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1.
PLoS One ; 17(2): e0261773, 2022.
Article in English | MEDLINE | ID: covidwho-1793545

ABSTRACT

PURPOSE: The COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience. METHODS: Our analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable Jordanians, living in camps, host communities and informal tented settlements. We utilize mixed-methods analysis combining multivariate regression with deductive qualitative tools to evaluate pandemic impacts and associated policy responses on adolescent wellbeing and mental health, at three and nine months after the pandemic onset. We also explore the role of support systems at individual, household, community, and policy levels. FINDINGS: We find the pandemic has resulted in severe economic and service disruptions with far-reaching and heterogenous effects on adolescent wellbeing. Nine months into the pandemic, 19.3% of adolescents in the sample presented with symptoms of moderate-to severe depression, with small signs of improvement (3.2 percentage points [pp], p<0.001). Two thirds of adolescents reported household stress had increased during the pandemic, especially for Syrian adolescents in host communities (10.7pp higher than any other group, p<0.001). Social connectedness was particularly low for girls, who were 13.4 percentage points (p<0.001) more likely than boys to have had no interaction with friends in the past 7 days. Adolescent programming shows signs of being protective, particularly for girls, who were 8.8 percentage points (p<0.01) more likely to have a trusted friend than their peers who were not participating in programming. CONCLUSIONS: Pre-existing social inequalities among refugee adolescents affected by forced displacement have been compounded during the COVID-19 pandemic, with related disruptions to services and social networks. To achieve Sustainable Development Goal targets to support healthy and empowered development in adolescence and early adulthood requires interventions that target the urgent needs of the most vulnerable adolescents while addressing population-level root causes and determinants of psychosocial wellbeing and resilience for all adolescent girls and boys.


Subject(s)
Adolescent Health/trends , COVID-19/psychology , Refugees/psychology , Adolescent , Child , Female , Humans , Jordan/epidemiology , Male , Mental Health , Pandemics , Psychology , SARS-CoV-2/pathogenicity , Social Environment , Socioeconomic Factors , Young Adult
2.
J Intensive Care Soc ; 23(1): 27-33, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1779527

ABSTRACT

OBJECTIVES: Continuous positive airway pressure (CPAP) may be a useful treatment strategy for patients with severe COVID-19 pneumonia but its effectiveness in preventing mechanical ventilation is unknown. We aimed to evaluate the outcomes of COVID-19 patients treated with CPAP and determine predictors of CPAP response. DESIGN: This was a retrospective observational cohort study. SETTING: The study took place in the intensive care unit (ICU) at Royal Papworth Hospital (RPH) in Cambridge, UK. PATIENTS: We included all consecutive patients with confirmed COVID-19 pneumonia who were transferred from neighbouring hospitals between 14th March and 6th May, 2020 for consideration of ventilatory support. INTERVENTION: We instituted the use of CPAP for all patients who arrived in RPH not intubated and were not making satisfactory progress on supplemental oxygen alone. MEASUREMENTS AND MAIN RESULTS: Of 33 self-ventilating patients included in this study, 22 (66.7%) were male and the mean age was 54 ± 13.23 patients received CPAP. They were more hypoxaemic than those treated with oxygen alone (PaO2/FiO2 ratio; 84.3 ± 19.0 vs 170.0 ± 46.0 mmHg, p = 0.001). There was a significant improvement in PaO2/FiO2 ratio 1-2 hours after CPAP initiation (167.4 ± 49.0 from 84.3 ± 19.0 mmHg, p = 0.001). 14 (61%) patients responded to CPAP and 9 required intubation. There was no difference between these two groups in terms of the severity of baseline hypoxaemia (PaO2/FiO2 ratio; 84.5 ± 16.0 vs 83.9 ± 23.0 mmHg, p = 0.94) but CPAP responders had significantly lower C-reactive protein (CRP) (176 ± 83 vs 274 ± 63 mg/L, p = 0.007), interleukin-6 (IL-6) (30 ± 47 vs 139 ± 148 pg/mL, p = 0.037), and D-dimer (321 ± 267 vs 941 + 1990 ng/mL, p = 0.003). CT pulmonary angiogram was performed in 6 out of 9 intubated patients and demonstrated pulmonary emboli in 5 of them. All patients were discharged from ICU and there were no fatalities. CONCLUSIONS: In this cohort, CPAP was an effective treatment modality to improve hypoxaemia and prevent invasive ventilation in a substantial proportion of patients with severe respiratory failure. Accepting the small sample size, we also found raised biomarkers of inflammation (CRP and IL-6) and coagulopathy (D-Dimer) to be more useful predictors of CPAP responsiveness than the severity of hypoxaemia, and could help to guide intubation decisions in this clinical setting.

