COVID‐19 pandemic and adolescent health and well‐being in sub‐Saharan Africa: Who cares?

Abstract

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.