3. Adolescents' Perceptions of Mental Health around the World: Key Findings from a 13-Country Qualitative Study

Purpose: Adolescence (ages 10-19) is a sensitive developmental period for the emergence of mental and behavioral health problems, but there is a lack of multi-country qualitative studies that explore how adolescents themselves understand these critical challenges. As part of UNICEF's 2021 State of the World's Children Report, the Global Early Adolescent Study collaborated with organizations in 13 countries to hold a series of focus group discussions (FGDs) with adolescents focused on mental health. These FGDs aimed to (1) understand adolescents' perspectives on significant mental health challenges in their age group, (2) understand adolescents' perspectives on the key risk and protective factors driving these challenges, and (3) understand the ways in which adolescents cope with these challenges, including barriers and facilitators to help-seeking. Methods: A total of 71 FGDs were conducted across 13 countries between February and June of 2021. Countries were selected to ensure geographic, economic, and cultural diversity, and included: Belgium, Chile, China, the Democratic Republic of Congo, Egypt, Indonesia, Jamaica, Jordan, Kenya, Malawi, Sweden, Switzerland, and the United States. Within each country, FGDs were stratified by sex and age such that there were at least two younger (ages 10-14) and two older (ages 15-19) focus groups. Depending on the COVID-19 restrictions at the time, FGDs were either held in-person or online. All FGDs were held in local languages and lasted between 60 and 90 minutes. FGDs were recorded, transcribed verbatim, and translated into English when necessary. These English translations were then coded and analyzed using an inductive thematic analysis approach. Results: Across diverse cross-cultural settings, a number of consistent findings emerged from the voices of adolescents. In particular, adolescents around the world emphasized the many contexts that drive mental health challenges, including family adversity, community violence, unsupportive school environments, poverty, social media culture, and restrictive gender norms. They also discussed significant barriers to seeking help for mental health challenges, such as community stigma, lack of social support, and fears of invalidation. These barriers frequently resulted in adolescents coping with these challenges without support, often using maladaptive strategies. Importantly, adolescents generally described and understood mental health in terms of distress (e.g., sadness, loneliness, shame, anger) rather than disorder (e.g., depression, anxiety). Conclusions: Above all, it was clear that adolescents around the world need much better formal and informal supports to adequately address mental and behavioral health problems, and that these responses must take into account the many contexts that contribute to these problems. Further, the non-clinical terminology frequently used by adolescents suggests that taking a purely diagnostic approach in addressing mental health challenges may exclude many adolescents in need of assistance. Sources of Support: Wellcome Trust.

A qualitative inquiry in understanding trusted media sources to reduce vaccine hesitancy among Kenyans

COVID-19 vaccine rollout in Kenya has been challenged by both the supply of and demand for vaccines. With a third of the adult population classifying as vaccine hesitant, reaching vaccination targets requires an understanding of how people make decisions regarding vaccines. Globally, pregnant and lactating women have especially low uptake rates, which could be attributed to the "infodemic,” or constant rush of new information, as this group is vulnerable to misinformation and uncertainty. While presentation of COVID-19 vaccines in the media allows for easy access, these sources are also susceptible to misinformation. Negative and unfounded claims surrounding SARS-CoV-2 infection and COVID-19 vaccines contribute to vaccine hesitancy. Given the influence that the media may have on people's attitudes toward vaccines, this study examines the relationship between the media and the vaccine decision-making process among pregnant and lactating women, healthcare workers, community members (male relatives, male neighbors, and gatekeepers), and policymakers in Kenya. Data were collected through in-depth interviews in urban and rural counties in Kenya to understand how media information was utilized and consumed. While healthcare workers were the most frequently cited information source for pregnant and lactating women, other healthcare workers, and community members, findings also show that the media (traditional, social, and Internet) is an important source for obtaining COVID-19 information for these groups. Policymakers obtained their information most frequently from traditional media. Ensuring that information circulating throughout these media channels is accurate and accessible is vital to reduce vaccine hesitancy and ultimately, meet COVID-19 vaccination goals in Kenya. Copyright © 2023 Fesshaye, Lee, Paul, Zavala, Singh, Karron and Limaye.