3.
J Adolesc Health ; 70(3S): S86-S96, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1778243

ABSTRACT

PURPOSE: Although there is a growing evidence base on the drivers of child marriage, comparatively little is known about the experiences of married girls in refugee settings and how their development trajectories diverge from those of their nonmarried peers, particularly in the context of the COVID-19 pandemic. Drawing on cross-national panel data from Bangladesh and Jordan, this article explores diversity in child marriage experiences in contexts affected by forced displacement, highlighting how married girls' well-being differs from that of their unmarried peers, and how COVID-19 has reinforced these differences. METHODS: We analyzed longitudinal survey data-collected pre- and post-COVID-19-from the Gender and Adolescence: Global Evidence study with 293 ever-married and 1,102 never-married adolescent girls. Multivariate regression analysis assessed the well-being of married and unmarried girls across contexts and refugee status, both prior to and during the COVID-19 pandemic. These quantitative data are complemented by in-depth qualitative data from adolescents (n = 112), and key informant interviews with service providers and community leaders (n = 62). RESULTS: Our findings highlight that married girls in contexts affected by displacement are disadvantaged in multiple ways, but that the patterning of disadvantage varies across contexts, and that marriage can also have protective effects in certain contexts. The COVID-19 pandemic has, however, served to exacerbate existing inequalities in all contexts. DISCUSSION: Although child marriage prevention efforts remain critical, there is also an urgent need for programming that targets married girls in refugee and host communities to mitigate negative outcomes among this vulnerable group.


Subject(s)
COVID-19 , Adolescent , Child , Family Conflict , Female , Humans , Marriage , Pandemics , SARS-CoV-2
4.
Social Sciences ; 10(12):470, 2021.
Article in English | MDPI | ID: covidwho-1554875

ABSTRACT

Our article explores how intersecting crises, sociocultural norms around gender, age, household and community and broader political and economic shifts are affecting youth transitions. We draw on qualitative virtual research with 138 young people in Ethiopia and Jordan undertaken between April and August 2020. COVID-19 is exacerbating ongoing crises and gender inequalities in Ethiopia and Jordan and foreclosing opportunities for youth transitions. In Ethiopia, the pandemic has compounded the precarity of young people who have migrated from rural to urban areas, often to locations where they are socially marginalised. In Jordan, the confinement of young people affected by forced displacement to their households with extended family during pandemic-related service closures augments existing perceptions of an extended 'waithood’—both psychosocially and economically. In both contexts, conservative gender norms further entrench the restrictions on adolescent girls’mobility with consequences for their opportunities and wellbeing. This article makes an important contribution to the literature on gender, migrant youth and the ongoing effects of the COVID-19 pandemic by showing how multiple crises have sharpened the social and political (im)mobilities that already shaped young men and women’s lives in Ethiopia and Jordan and the consequences for their trajectories to adulthood.

