Assessing the health, social, educational and economic impact of the COVID-19 pandemic on adolescents in low- and middle-income countries: a rapid review of the literature

Nimble adaptations to sexual and reproductive health service provision to adolescents and young people in the early phase of the COVID-19 pandemic

Early in the COVID-19 pandemic, emerging evidence showed that the provision and use of a range of health services, including sexual and reproductive health (SRH) services, were affected. Otherwise, there was little evidence on whether and how they were adapted to maintain the access of different population groups, including adolescents. The study aims to provide an overview of adaptations to adolescent sexual and reproductive health (ASRH) services carried out during the early phases of the pandemic in low- and middle-income countries (LMICs). The Human Reproduction Program (HRP) at the World Health Organization (WHO) called upon WHO and United Nations Populations Fund (UNFPA) regional offices to reach out to organisations that provided ASRH services to submit analytic case studies using a short-form survey. The study team charted information from 36 case studies and performed a content analysis. Results show that the adaptations covered a wide array of SRH services that were provided to a diverse group of adolescents. Most adaptations focused on SRH education and access to contraception in comparison to other SRH services. Over half of the case studies included mental health services, most of which were not provided before the pandemic. The adaptations varied between being face-to-face, remote, digital, and non-digital. Most adaptations complemented a pre-existing service and were nimble, feasible, and acceptable to the targeted adolescents. Lessons learned from this study could be extrapolated into other humanitarian settings and rapid responses for future public health emergencies, provided that rigorous evaluation takes place.

Effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents

OBJECTIVE

The daily lives of adolescents have changed significantly because of COVID-19 pandemic. We investigated the effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents.

METHODS

Data from the 2021 Korea Youth Risk Behavior Survey were used. In total, 54,848 survey participants were included in the analysis. Allergic diseases included allergic rhinitis, atopic dermatitis, and asthma. Changes attributed to COVID-19 included family economic difficulties, physical activity, breakfast skipping frequency, alcohol consumption, smoking, and depressive moods. Chi-square tests and multiple logistic regression analyses were conducted to examine the impact of changes in daily life attributed to COVID-19 on allergic diseases.

RESULTS

Among the Korean adolescents surveyed, 29.8% experienced a deterioration in their economic status due to COVID-19, 49.1% reported decreased physical activity, 2.8% reported increased alcohol consumption, 1.0% reported an increase in their smoking behavior, and 36.9% reported an increase in depressive moods. Those diagnosed with atopic dermatitis, allergic rhinitis, or asthma within the previous 12 months accounted for 17.1%, 6.2%, and 1.0% of the population, respectively. Adolescents who were significantly affected by COVID-19 in their daily lives were frequently diagnosed with allergic diseases within the last 12 months.

CONCLUSION

Changes in daily life due to COVID-19, including decreased physical activity and increased depressive mood, were common in adolescents and were associated with an increased prevalence of allergic diseases. Since changes in daily life due to the pandemic may increase the burden of allergic disease, additional interventions for disease management should be considered.

An exploratory cross-cultural study of community-based health literacy interventions to promote the mental well-being of disadvantaged and disabled young Africans: a multi-method approach

Background

This study explores the impact of community-based health literacy interventions on the health and mental well-being of disadvantaged young Africans in Zambia, Sierra Leone, Rwanda, and South Africa. The pandemic has exacerbated mental health problems amongst children and young people, underscoring the urgent need for equitable access to mental healthcare resources. Emphasizing the importance of equitable access to mental healthcare resources, the research addresses educational and income disparities in low- and middle-income countries (LMICs), particularly amongst young Africans with disabilities or vulnerabilities.

Methods

The study comprised 1,624 young Africans, of whom 1,592 were surveyed, while 191 later participated in in-depth interviews and focus groups. Additionally, 32 participants exclusively joined focus groups. Participants were recruited to complete the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), WHO-5 Well-being Index, Pandemic Anxiety Scale (PAS), and Self-rating of Happiness, as well as semi-structured interviews or focus groups.