Measured and unmeasured contributions of peer education: experiences from the Get Up, Speak Out for Youth Rights! (GUSO) programme in Kisumu and Siaya Counties, Kenya

Peer education is a widely used strategy in sexual reproductive health and rights (SRHR) programmes for young people, yet measurement of its effectiveness often focuses on a narrow set of outcomes. This qualitative study explored how peer education was integrated into the Get Up, Speak Out for Youth Rights! (GUSO) programme in Kisumu and Siaya Counties, Kenya and the contribution it made to measured and unmeasured outcomes. Findings indicate that whilst peer educators were a central part of the GUSO theory of change, the intentionality of design varied between partners and sites, and their contributions were formally measured only in relation to two of five outcome areas. In addition to their contributions to these measured outcomes, the study found that peer educators also contributed to a range of other, unmeasured outcomes related to community support and mobilisation;gender norms;and economic empowerment. Findings show that peer educators may contribute to many unmeasured – and sometimes unexpected – outcomes that go beyond traditional measurement of their contributions. These merit further exploration in the literature and in programming. Programme developers are encouraged to be more intentional in the design and measurement of peer education, ensuring that the breadth of its contribution to programming are recognised.

Perceived Risks of Infection, Hospitalization, and Death From COVID-19 at the Equator: Ecuador and Kenya

Objectives: This study's goal was to determine the perceived risks of infection as well as the perceived risks of hospitalization and death from COVID-19 in Ecuador and Kenya. It also assessed the factors associated with the risk-related perceptions. Methods: Cross-sectional studies with samples from the adult populations in both countries were conducted to assess the perceived risks of contracting COVID-19. Data were collected online using the Qualtrics platform (Qualtrics, Provo, Utah, United States) from samples of 1050 heads of households, aged 18 years or older, in each country. A total of 3 statistical analyses were conducted: summary statistics, correlation, and linear regression. Results: The average perceived risks of COVID-19 infection, hospitalization, and death in the Kenyan sample were 27.1%, 43.2%, and 17.2%, respectively, and the values for the Ecuadorian sample were 34%, 32.8%, and 23.3%, respectively. The Pearson's correlation coefficients between the risk measures in each country were less than 0.38. Risk measures were associated with several sociodemographic variables (e.g., income, gender, location), but not with age. Conclusions: The perceived risks of COVID-19 infection, hospitalization, and death in Kenya and Ecuador were significantly higher relative to the statistics reported;however, no strong association existed between perceived risk and age, which is a key factor in adverse health outcomes, including death, among COVID-19 infected individuals. © The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc.

Restocking of small water bodies for a post Covid recovery and growth of fisheries and aquaculture production: Socioeconomic implications

Restocking of fish in Small Water Bodies (SWBs) is one of the technologies that can be used to enhance fish-food production for post Covid recovery and growth in food security, and national development. The current study aimed at assessing the socioeconomic impact and stock performance of restocked Nile tilapia fingerlings in SWBs in 15 counties in the Western and Central regions where the Aquaculture Business Development Programme (ABDP) is implemented. The study employed both primary and secondary data from socioeconomics, environmental characteristics and fisheries and aquaculture aspects. There was no restocked dam with a low (<1.66) socioeconomic impact, indicating the potential for restocking. The majority (n = 27;79%) of the restocked SWBs had a moderate (1.66–2.33) impact, owing to the inherent constraints of adoptability by the local community. Twenty one percent (n = 7;21%) of the SWBs had a high (2.34–3.00) impact and with better environmental conditions. The average condition factor (K) of tilapia in restocked SWBs was 1.24 ± 0.53 SD, suggesting excellent fish growth condition. Notably, restocking the SWBs could benefit riparian fishing communities by improving their livelihoods and providing food and nutritional security. Given the limited exploitation of fish in most SWBs in the developing countries, additional community awareness and capacity building interventions are needed to enhance optimal use of SWBs in post Covid era. © 2022 The Author(s)

111. Adaptation and Delivery of a Partially Virtual Curriculum for Pre-Exposure Prophylaxis Peer Mentors in Kenya: Lessons Learned