5.
Dev Policy Rev ; 2021 Oct 28.
Article in English | MEDLINE | ID: covidwho-1488190

ABSTRACT

MOTIVATION: The Covid-19 pandemic delivered an unprecedented shock to education systems globally, with school closures affecting 1.6 billion children. Education systems in LMICs are facing significant budget cuts further constraining capacities to adapt to Covid-19 impacts. The need for evidence to inform policy dialogues about how best to mitigate impacts and support education systems to "build back better" is pressing. PURPOSE: In Ethiopia, schools reopened in October 2020 after a 7-month pandemic-related closure. Employing an adapted resilience systems analysis framework, this article focuses on the extent to which Ethiopia's education system-which has in recent decades seen rapid progress in enrolment rates-has adapted to the impacts of the pandemic on adolescents' education and learning, and has achieved this equitably. METHODS AND APPROACH: The article draws on mixed-methods data from Ethiopia collected virtually with a pre-existing cohort of 3,066 adolescents (1,683 girls & 1,383 boys) during the immediate onset of the pandemic (April-June 2020) and following the reopening of schools (November 2020-February 2021). Adolescent perspectives are complemented by 27 key informant interviews at community and district levels. FINDINGS: Findings highlight that rural adolescents, girls and adolescents with disabilities were less likely to access distance education during school closures due to connectivity challenges and discriminatory norms, and to subsequently re-enrol. Implementation of adaptive measures, including hygiene guidance, smaller class sizes and catch-up classes, has been highly uneven, and outreach to support re-enrolment of socially marginalized adolescents very limited. POLICY IMPLICATIONS: For LMICs like Ethiopia to build back better post-pandemic and stay on track to achieve Sustainable Development Goal 4's commitment to inclusive and equitable quality education for all, scaled-up investments in blended learning approaches, addressing the digital divide, and ensuring targeted outreach and social protection to support re-enrolment of socially marginalized adolescents is critical.

7.
International Journal of Educational Development ; : 102428, 2021.
Article in English | ScienceDirect | ID: covidwho-1225250

ABSTRACT

This article explores the social determinants of adolescents’ access to education during the COVID-19 pandemic in three diverse urban contexts in Bangladesh, Ethiopia and Jordan. It provides novel empirical data from the Gender and Adolescence: Global Evidence longitudinal study, drawing on phone surveys (4,441), qualitative interviews with adolescents aged 12–19 years (500), and key informant interviews conducted between April and October 2020. Findings highlight that the pandemic is compounding pre-existing vulnerabilities to educational disadvantage, and that gender, poverty and disability are intersecting to deepen social inequalities. The paper concludes by reflecting on policy implications for inclusive distance education in emergencies.

8.
Eur Heart J Case Rep ; 4(6): 1-6, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1030295

ABSTRACT

BACKGROUND: COVID-19 can present with cardiovascular complications. CASE SUMMARY: We present a case report of a 43-year-old previously fit patient who suffered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with thrombosis of the coronary arteries causing acute myocardial infarction. These were treated with coronary stenting during which the patient suffered cardiac arrest. He was supported with automated chest compressions followed by peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO). No immediate recovery of the myocardial function was observed and, after insufficient venting of the left ventricle was diagnosed, an Impella 5 pump was implanted. The cardiovascular function recovered sufficiently and ECMO was explanted and inotropic infusions discontinued. Due to SARS-CoV-2 pulmonary infection, hypoxia became resistant to conventional mechanical ventilation and the patient was nursed prone overnight. After initial recovery of respiratory function, the patient received a tracheostomy and was allowed to wake up. Following a short period of agitation his neurological function recovered completely. During the third week of recovery, progressive multisystem dysfunction, possibly related to COVID-19, developed into multiorgan failure, and the patient died. DISCUSSION: We believe that this is the first case report of coronary thrombosis related to COVID-19. Despite the negative outcome in this patient, we suggest that complex patients may in the future benefit from advanced cardiovascular support, and may even be nursed safely in the prone position with Impella devices.