Results

The findings highlight the significance of tailored health literacy interventions in addressing mental health challenges and promoting well-being in marginalized African communities. In the sample, 43.1% (686) reported to have at least a physical disability or serious health condition and 51.4% (818) had special educational needs (SENs). Mental health scores were significantly lower in participants with two or more physical disabilities and pre-existing mental health problems. Factors significantly associated with poor mental health included poor health literacy, physical disabilities, and pre-existing mental health problems. Four main themes were generated from the thematic analysis: early childhood trajectories and mental illness experiences; positionality, open communication, and mental illness experience; mental illness experience, emotional honesty, and social stratification; and spirituality, cultural beliefs, and mental illness experience.

Conclusion

The study emphasizes the need for context-specific, culturally appropriate health literacy interventions to support the mental health and well-being of young Africans in LMICs. By focusing on the lived experiences of disadvantaged groups, the research contributes to a better understanding of effective strategies for promoting health literacy and addressing health inequalities in African communities during and after health emergencies.

Psychosocial alterations during the COVID-19 pandemic and the global burden of anxiety and major depressive disorders in adolescents, 1990-2021: challenges in mental health amid socioeconomic disparities

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic, a global health crisis, profoundly impacted all aspects of daily life. Adolescence, a pivotal stage of psychological and social development, is heavily influenced by the psychosocial and socio-cultural context. Hence, it is imperative to thoroughly understand the psychosocial changes adolescents experienced during the pandemic and implement effective management initiatives.

DATA SOURCES

We examined the incidence rates of depressive and anxiety disorders among adolescents aged 10-19 years globally and regionally. We utilized data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to compare pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Our investigation covered 204 countries and territories across the six World Health Organization regions. We conducted a comprehensive literature search using databases including PubMed/MEDLINE, Scopus, and Google Scholar, employing search terms such as "psychosocial", "adolescent", "youth", "risk factors", "COVID-19 pandemic", "prevention", and "intervention".

RESULTS

During the pandemic, the mental health outcomes of adolescents deteriorated, particularly in terms of depressive and anxiety disorders. According to GBD 2021, the incidence rate of anxiety disorders increased from 720.26 [95% uncertainty intervals (UI) = 548.90-929.19] before the COVID-19 pandemic (2018-2019) to 880.87 per 100,000 people (95% UI = 670.43-1132.58) during the COVID-19 pandemic (2020-2021). Similarly, the incidence rate of major depressive disorder increased from 2333.91 (95% UI = 1626.92-3138.55) before the COVID-19 pandemic to 3030.49 per 100,000 people (95% UI = 2096.73-4077.73) during the COVID-19 pandemic. This worsening was notably pronounced in high-income countries (HICs). Rapid environmental changes, including heightened social anxiety, school closures, economic crises, and exacerbated racism, have been shown to adversely affect the mental well-being of adolescents.

CONCLUSIONS

The abrupt shift to remote learning and the absence of in-person social interactions heightened feelings of loneliness, anxiety, sadness, and stress among adolescents. This change magnified existing socioeconomic disparities, posing additional challenges. These complexities profoundly impact adolescents' well-being, especially vulnerable groups like those from HICs, females, and minorities. Acknowledging the underreporting bias in low- to middle-income countries highlights the importance of addressing these mental health alterations in assessments and interventions within these regions as well. Urgent interventions are crucial as the pandemic-induced mental stress may have lasting effects on adolescents' mental health.

'Life became harder with COVID-19': exploring the experiences of the COVID-19 pandemic among youth living in eThekwini district, South Africa

BACKGROUND

In South Africa, pervasive age and gender inequities have been exacerbated by the COVID-19 pandemic and public health response. We aimed to explore experiences of the COVID-19 pandemic among youth in eThekwini district, South Africa.

