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      Dramatic effects of COVID-19 public health measures and mass reverse migration on youth sexual and reproductive health in rural Uganda

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          Abstract

          Introduction

          Youth (aged 10 to 24 years) comprise nearly one-third of Uganda’s population and often face challenges accessing sexual and reproductive health (SRH) services, with a disproportionately high incidence of negative SRH outcomes. Responding to COVID-19, Uganda implemented strict public health measures including broad public transportation, schooling, and business shut-downs, causing mass reverse-migration of youth from urban schools and workplaces back to rural home villages. Our study aimed to qualitatively describe the perceived unintended impacts of COVID-19 health measures on youth SRH in two rural districts.

          Methods

          Semi-structured focus group discussions (FGD) and key informant interviews (KII) with purposively selected youth, parents, community leaders, community health worker (CHW) coordinators and supervisors, health providers, facility and district health managers, and district health officers were conducted to explore lived experiences and impressions of the impacts of COVID-19 measures on youth SRH. Interviews were recorded, transcribed, and coded using deductive thematic analysis.

          Results

          Four COVID-19-related themes and three subthemes resulted from 15 FGDs and 2 KIIs (n=94). Public transportation shutdown and mandatory mask-wearing were barriers to youth SRH care-seeking. School/workplace closures and subsequent urban youth migration back to rural homes increased demand at ill-prepared, rural health facilities, further impeding care-seeking. Youth reported fear of discovery by parents, which deterred SRH service seeking. Lockdown led to family financial hardship, isolation, and overcrowding; youth mistreatment, gender-based violence, and forced marriage ensued with some youth reportedly entering partnerships as a means of escape. Idleness and increased social contact were perceived to lead to increased and earlier sexual activity. Reported SRH impacts included increased severity of infection and complications due to delayed care seeking, and surges in youth sexually transmitted infections, pregnancy, and abortion.

          Conclusion

          COVID-19 public health measures reportedly reduced youth care seeking while increasing risky behaviours and negative SRH outcomes. Investment in youth SRH programming is critical to reverse unintended pandemic effects and regain momentum toward youth SRH targets. Future pandemic management must consider social and health disparities, and mitigate unintended risks of public health measures to youth SRH.

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          Most cited references27

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          Impact of COVID-19 and Lockdown on Mental Health of Children and Adolescents: A Narrative Review with Recommendations.

          HIGHLIGHTS • We conducted a narrative review of articles on mental health aspects of children and adolescents during the COVID-19 pandemic and lockdown. • Most studies are cross-sectional in nature. Findings show that quality and magnitude of impact is determined by vulnerability factors like developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection or fear of infection. • There is a crucial requirement for planning longitudinal and developmental studies, and evidence based elaborative strategies to cater to mental health needs of the vulnerable children and adolescents during and after the pandemic by mobilising direct and digital collaborative networks.
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            Uganda demographic and health survey 2016

            (2018)
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              Is Open Access

              Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda

              Background COVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals’ movements in Uganda limited access to services. Methods An observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019–March 2020), during (April 2020–June 2020) and after the national lockdown (July 2020–December 2020). Results Between 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks. During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown. Conclusion The Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.
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                Author and article information

                Journal
                Paediatr Child Health
                Paediatr Child Health
                pch
                Paediatrics & Child Health
                Oxford University Press (US )
                1205-7088
                1918-1485
                June 2022
                03 May 2022
                03 May 2023
                : 27
                : Suppl 1 , Effects of the COVID-19 Pandemic on Children and Youth
                : S40-S46
                Affiliations
                [1 ] Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada
                [2 ] Faculty of Interdisciplinary Studies, Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda
                [3 ] Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology , Mbarara, Uganda
                [4 ] Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda
                [5 ] Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada
                [6 ] Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada
                [7 ] Department of Pediatrics, Cumming School of Medicine, University of Calgary , Calgary, Alberta, Canada
                Author notes
                Correspondence: Elizabeth Kemigisha, Faculty of Interdisciplinary Studies, Department of Human Development and Relational Sciences, Mbarara University of Science and Technology, Mbarara, Uganda. Telephone (256) 772858818, e-mail ekemigisha@ 123456must.ac.ug

                These authors contributed equally to this manuscript.

                Author information
                https://orcid.org/0000-0003-0826-7298
                Article
                pxab107
                10.1093/pch/pxab107
                9126275
                35620554
                a1ed96f6-e8fe-468f-9a3b-a1b423caff8c
                © The Author(s) 2022. Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                History
                : 31 July 2021
                : 23 December 2021
                Page count
                Pages: 7
                Funding
                Funded by: Government of Canada, DOI 10.13039/501100000023;
                Funded by: Global Affairs Canada, DOI 10.13039/501100008627;
                Award ID: P-006328
                Categories
                Original Articles
                AcademicSubjects/MED00670

                adolescent,covid-19,qualitative research,reproductive health,sexual health,uganda

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