9.
Eur J Dev Res ; 32(5): 1613-1638, 2020.
Article in English | MEDLINE | ID: covidwho-1019959

ABSTRACT

Across diverse contexts, emerging evidence suggests that the COVID-19 pandemic is increasing levels of anxiety and stress. In calling for greater attention to people's psychosocial and emotional well-being, global actors have paid insufficient attention to the realities of the pandemic in low- and middle-income countries, where millions of people are already exposed to intersecting vulnerabilities. Chronic poverty, protracted violence, conflict and displacement, coupled with weak health, education and protection systems, provide the backdrop of many adolescents' lives. Drawing on qualitative in-country telephone interviews with over 500 adolescents in Ethiopia, Côte d'Ivoire and Lebanon, this article unpacks the age and gendered dimensions of COVID-19 and its response. We conclude by discussing the implications for COVID-19 recovery efforts, arguing that embedding adolescent-centred, inclusive approaches in education, community-based health and social protection responses, has the potential to mitigate the psycho-emotional toll of the pandemic on young people and promote resilience.


De nouvelles données probantes issues de différents contextes suggèrent que la pandémie de COVID-19 augmente le niveau d'anxiété et de stress. En appelant à une plus grande attention au bien-être psychosocial et émotionnel des populations, les acteurs mondiaux ont accordé une attention insuffisante aux réalités de la pandémie dans les pays à revenu faible et intermédiaire, où des millions de personnes sont déjà exposées à des vulnérabilités croisées. La pauvreté chronique, la violence prolongée, les conflits et les déplacements, associés à la faiblesse des systèmes de santé, d'éducation et de protection sociale, sont la toile de fond de la vie de nombreux adolescents et adolescentes. Cet article s'appuie sur des entretiens téléphoniques qualitatifs avec plus de 500 adolescent.e.s et 55 informateurs-trices clés en Éthiopie, en Côte d'Ivoire et au Liban, pour démêler les dimensions sexospécifiques et liées à l'âge de la COVID-19 et de sa réponse. Nous abordons en conclusion ce que cela implique pour les efforts de relance suite à la COVID-19, en faisant valoir que l'intégration d'approches inclusives et centrées sur les adolescent.e.s dans l'éducation, dans les réponses sanitaires et sociales à base communautaire, a le potentiel d'atténuer le bilan psycho-émotionnel de la pandémie sur les jeunes et de promouvoir la résilience.

11.
J Migr Health ; 1-2: 100031, 2020.
Article in English | MEDLINE | ID: covidwho-966885

ABSTRACT

This article explores how intersecting vulnerabilities faced by Rohingya adolescents living in Cox's Bazar, Bangladesh, have been exacerbated during the COVID-19 pandemic. Both the direct health impacts and the indirect repercussions of COVID-19 mitigation strategies have served to heighten pre-existing risks, preventing adolescents from reaching their full capabilities. This article provides empirical mixed-methods data from the Gender and Adolescence: Global Evidence (GAGE) longitudinal study, drawing on phone surveys adolescents aged 10-14 and 15-19 (1,761), qualitative interviews with adolescents aged 15-19 years (30), and key informant interviews (7) conducted between March and August 2020 with both Rohingya and Bangladeshi adolescents residing in refugee camps and host communities, respectively. While this article focuses on displaced Rohingya adolescents' experiences during COVID-19, we contextualize our findings by drawing on data collected from Bangladeshi adolescents who serve as comparators. Findings highlight that the pandemic has lead to a decline in Rohingya adolescents' reported health status, exacerbated food insecurity, educational and economic marginalization and bodily integrity risks, amongst both girls and boys. This paper concludes by reflecting on the policy implications necessary to safeguard refugee adolescent trajectories in the context of COVID-19.

12.
Elife ; 92020 08 21.
Article in English | MEDLINE | ID: covidwho-727516

ABSTRACT

We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034 (11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45-6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99-3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07-2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28-0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25-2.21]) and Asian (1.51 [1.28-1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34-3.15]).


Subject(s)
Coronavirus Infections/epidemiology , Health Personnel/statistics & numerical data , Pneumonia, Viral/epidemiology , Adolescent , Adult , Age Factors , Aged , Asymptomatic Infections/epidemiology , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Hospitals, Teaching/statistics & numerical data , Humans , Incidence , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom/epidemiology , Young Adult
14.
Nature ; 2020 May 21.
Article in English | MEDLINE | ID: covidwho-342638
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