Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: evidence from a prospective cohort survey in Nairobi informal settlements

Pinchoff, Jessie; Austrian, Karen; Rajshekhar, Nandita; Abuya, Timothy; Kangwana, Beth; Ochako, Rhoune; Tidwell, James B.; Mwanga, Daniel; Muluve, Eva; Mbushi, Faith; Nzioki, Mercy; Ngô, Thoại D.

doi:10.1136/bmjopen-2020-042749

Cited by 82 publications

(126 citation statements)

References 36 publications

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“…Food insecurity was especially high for those households in which one or more people lost their income [34]. This was also found in Nairobi, where early in the pandemic 77% of women and 68% of men surveyed said they had skipped a meal due to COVID-19 in the previous week [35]. Other studies have found that adolescents who experience violence at home (especially those in low-income households), worsening relationships with adults in the household, and food insecurity are more likely to be depressed [11,36,37].…”

Section: Discussionmentioning

confidence: 79%

How Has COVID-19-Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya?

Pinchoff

Friesen

Kangwana

et al. 2021

Journal of Adolescent Health

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Adolescent mental health has been under-researched, particularly in Africa. COVID-19related 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 10e19 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 adulteadolescent pairs (Nairobi, n ¼ 814; Kilifi, n ¼ 914; Kisumu, n ¼ 496) completed the survey. Over a third (36%) of adolescents reported depressive symptoms, highest among older (15e19 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 2.0e3.1), if their adult head of household reported depressive symptoms (odds ratio 2.6, 95% confidence interval 2.1e3.2). 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.

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Section: Discussionmentioning

confidence: 79%

How Has COVID-19-Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya?

Pinchoff

Friesen

Kangwana

et al. 2021

Journal of Adolescent Health

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“…Our quantitative and qualitative results suggest that poverty and loss of financial resources related to COVID-19 debilitated existing relationships and motivated transactional partnerships. Economic consequences of COVID-19 amplified a gender divide [27]. We found that existing relationships were destabilized and reevaluated in the face of a partner's income loss, leading to conflict, accusations of infidelity, and relationship dissolution.…”

Section: Discussionmentioning

confidence: 86%

“…Studies conducted during lockdowns in high-income settings demonstrate a sudden increase in shared time between cohabitating partners, with no impact on the overall quality of their relationships [16] or increases in conflict [25]. Studies centered on issues of intimacy during COVID-19 also report declines in the frequency of sexual intercourse among cohabitating partners during lockdown, related to increased anxiety and depression [24,26,27]. In our study, 28% of participants who spent more time with their partners described rising tensions and decreased emotional support, while 23% experienced the opposite.…”

Section: Discussionmentioning

confidence: 99%

Youth Relationships in the Era of COVID-19: A Mixed-Methods Study Among Adolescent Girls and Young Women in Kenya

Karp

Sheehy

Anjur‐Dietrich

et al. 2021

Journal of Adolescent Health

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Background: Measures to mitigate COVID-19's 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' and young women's relationships in Kenya. Bivariate and multivariate logistic regression examined factors associated with relationship quality dynamics and SRH outcomes among 756 partnered adolescents aged 15e24 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 ¼ 2.43 and 2.02; p < .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 < .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' financial dependency on their partners. Conclusions: COVID-19 disrupted adolescent girls' and young women's 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's consequences on girls' SRH.

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“…Robust data are essential for evaluating the hypotheses that lockdowns cause substantial harm or are futile and for targeting locations that are the most in need of resources. The impact of NPIs has been evaluated in various low-and middle-income countries, generating evidence of early reductions in income and food security and the rapid, substantial uptake of protective behaviors [18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study

Harling¹,

Gómez‐Olivé²,

Tlouyamma³

et al. 2021

JMIR Public Health Surveill

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Background In March 2020, South Africa implemented strict nonpharmaceutical interventions (NPIs) to contain the spread of COVID-19. Over the subsequent 5 months, NPI policies were eased in stages according to a national strategy. COVID-19 spread throughout the country heterogeneously; the disease reached rural areas by July and case numbers peaked from July to August. A second COVID-19 wave began in late 2020. Data on the impact of NPI policies on social and economic well-being and access to health care are limited. Objective We aimed to determine how rural residents in three South African provinces changed their behaviors during the first COVID-19 epidemic wave. Methods The South African Population Research Infrastructure Network nodes in the Mpumalanga (Agincourt), KwaZulu-Natal, (Africa Health Research Institute) and Limpopo (Dikgale-Mamabolo-Mothiba) provinces conducted up to 14 rounds of longitudinal telephone surveys among randomly sampled households from rural and periurban surveillance populations every 2-3 weeks. Interviews included questions on the following topics: COVID-19–related knowledge and behaviors, the health and economic impacts of NPIs, and mental health. We analyzed how responses varied based on NPI stringency and household sociodemographics. Results In total, 5120 households completed 23,095 interviews between April and December 2020. Respondents’ self-reported satisfaction with their COVID-19–related knowledge and face mask use rapidly rose to 85% and 95%, respectively, by August. As selected NPIs were eased, the amount of travel increased, economic losses were reduced, and the prevalence of anxiety and depression symptoms fell. When the number of COVID-19 cases spiked at one node in July, the amount of travel dropped rapidly and the rate of missed daily medications doubled. Households where more adults received government-funded old-age pensions reported concerns about economic matters and medication access less often. Conclusions South Africans complied with stringent, COVID-19–related NPIs despite the threat of substantial social, economic, and health repercussions. Government-supported social welfare programs appeared to buffer interruptions in income and health care access during local outbreaks. Epidemic control policies must be balanced against the broader well-being of people in resource-limited settings and designed with parallel support systems when such policies threaten peoples’ income and access to basic services.

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Gendered economic, social and health effects of the COVID-19 pandemic and mitigation policies in Kenya: evidence from a prospective cohort survey in Nairobi informal settlements

Cited by 82 publications

References 36 publications

How Has COVID-19-Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya?

How Has COVID-19-Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya?

Youth Relationships in the Era of COVID-19: A Mixed-Methods Study Among Adolescent Girls and Young Women in Kenya

Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study

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