Purpose: While Pre-Exposure Prophylaxis (PrEP) is highly effective at preventing HIV, uptake is low among adolescents. In low- and middle-income countries (LMIC), peer mentors (PMs) are considered best practice to increase PrEP acceptability and uptake. Globally, COVID19 has shifted much education and training to virtual formats. Most young people in LMIC have cell phones. Our objective is to describe our experiences developing and delivering a mixed virtual/physical curriculum for training PrEP PMs. Methods: IRB and local research ethics committee approval was obtained. A literature search (PubMed, EBSCO, USAID website, and MedEd Portal) yielded one published curriculum for PrEP PMs. This curriculum was combined with locally developed HIV PM education modules to create a new curriculum, with planned virtual and physical sessions. Curriculum materials were reviewed and agreed upon by all authors. All sessions were delivered by authors, with the majority delivered by Americans. The first 4 hours were done virtually via Zoom, covering the basics of HIV, detailed information on PrEP, adolescent development, and confidentiality. The remaining sessions were held in person and covered expectations of PMs, basic family planning, research ethics, action planning, role playing, and a review of virtual topics. Feedback was solicited from the PMs after virtual training. A debriefing session was held with the five facilitators involved in training: 1 research staff and 1 physician investigator from Kenya, 1 research staff and 2 physician investigators from the US - all female. Results: All five PMs (aged 21 – 27) participated. One identified as female, and one as LGBTQ. Feedback was solicited via anonymous survey (n=3) after the virtual sessions and debriefing with Kenyan research staff. Respondents strongly agreed that the virtual training was worth their time. Although PMs felt they were able to learn in the virtual format, facilitators noted more engagement during in-person sessions. Facilitators noted the importance of introductions and challenges of building cohesiveness for virtual sessions, particularly with sensitive content and internet limitations restricting video use (eg. low bandwidth, use of cell phones). Kenyan investigators noted that the Kenyan educational system is hierarchical, with students largely learning passively. They felt that this, combined with the newness of virtual learning and minimal dedicated time for introductions, may have hampered active virtual participation. While no PMs pointed to race or accent as limitations, facilitators noted differences between American and Kenyan English idioms, cadence, speed, and pronunciation that may have caused difficulty. Given Kenya's history of colonialism, all raised concerns that PMs may have been more deferential to light-skinned, foreign facilitators. Facilitators who observed both virtual and in-person sessions felt it was easier to break barriers of colonialism and assess for differences in spoken English in person. Facilitators felt that if virtual training were to be used in the future, it would be beneficial to have physical sessions first to set an interactive, educational tone and allow participants to build rapport. Conclusions: Virtual delivery of PM educator training in a LMIC setting is difficult and requires careful consideration or technological limitations and culture. Sources of Support: Indiana CTSI;Grant Number UL1RR025761-01.

Transnational lived citizenship turns local: Covid-19 and Eritrean and Ethiopian diaspora in Nairobi

This paper analyses how migrant community practices of transnational lived citizenship were altered by both, COVID-19 and the policy response from the Kenyan government. It is based on interviews with members of the Eritrean and Ethiopian diaspora residing in Nairobi. The paper demonstrates how policies introduced because of the pandemic caused migrant communities to lose local and remittance income. More than the loss of material resources, however, they were impacted by the elimination of social spaces that enable diaspora lives. These two dynamics have intensified a trend that may have been present before the pandemic, a local turn of transnational lived citizenship. By focusing on lived experiences and how they have been re-assessed during the pandemic, the paper argues that transnational lived citizenship is always in flux and can easily become reconfigured as more localized practices. The concept of transnational lived citizenship is demonstrated to be a useful lens for analysing shifting migrant livelihoods and belonging. © 2022 The Authors. Global Networks published by Global Networks Partnership and John Wiley & Sons Ltd.

Essential emergency and critical care as a health system response to critical illness and the COVID19 pandemic: what does it cost?

Essential Emergency and Critical Care (EECC) is a novel approach to the care of critically ill patients, focusing on first-tier, effective, low-cost, life-saving care and designed to be feasible even in low-resourced and low-staffed settings. This is distinct from advanced critical care, usually conducted in ICUs with specialised staff, facilities and technologies. This paper estimates the incremental cost of EECC and advanced critical care for the planning of care for critically ill patients in Tanzania and Kenya.The incremental costing took a health systems perspective. A normative approach based on the ingredients defined through the recently published global consensus on EECC was used. The setting was a district hospital in which the patient is provided with the definitive care typically provided at that level for their condition. Quantification of resource use was based on COVID-19 as a tracer condition using clinical expertise. Local prices were used where available, and all costs were converted to USD2020.The costs per patient day of EECC is estimated to be 1 USD, 11 USD and 33 USD in Tanzania and 2 USD, 14 USD and 37 USD in Kenya, for moderate, severe and critical COVID-19 patients respectively. The cost per patient day of advanced critical care is estimated to be 13 USD and 294 USD in Tanzania and USD 17 USD and 345 USD in Kenya for severe and critical COVID-19 patients, respectively.EECC is a novel approach for providing the essential care to all critically ill patients. The low costs and lower tech approach inherent in delivering EECC mean that EECC could be provided to many and suggests that prioritizing EECC over ACC may be a rational approach when resources are limited.