METHODS

Between December 2021-May 2022 we explored experiences of the COVID-19 pandemic on youth aged 16-24 residing in eThekwini, South Africa. We collated responses to the open-ended question "Has the COVID-19 pandemic affected you in any other way you want to tell us about?" in an online survey focused on understanding the pandemic's multi-levelled health and social effects. We used a thematic analysis to summarise the responses.

RESULTS

Of 2,068 respondents, 256 (12.4%, median age = 22, 60.9% women) completed the open-ended survey question (11% in isiZulu). Results were organized into three main themes encompassing (1) COVID-19-related loss, fear, grief, and exacerbated mental and physical health concerns; (2) COVID-19-related intensified hardships, which contributed to financial, employment, food, education, and relationship insecurities for individuals and households; and (3) positive effects of the pandemic response, including the benefits of government policies and silver linings to government restrictions.

CONCLUSIONS

We found that South African youth experienced significant grief and multiple losses (e.g., death, income, job, and educational) during the COVID-19 pandemic. Trauma-aware interventions that provide economic and educational opportunities must be included in post-COVID recovery efforts.

The downstream effects of COVID-19 on adolescent girls in the Peruvian Amazon: qualitative findings on how the pandemic affected education and reproductive health

Due to COVID-19, schools were closed to mitigate disease spread. Past studies have shown that disruptions in education have unintended consequences for adolescents, including increasing their risk of school dropout, exploitation, gender-based violence, pregnancy and early unions. In Peru, the government closed schools from March 2020 to March 2022, declaring a national emergency that affected an estimated 8 million children. These closures may have unintended consequences, including increased adolescent pregnancy, particularly in Peru's rural, largely indigenous regions. Loreto, located in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country and poor maternal and child health outcomes. The underlying causes may not be fully understood as data are limited, especially as we transition out of the pandemic. This qualitative study investigated the downstream effects of COVID-19 on adolescent education and reproductive health in Loreto's districts of Nauta and Parinari. In-depth interviews (n=41) were conducted with adolescents and community leaders. These were held in June 2022, 3 months after the reinstitution of in-person classes throughout Peru. Focus group discussions (FGDs) were also completed with community health workers and educators from the same study area in October 2022 to supplement our findings (3 FGDs, n=15). We observed that the economic, educational and health effects of the COVID-19 pandemic contributed to reduced contraceptive use, and increased school abandonment, early unions and adolescent pregnancy. The interplay between adolescent pregnancy and both early unions and school abandonment was bidirectional, with each acting as both a cause and consequence of the other.

Psychological distress among Brazilian workers during the initial stage of the COVID-19 pandemic: a descriptive study

Background

COVID-19 pandemic imposed drastic and abrupt changes to working environment and organization and that might have caused additional negative effects on mental health. Thus, this study aimed to quantify and assess the severity of psychological distress experienced by Brazilian essential and nonessential workers during the first months of the COVID-19 pandemic.

Methods

This descriptive study included 2,903 participants who answered an online questionnaire between April and May 2020. The research questionnaire was translated and culturally adapted to the Brazilian population from a questionnaire developed and validated for the Spanish population. Variables were analyzed using simple and cumulative percentage distributions and measures of central tendency and dispersion. The Wilson score interval was used to calculate confidence interval (CI) for the main outcome, psychological distress.

Results

It was observed a high prevalence (72.6%) of psychological distress among the study's participants. They also presented a median risk perception score of 60 (out of a maximum of 90), and their greatest concern was transmitting the virus to family members, close contacts or patients. Furthermore, it was found a lower sense of coherence and work engagement among the participants than those observed in previous studies conducted in other countries.

Conclusion

Almost three quarters of the study's participants were classified as presenting psychological distress. Thus, it is imperative to provide mental health remotely delivered interventions to workers during public health events that require prolonged social distancing measures.

