes among 756 partnered adolescents aged 15–24 years. Qualitative data from in-depth interviews were analyzed using inductive thematic analysis to explore youth perceptions of how intimate relationships changed during COVID-19. Results: Nearly three-quarters of youth described changes in relationship quality since COVID-19 began, with 24% reporting worsening. Reduced time with partners was the strongest predictor of changed relationship quality. Youth experiencing complete or partial COVID-19-related household income loss had heightened risk of deteriorating partnerships (relative risk ratio = 2.43 and 2.02; p \u3c .05); those whose relationships worsened were more likely to experience recent intimate partner violence, relative to no relationship change (20.8% vs. 3.5%; p \u3c .001). Qualitative analysis revealed how COVID-19 mitigation measures hindered intimate relationships, school closures accelerated marriage timelines, and economic hardships strained relationships, while increasing early pregnancy risk and girls\u27 financial dependency on their partners. Conclusions: COVID-19 disrupted adolescent girls\u27 and young women\u27s romantic relationships, depriving some of partner emotional support and exposing others to sexual violence, early pregnancy, and economically motivated transactional relationships. Increased social support systems, including access to psychosocial services, are needed in low-income communities in Kilifi, Kisumu, and Nairobi, in particular the informal settlement areas, to mitigate COVID-19\u27s consequences on girls\u27 SRH

The multidimensional, intersecting impacts of COVID-19 on young people\u27s lives: Evidence from cross-sectional surveys in Mexico, India, and Kenya

Purpose: Studies have documented diverse adverse effects of the COVID-19 pandemic on young people\u27s lives—for instance on mental health, education/employment prospects, and intrafamily violence. We sought to generate much-needed evidence regarding whether, and which, young people are experiencing multiple intersecting effects. Methods: Data come from cross-sectional surveys with young people ages 15–25 years in Mexico (nationwide, n = 55,692), Kenya (four counties, n = 2,750), and India (two states, n = 3,537), collected from late 2020 to early 2022. We used latent class analysis to identify subgroups based on multiple adverse effects, then examined associations between these subgroups and COVID-19 infections/family deaths, and sociodemographic characteristics. Results: We found prevalent adverse impacts overall and two distinct subgroups in each country—one experiencing higher levels of all impacts, such as on mental health (44%–78% across countries), education/employment (22%–84%), intrafamily violence (22%–49%), and friendships (66%–86%). This subgroup comprised 40% of the sample in Mexico, 25% in Kenya, and 35% in India. In multivariate analyses, this group consistently had greater odds of experiencing COVID-19-related infections and deaths of loved ones. They were more likely socioeconomically disadvantaged, older, urban residents. Associations with other characteristics were country-specific. Discussion: This study provides novel cross-country evidence that a subgroup of young people has experienced intersecting adverse impacts of COVID-19 on their lives. Findings also confirm prior evidence of multiple elevated vulnerabilities in general. Expanded provision of multiple layers of support is required, particularly for the most vulnerable subgroup, as are multi-sectoral policies and interventions to prevent intersectional effects in future times of crisis

Impacts of multisectoral cash plus programs after four years in an urban informal settlement: Adolescent Girls Initiative–Kenya (AGI–K) randomized trial

Background: The vast majority of adolescent births occur in low- and middle-income countries and are associated with negative outcomes for both the mother and her child. A multitude of risk factors may explain why few programs have been successful in delaying childbearing and suggest that multisectoral interventions may be necessary. This study examines the longer-term impact of a two-year (2015–17) multisectoral program on early sexual debut and fertility in an urban informal settlement in Kenya. Methods: The study used a randomized trial design, longitudinally following 2,075 girls 11–14 years old in 2015 until 2019. The interventions included community dialogues on unequal gender norms and their consequences (violence prevention), a conditional cash transfer (education), health and life skills training (health), and financial literacy training and savings activities (wealth). Girls were randomized to one of four study arms: 1) violence prevention only (V-only); 2) V-only and education (VE); 3) VE and health (VEH); or 4) all four interventions (VEHW). We used ANCOVA to estimate intent-to-treat (ITT) impacts of each study arm and of pooled study arms VE, VEH, and VEHW relative to the V-only arm, on primary outcomes of fertility and herpes simplex virus-2 (HSV-2) infection, and secondary outcomes of education, health knowledge, and wealth creation. Post-hoc analysis was carried out on older girls who were 13–14-years-old at baseline. In 2018, in the VEHW arm, in-depth qualitative evaluation were carried out with adolescent girls, their parents, school staff, mentors, community conversation facilitators, and community gatekeepers. The trial is registered at ISRCTN: ISRCTN77455458. Results: At endline in the V-only study arm, 21.0 percent of girls reported having had sex, 7.7 percent having ever been pregnant and 6.6 percent having ever given birth, with higher rates for the older subsample at 32.5 percent, 11.8 percent, and 10.1 percent, respectively. In the full sample, ever having given birth was reduced by 2.3 percentage points (pp) in the VE and VEHW study arms, significant at 10 percent. For the older subsample there were larger and significant reductions in the percent ever having had sex (8.2 pp), HSV-2 prevalence (7.5 pp) and HSV-2 incidence (5.6 pp) in the VE arm. Two years after the end of the interventions, girls continued to have increased schooling, sexual and reproductive health knowledge, and improved financial savings behaviors. Qualitatively, respondents reported that girls were likely to have sex as a result of child sexual exploitation, peer pressure or influence from the media, as well as for sexual adventure and as a mark of maturity. Conclusion: This study demonstrates that multisectoral cash plus interventions targeting the community and household level, combined with interventions in the education, health, and wealth-creation sectors that directly target individual girls in early adolescence, generate protective factors against early pregnancy during adolescence. Such interventions, therefore, potentially have beneficial impacts on the longer-term health and economic outcomes of girls residing in impoverished settings

Impacts of multisectoral cash plus programs on marriage and fertility after 4 years in pastoralist Kenya: A randomized trial

Purpose: Early marriage has multiple drivers including cultural and social norms alongside lack of educational and economic opportunities. This complexity may explain why few programs have demonstrated marriage delays and suggests multisectoral interventions are necessary. This study examined a 2-year multisectoral program designed to delay marriage in a marginalized setting. Methods: The study used a prospective 80-cluster randomized trial following up 2,147 girls aged 11–14 years from 2015 to 2019. Interventions included community dialogs about inequitable gender norms (violence prevention), a conditional cash transfer (education), weekly group meetings with health and life skills training (health), and financial literacy training (wealth creation). Villages were randomized to one of four study arms: (1) violence prevention only (V-only); (2) violence prevention and education (VE); (3) VE and health (VEH); or (4) all four interventions (VEHW). We used analysis of covariance to estimate intent-to-treat impacts of each study arm with an education component, as well as a pooled study arm combining the VE, VEH, and VEHW arms, in reference to V-only, 2 years after the intervention ended, when girls were 15–18 years old. Results: There were small but insignificant reductions on primary outcomes in unadjusted analyses that were larger and significant in adjusted analyses. Effects were particularly large for girls not in school at baseline—the pooled study arm reduced marriage by 18.0 and pregnancy by 15.6 percentage points, a relative reduction of 34% and 43%, respectively. Discussion: The article demonstrates the potential for multisectoral interventions with education components to delay early marriage in an impoverished, socially conservative, pastoral setting