Influence of COVID-19 Pandemic on Food Market Prices and Food Supply in Urban Markets in Nairobi, Kenya

The COVID-19 pandemic caused an unprecedented disruption of food systems worldwide, with most governments taking severe containment measures to curb the spread. This resulted in unpredicted negative impacts of the agri-food supply chains coupled with food price inflations. Ultimately, this affected the food security and urban livelihoods for most households, who are dependent on urban markets for food supply. This study examined the implications of the pandemic on food prices and commodities supplies to urban markets conducted through structured interviews. A review of the secondary data was also conducted to show the trends of commodity prices over the last 5 years. The high inflation of commodity prices with a decline in sales volumes was reported by most traders (97%) with decreases in supply quantities. Changes in the consumption behaviour in households was reported by consumers (75%), with 65% experiencing reduced food diversity at home. Households adopted varied coping mechanisms, including reduced food portions (52%), reduced food varieties (44%) and skipping meals (32%). Market prices increased by an average margin of 13.8% for grains and pulses with price decline observed for cabbages (−30.8%) and Irish potatoes (−19.4%). The findings may inform policymakers of additional future shock and pandemic control protocols, whose actions would assure food protection of urban livelihoods. © 2023 by the authors.

Mobile health and the social organization of care in the global south: Beyond technological fixes

The notion of a global "care crisis" has recently loomed large in public consciousness, drawing attention to the longstanding problem of how our care infrastructures are increasingly overburdened and unsupported. The chronic under-investment in paid and unpaid healthcare work has been made especially clear in light of the shocks of the COVID-19 pandemic. In response to this crisis, transnational agencies, national governments, hospitals, and non-governmental organizations (NGOs) have sought to leverage increasing smartphone and mobile internet use globally to create "technological fixes" that restructure work, time, and space with the aim of meeting care needs with limited resources-this in contrast to investments that could increase resources but ultimately compromise on capitalistic aims of profit and efficiency. In this dissertation, I examine multiple types of fixes that have gotten significant traction in global health, including digital payments, personal chat apps, and semi-automated chatbots, focusing on contexts within India and Kenya. I describe care workers' and health organizations' experiences with these technologies and how they integrate with larger health infrastructures. Drawing on feminist social reproduction theory, I tease out ways that these technologies meet real and urgent care needs, while also belying the mere redistribution, short-term valuation, and narrowing of care work that takes place by and through technological fixes (often most affecting those with the least power in a given context). Taking this dilemma seriously, I argue for the responsibility of researchers and practitioners to combat dominant narratives of technological fixes for the care crisis, even as we seek to support care work through design. Thus, this work considers how we might center futures of care work in which societies make concrete investments in care workers and care infrastructures, not for efficiency's sake but for the needs and aspirations of care workers and the sustainability of our care infrastructures. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Provider perspectives on service delivery modifications to maintain access to HIV pre-exposure prophylaxis during the COVID-19 pandemic: qualitative results from a PrEP implementation project in Kenya.

