Dear Editor,
The health and well‐being impact of COVID‐19 on global development agendas has wildly
been debated. The World Bank has reported that the poor will be hardest hit from the
COVID‐19 crisis, and that the pandemic could render about 49 million people including
children and young people into extreme poverty in 2020.
1
Crucially, low‐ and middle‐income countries (LMICs) would be greatly affected with
almost half of the projected new poor (23 million) been in sub‐Saharan Africa.
1
Sub‐Saharan Africa again bears the highest COVID‐19 risk factors according to the
global Multidimensional Poverty Index with almost 90% of the population, 882 million
people experiencing at least one COVID‐19 risk factor.
2
Considering that the world's largest population, ‘adolescents’ reside in LMICs
3
suggests that most of the world's young population are at risk of the potential devastation
of COVID‐19.
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 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 hardship‐related 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 of COVID‐19 pandemic. There have been reported cases of COVID‐19
infection among some senior high school (SHS) students who resumed school on demand
of the government of Ghana to complete the final stage of their SHS education amidst
the national closure of schools in Ghana.
17
Despite the heightened confirmed cases of COVID‐19 infection in some schools and its
potential causes of distress and panic among the students and their families, schools
remain open for SHS final year students in Ghana. Consequently, one adolescent student
who fell ill while in school died from alleged neglect by his teachers over the fear
that the boy was suffering from COVID‐19 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 emotion‐focused 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 this vulnerable cohort. There should be social protection
interventions targeting adolescents' social, economic and educational empowerment
for, especially poor adolescents during the pandemic. This will possibly combat intergenerational
poverty and give the next generation a healthy start in life particularly in sub‐Saharan
Africa.
CONFLICT OF INTEREST
The author declares no potential conflict of interest.