How Has COVID-19 Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya? (preprint)

Background: Adolescent mental health has been under-researched, particularly in Africa. COVID-19 related household economic stress, coupled with school closures, will likely have adverse effects on adolescent mental health. We investigate the relationship between adolescent mental health, adult income loss, and household dynamics during the pandemic in Kenya. Methods: A mobile phone-based survey was conducted with one adult and adolescent (age 10-19 years) pair from a sample of households identified through previous cohort studies in three Kenyan counties (Nairobi, Kilifi, Kisumu). Survey questions covered education, physical and mental health, and COVID-19 related impacts on job loss, food insecurity, and healthcare seeking. Logistic regression models were fit to explore relationships between adult income loss, household dynamics, food insecurity, adult and adolescent depressive symptoms (defined as PHQ-2 score ≤ 2). Findings: A total of 2,224 adult – adolescent pairs (Nairobi n=814; Kilifi n=914; Kisumu n=496) completed the survey. Of all adolescents, 36% reported depressive symptoms, highest among older (15-19 years) boys. Adult complete loss of income was associated with adult and adolescent skipping meals, adult depressive symptoms, household tensions/violence. Adolescents had 2.5 higher odds of depressive symptoms if COVID-19 was causing them to skip meals (Odds Ratio (OR)=2.5; 95% Confidence Intervals (CI): 2.0, 3.1) and if their adult head of household reported depressive symptoms (OR=2.6; 95% CI: 2.1, 3.2). Adolescents also had 2.5 higher odds of skipping necessary health services if their adult head of household had lost full income (OR=2.5; 95% CI: 1.6, 3.9). Interpretation: Income loss during the pandemic adversely affects food insecurity, household dynamics, and healthcare-seeking behavior, worsening adolescent depressive symptoms. With schools re-opening, adolescent mental health should be formally addressed, potentially through cash transfers, school or community-based psychosocial programming.Funding: Innovation for Poverty Action, University of California San Diego, UK Foreign Commonwealth and Development OfficeDeclaration of Interest: No conflict of interests to declare.Ethical Approval: We received ethical approval from both the Population Council IRB (p936) and AMREF ESRC (P803/2020). Participants 18 years and over provided verbal informed consent, and those under 18 provided verbal assent with parent or guardian consent. Participants were told they could terminate the survey at any time or refuse to answer specific questions. Participants wereinformed beforehand that they would be paid 100 Kenyan shillings (~US$1) for their time(transferred via mPesa mobile money).

The impact of COVID-19 control measures on social contacts and transmission in Kenyan informal settlements (preprint)

BackgroundMany low- and middle-income countries have implemented control measures against coronavirus disease 2019 (COVID-19). However, it is not clear to what extent these measures explain the low numbers of recorded COVID-19 cases and deaths in Africa. One of the main aims of control measures is to reduce respiratory pathogen transmission through direct contact with others. In this study we collect contact data from residents of informal settlements around Nairobi, Kenya to assess if control measures have changed contact patterns, and estimate the impact of changes on the basic reproduction number (R0). MethodsWe conducted a social contact survey with 213 residents of five informal settlements around Nairobi in early May 2020, four weeks after the Kenyan government introduced enhanced physical distancing measures and a curfew between 7pm and 5am. Respondents were asked to report all direct physical and non-physical contacts made the previous day, alongside a questionnaire asking about the social and economic impact of COVID-19 and control measures. We examined contact patterns by demographic factors, including socioeconomic status. We described the impact of COVID-19 and control measures on income and food security. We compared contact patterns during control measures to patterns from non-pandemic periods to estimate the change in R0. FindingsWe estimate that control measures reduced physical and non-physical contacts, reducing the R0 from around 2.6 to between 0.5 and 0.7, depending on the pre-COVID-19 comparison matrix used. Masks were worn by at least one person in 92% of contacts. Respondents in the poorest socioeconomic quintile reported 1.5 times more contacts than those in the richest. 86% of respondents reported a total or partial loss of income due to COVID-19, and 74% reported eating less or skipping meals due to having too little money for food. InterpretationCOVID-19 control measures have had a large impact on direct contacts and therefore transmission, but have also caused considerable economic and food insecurity. Reductions in R0 are consistent with the linear epidemic growth in Kenya and other sub-Saharan African countries that implemented similar, early control measures. However, negative and inequitable impacts on economic and food security may mean control measures are not sustainable in the longer term. Research in context Evidence before this studyWe conducted a PubMed search on 6 June 2020 with no language restrictions for studies published since inception, using the search terms ("social mix*" OR "social cont*" OR "contact pattern*) AND ("covid*"). The search yielded 53 articles, two of which reported changes in social contacts after COVID-19 control measures. The first study reported changes in contact patterns in Wuhan and Shanghai, and the second changes in contact patterns in the UK. We found no studies examining changes in contact patterns due to control measures in sub-Saharan Africa, and no studies disaggregating contacts by socioeconomic status. Added value of this studyThis is the first study to estimate the reproduction number of COVID-19 under control measures in sub-Saharan Africa using primary contact data. This study also moves beyond existing work to i) measure contacts in densely populated informal settlements, ii) explore how social contacts vary across socioeconomic status, and iii) assess the impact of control measures on economic and food security in these areas. Implications of all the evidenceCOVID-19 control measures have substantially reduced social contacts and disease transmission. People of lower socioeconomic status face greater transmission risk as they report more contacts. Control measures have led to considerable economic and food insecurity, and may not be sustainable in the long term without efforts to reduce the burden of control measures on households.