INTRODUCTION: HIV pre-exposure prophylaxis (PrEP) is an essential prevention strategy being scaled up for priority populations in Kenya, including for HIV serodiscordant couples. The COVID-19 pandemic posed challenges to PrEP rollout. We conducted a qualitative study of PrEP providers to understand how clinics adjusted PrEP delivery during the COVID-19 pandemic. METHODS: Since 2017, the Partners Scale-Up Project has integrated PrEP into 25 HIV clinics in Central and Western Kenya. We conducted qualitative interviews with 40 purposively sampled clinic personnel. We interviewed personnel once during the first pandemic wave (May-Aug 2020) and again after some decline in COVID-19 rates (Nov-Jan 2021). We analysed data using inductive memo-writing and summarized data by themes along the PrEP delivery cascade, guided by the Framework for Reporting Adaptation and Modifications (FRAME). RESULTS: We interviewed 27 clinical officers, five nurses, four health records and information officers, and four counsellors from Central (n = 20) and Western (n = 20) Kenya. About half (n = 19) were female, with a median age of 32 (IQR: 29-34) and 2.3 years of experience delivering PrEP (IQR: 2-3). All participants reported clinic changes in PrEP demand creation and service delivery during the pandemic. Modifications occurred during PrEP implementation and sustainment phases, were partly reactive to the pandemic and also facilitated by interim Ministry of Health guidance on PrEP delivery during COVID, and were made by PrEP delivery teams, clients and clinic managers. Commonly reported modifications included dispensing multiple-month PrEP refills, intensifying phone-based client engagement and collaborating with other HIV clinics to ensure that clients with prolonged stays in other regions could continue to access PrEP. Some clinics also adopted practices to streamline visits, such as within clinical-room PrEP dispensing, pre-packing PrEP and task-shifting. Most providers liked these changes and hoped they would continue after the pandemic subsides. CONCLUSIONS: COVID-19 served as a catalyst for PrEP delivery innovations in Kenya. HIV clinics successfully and rapidly adapted their PrEP demand creation, refill and retention strategies to promote PrEP uptake and effective use. These modified implementation strategies highlight opportunities to streamline the delivery of PrEP, as well as other HIV and chronic care services, and strengthen engagement with populations post-pandemic.

Kenya's Experience: Factors Enabling and Impeding the COVID-19 Response.

This case study describes the country-level response to the COVID-19 pandemic in Kenya between February 2020 and May 2021. We organize the presentation of COVID-19 response strategies across the five stages of (a) engagement, (b) assessment, (c) planning, (d) action/implementation, and (e) evaluation. We describe the participatory monitoring and evaluation (M&E) process implemented in collaboration with the WHO Regional Office for Africa Monitoring and Evaluation Team. The M&E system was used to organize and make sense of emerging data regarding specific response activities and changing COVID incidence. We share the results of that collaborative sensemaking, with particular attention to our analysis of the factors that facilitated and those that impeded our pandemic response. We conclude with lessons learned and practical implications from Kenya's experience to help guide future country-level responses to rapidly changing public health crises.

Recovering from the Unprecedented Backsliding in Immunization Coverage: Learnings from Country Programming in Five Countries through the Past Two Years of COVID-19 Pandemic Disruptions.

Between 2020 and 2021, the COVID-19 pandemic severely strained health systems across countries, leaving millions without access to essential healthcare services. Immunization programs experienced a 'double burden' of challenges: initial pandemic-related lockdowns disrupted access to routine immunization services, while subsequent COVID-19 vaccination efforts shifted often limited resources away from routine services. The latest World Health Organization (WHO) and United Nations Children's Fund (UNICEF) estimates suggest that 25 million children did not receive routine vaccinations in 2021, six million more than in 2019 and the highest number witnessed in nearly two decades. Recovering from this sobering setback requires a united push on several fronts. Intensifying the catch-up of routine immunization services is critical to reach children left behind during the pandemic and bridge large immunity gaps in countries. At the same time, we must strengthen the resilience of immunization systems to withstand future pandemics if we hope to achieve the goals of Immunization Agenda 2030 to ensure vaccinations are available for everyone, everywhere by 2030. In this article, leveraging the key actions for sustainable global immunization progress as a framework, we spotlight examples of strategies used by five countries-Cambodia, Cameroon, Kenya, Nigeria, and Uganda-who have exhibited exemplar performance in strengthening routine immunization programs and restored lost coverage levels in the last two years of the COVID-19 pandemic. The contents of this article will be helpful for countries seeking to maintain, restore, and strengthen their immunization services and catch up missed children in the context of pandemic recovery and to direct their focus toward building back a better resilience of their immunization systems to respond more rapidly and effectively, despite new and emerging challenges.

Efforts and Challenges to Ensure Continuity of Mental Healthcare Service Delivery in a Low Resource Settings During COVID-19 Pandemic-A Case of a Kenyan Referral Hospital.