Characteristics, utilization of reproductive health services and AI prediction among Taiwanese adolescent mothers during the COVID-19 pandemic

Background

Although adolescent birth rates have declined globally, the sexual and reproductive health of adolescent mothers remains an area of specific concern, and these were impacted by the COVID-19 pandemic. This study investigates characteristics, utilization of reproductive health services (RHS) and artificial intelligence (AI) prediction during the pandemic.

Methods

We conducted an exploratory study using data for 2020-2022 from the Taipei City Government Health Bureau. Adolescent mothers under the age of 20 received post-birth telephone-based RHS, covering contraception, abortion, postpartum care, and social welfare support. The data analysis included descriptive statistics, and various machine learning techniques were employed, including random forest, SVM, KNN, logistic regression, and Bayesian network analysis.

Results

Of 112 participants, most were aged 17 to 19 (80.4%) and married (58.0%). The majority had full-term deliveries (86.6%) with healthy infants. A high percentage had not used contraception before conception (60.7%), and some had had earlier abortion or termination experiences (13.4%). In the examination of eight influential factors, the machine learning models, specifically the random forest and Bayesian network analyses, exhibited the highest accuracy, achieving 90.91% and 89%, respectively, in predicting service acceptance. The key determinants identified were abortion experience and marital status, directly influencing the acceptance of services.

Conclusion

The COVID-19 pandemic reduced hospital visits for adolescent mothers, but the RHS provided timely guidance. Telemedicine consultations and internet-based psychological consultations may play a crucial role in facilitating such services in the future.

Adolescent Social Outcomes Declined During COVID-19: Evidence From Bangladesh, Jordan, And Ethiopia

Although adolescents have been less susceptible to COVID-19-related morbidity and mortality than older people, the social containment policies put in place to curb the disease constrained their ability to thrive. This study explored changes in adolescent outcomes during the COVID-19 pandemic, particularly among vulnerable adolescents, focusing on education, economic participation, early marriage, self-reported health, and food security. We investigated the role of governmental and nongovernmental cash and food aid in mitigating negative effects. Using panel data collected both before (2017-20) and at two points during (2020-21) the pandemic on more than 7,000 adolescents from Bangladesh, Jordan, and Ethiopia, we found evidence of worsening outcomes across all measures except self-reported health. Declines were generally worse for more vulnerable adolescents. There is little evidence that aid mitigated negative impacts for adolescents in general or for vulnerable adolescents in particular. This research highlights the need for greater focus on developing social protection that is responsive to the multifaceted needs of adolescents.

Young People and the Future: School Students' Concerns and Hopes for the Future after One Year of COVID-19 in Austria-Findings of a Mixed-Methods Pilot Study

The COVID-19 pandemic resulted in enormous changes in everyday life and numerous burdens for adolescents. This pilot study focused on how young people look to the future in the face of these burdens. Responses to two open-ended questions on concerns and hopes for the future that were part of a larger online survey on the mental health of school students in Austria were analyzed using qualitative content analysis. Subsequently, differences in the experiences of boys and girls, young people with and without a migration background and psychologically stressed and non-stressed young people were examined by applying a mixed-methods approach. Data collection took place from 3 February to 28 February 2021. From a total survey sample of 3052 adolescents aged 14-20, a representative sample according to gender and migration background (N = 500) was drawn. Qualitative content analysis revealed several areas of concern about the future, including school-related concerns, concerns about the further development of the pandemic and the associated restrictions, concerns related to a lack of locus of control, health-related concerns and concerns about social relationships. The analysis also indicated young people's greatest hopes for the future, such as hopes related to further pandemic development, hopes regarding major life goals, school, social relationships and health. Young people's experiences differ according to gender, migration background and the extent of psychological distress. This study contributes to research on the psychological well-being of adolescents during the pandemic and provides important insights into the subjective experience of young people. It aims to gain a more comprehensive understanding of the concerns and hopes for the future of young people in a time marked by various challenges. The results of the study should be used to develop ideas for measures, such as the expansion of school psychological services and low-threshold support services for students, such as school social work and counseling.