key: cord-0854912-r24ttrhk
authors: Addae, Evelyn Aboagye
title: COVID‐19 pandemic and adolescent health and well‐being in sub‐Saharan Africa: Who cares?
date: 2020-08-27
journal: Int J Health Plann Manage
DOI: 10.1002/hpm.3059
sha: b8eaa6952fcf85de740a0f4ebf8044a0fdca8aff
doc_id: 854912
cord_uid: r24ttrhk

nan

The COVID-19 virus can affect children and adolescents, but it appears to be associated with fewer symptoms and less severe disease compared with adults including older people, with correspondingly lower case-fatality rates. 4, 5 Nevertheless, adolescents would greatly suffer through emergency policies and public health measures put in place to combat the pandemic. Yet, the implications of COVID-19 mitigation strategies on adolescents and the intervention programmes to avert the shock have not received much policy consideration, particularly in sub-Saharan Africa. Adolescence is a critical developmental stage where adolescents experience biological, cognitive, psychological, behavioural and social development. 6 Exposure to the detrimental impacts of COVID-19 would greatly result in developmental losses in adolescence that can never be regained. As sub-Saharan Africa has had its fair share of pandemics in previous years, it is hence crucial that governments learn lessons from the impacts of previous pandemics in sub-Saharan Africa and the recent COVID-19 pandemic on the health and well-being of adolescents. This will safeguard the provision of aptly interventions for adolescents during and after the COVID-19 pandemic.

In sub-Saharan Africa, the COVID-19 pandemic has exacerbated the impact of the deficit in existing health systems. 7 The available healthcare resources are powerless to address the demand of COVID-19 and ongoing healthcare needs of the populace; rendering health workers incapable to fully execute their duties. 7 Evidence from the Ebola pandemic in sub-Saharan Africa inferred that despite the augmented need for sexual and reproductive health services during the outbreak, there was a decline in the capability to utilise these services by adolescents. 8 Many health facilities were not ready to provide adolescent and youth-friendly services during the pandemic. 8 Adolescents, predominantly girls, were more threatened as the conversion of some health facilities to Ebola quarantine centres limited access to non-Ebola health services. 9 Adolescents again suffered unmet needs as funds that were meant to provide specific health services for young girls such as reproductive health services and provision of sanitary needs were diverted to combat Ebola disease. 8, 10 Learning from these previous lessons, the COVID-19 pandemic could hence unleash a critical health deficit moment for adolescents in sub-Saharan Africa.

To control the community spread of the COVID-19 virus, many countries worldwide are forced to take harsh measures including the closure of schools. 11 The implications of the school closure suggest that several school protective functions would be lost, exposing adolescents to potential social vices and other health risk behaviours such as amplified teenage pregnancies, increased child labour, increased early marriage or increased transactional sex as reported during the Ebola crises in Sierra Leone. 10, 12, 13 Recent evidence amidst COVID-19 pandemic also reveals concerns over a possible rise in interpersonal violence against adolescents in sub-Saharan Africa during Int J Health Plann Mgmt. 2020;1-4.

wileyonlinelibrary.com/journal/hpm school closures. For instance, reports revealed a spike in gender-based violence and exploitation in Nigeria and

Kenya during COVID-19-related emergency lockdowns and the concomitant isolation and quarantine. 14, 15 Ghana has also been warned by UNFPA-Ghana to expect a spike in gender-based violence, sexual exploitation, rape, incest and other forms of violence during the pandemic. 16 These reports suggest a possible upsurge in violence against adolescents in sub-Saharan Africa amidst the COVID-19 pandemic. Additionally, there is a higher propensity that many adolescent students in these challenging settings of sub-Saharan Africa will not return to school during the reopening of schools and post-COVID-19 owing to the heightened poverty as well as the likelihood of hardshiprelated teenage pregnancies as was the case in Sierra Leone during the Ebola outbreak. 13 Recent reports from Ghana indicate that some Ghanaian adolescent students are already suffering the impacts infection. 18 Following the death of the student was a distressing protest staged by students in the school where the incident happened as the students were distressed over the death of their colleague. They believe if the school authorities had acted swiftly, his life would have been saved. Ghana armed police had to calm the social unrest in the affected school. 18 Such occurrences indicate inadequate awareness about the COVID-19 spread and symptoms by school teachers and authorities and the potential impact of COVID-19 on adolescents mental health. Misinformation and issues relating to possible and actual spread of the virus particularly through social media outlets could hence be a concern in disadvantaged settings. Importantly, the fear of possible contagion of the pandemic, news about family members and friends infected, levels of separation anxiety, and tendency to adopt an emotionfocused coping lifestyle could potentially intensify mental health problems of adolescents in school and home settings.

Lastly, although governments worldwide are making efforts to promote the educational well-being of students during school closures, for poor adolescents the consequences of this policy response 'school closure' on their educational development and well-being can be very devastating. Governments in many countries worldwide including some countries in sub-Saharan Africa have adopted online, television and radio platforms to provide alternative education routes for students. 11 However, many adolescents in sub-Saharan Africa live in extreme poverty where access to the required resources and gadgets such as electricity, Internet, computers, smartphones, television and radio is a challenge. 11 Poor adolescent students would, hence, be deprived of such interventions, resulting in their academic progress being left behind.

In conclusion, evidence from previous pandemics in sub-Saharan Africa and recent evidence from Ghana, Nigeria and Kenya amidst COVID-19 pandemic reveal possible disparaging mid-and long-term impacts of COVID-19 on adolescents such as widened inequality gap in adolescent health, educational and psychological well-being, and loss of social and human capital (potential protective health assets) which may have deleterious life-course consequences for adulthood. There is an urgent need for public health interventions that support the sexual and reproductive health of adolescents, provision of alternative healthcare facilities and services for non-COVID-19

healthcare needs during the COVID-19 pandemic as well as ensuring the safety of adolescents at quarantine centres. Governments should guarantee that appropriate trade-off is made when making policies that concern adolescents during the COVID-19 pandemic such as assessing critically the cost of reopening schools against the health, well-being and lives of students. Governments should also provide adequate health education on COVID-19

to their citizens especially parents, guardians, teachers and authorities in schools and child care institutions. This would equip the public and guardians to respond aptly to healthcare emergencies regarding children and adolescents during the COVID-19 pandemic to avoid preventable deaths of children and adolescents over fear of COVID-19 infection. Moreover, tracking and addressing violence against adolescents during COVID-19 and potential future outbreaks are critical social and public health policy deliveries to safeguard the future and development of

COVID-19 will Hit the Poor the Hardest. Here's What we can Do About It

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