The rising number of patients with Covid-19 as well as the infection control measures have affected healthcare service delivery, including mental healthcare. Mental healthcare delivery in low and middle income countries where resources were already limited are likely to be affected more during this pandemic. This paper describes the efforts of ensuring mental healthcare delivery is continued in a referral hospital in Kenya, Moi Teaching and Referral hospital, as well as the challenges faced. These efforts are guided by the interim guidelines developed by the Kenyan ministry of health. Some of the adjustments described includes reducing number of patients admitted, shortening the stay in the inpatient setting, using outdoors for therapy to promote physical distancing, utilization of electronic platforms for family therapy sessions, strengthening outpatient services, and supporting primary care workers to deliver mental health care services. Some of the challenges include limited ability to move about, declining ability for patients to pay out of pocket due to the economic challenges brought about by measures to control Covid-19, limited drug supplies in primary care facilities, inability to fully implement telehealth due to connectivity issues and stigma for mental health which results in poor social support for the mentally ill patients. It is clear that current pandemic has jeopardized the continuity of usual mental healthcare in many settings. This has brought to sharp focus the need to decentralize mental health care and promote community based services. Meanwhile, there is need to explore feasible alternatives to ensure continuity of care.

Comparison of nucleocapsid and spike antibody ELISAs for determining SARS-CoV-2 seropositivity in Kenyan women and infants.

A multitude of enzyme-linked immunosorbent assays (ELISAs) has been developed to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies since the coronavirus disease 2019 pandemic started in late 2019. Assessing the reliability of these assays in diverse global populations is critical. This study compares the use of the commercially available Platelia Total Ab Assay (Bio-Rad) nucleocapsid ELISA to the widely used Mount Sinai spike IgG ELISA in a Kenyan population seroprevalence study. Using longitudinal plasma specimens collected from a mother-infant cohort living in Nairobi, Kenya between May 2019 and December 2020, this study demonstrates that the two assays have a high qualitative agreement (92.7%) and strong correlation of antibody levels (R2 = 0.973) in repeated measures. Within this cohort, seroprevalence detected by either ELISA closely resembled previously published seroprevalence estimates for Kenya during the sampling period and no significant difference in the incidence of SARS-CoV-2 antibody detection by either assay was observed. Assay comparability was not affected by HIV exposure status. These data support the use of the Platelia SARS-CoV-2 Total Ab ELISA as a suitable high-throughput method for seroprevalence studies in Kenya.

Avatars Meet Face-to-Face: Learning Leadership Online--A Thematic Analysis of East-African Perspectives

Within education, the online forum is becoming a preferred mode of study across the globe and the COVID-19 era highlights its importance. Research around online education has concentrated on the USA and Europe, and this study sought to redress the Western bias by exploring and comparing the perceptions of six post-graduate East-African students and lecturers at Pan Africa Christian University in Kenya on learning leadership online versus on-campus. It is debatable whether leaders are born or made, however, post-industrial theories embrace the concept that leadership is teachable. Semi-structured interviews were conducted, recorded, transcribed and thematically analysed, using a top-down approach, from a critical realist perspective. The results show that participants' leadership ideals synthesised Afrocentric perspectives of communality, with Western ideals of transformational and servant leadership. Furthermore, there are differences between perceptions of East-African students and lecturers on online leadership learning. Students preferred the online avatar experience, whilst lecturers preferred on-campus or blended methods of leadership studies. Face-to-face connection was deemed important by students and lecturers but impeded by the inability to see facial reactions using the current online platform. This exploratory study gives insight into an East-African experience and sends a clear message to Kenyan institutions to invest further in video technology. Future research could include a longitudinal study of destinations and successes of Kenyan University online leadership alumni. The impact of the global coronavirus pandemic, with lockdowns and social distancing, further underlines the importance of ongoing online leadership research and education across the world.

Gendered Effects of COVID-19 School Closures: Kenya Case Study. GIRL Center Research Brief No. 11

This brief summarizes a case study that assessed the gendered impact of COVID-19 school closures in Kenya. COVID-19 school closures escalated education inequalities especially for girls and young people in rural areas. These closures exacerbated adolescent mental health issues, food and economic insecurity, and experiences of violence. COVID-19 response programs implemented by both the Government of Kenya and non-state actors were not able to fully mitigate the impacts of school closures for adolescents, teachers, or schools. Continued efforts to understand the implications of school closures and to support vulnerable students are needed. [This brief was prepared with the support of Faith Mbushi, Natalie Wyss, Emily EunYoung Cho, Karen Austrian, Eva Muluve, Laura Muthoni, and Beth Kangwana.]