Impact of Covid-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya

Bibliographic Data

ID21880876
AuthorsGarazi Zulaika (0000-0003-1452-6225, Liverpool School of Tropical Medicine, corresponding author), Miriam Bulbarelli (United Nations University – Maastricht Economic and Social Research Institute on Innovation and Technology), Elizabeth Nyothach (0000-0003-0904-9081, Kenya Medical Research Institute), Annemieke van Eijk (Liverpool School of Tropical Medicine), Linda Mason (0000-0003-1568-9261, Liverpool School of Tropical Medicine), Eunice Fwaya (0000-0002-4873-6151, Ministry of Health), David Obor (0000-0002-2852-6368, Kenya Medical Research Institute), Daniel Kwaro (0000-0002-0929-8072, Kenya Medical Research Institute), Duolao Wang (0000-0003-2788-2464, Liverpool School of Tropical Medicine), Supriya D Mehta (0000-0002-7926-2489, University of Illinois Chicago), Penelope A Phillips‐Howard (0000-0003-1018-116X, Liverpool School of Tropical Medicine, corresponding author)
Year2022
Volume7
Issue1
Pagese007666
Publication date2022-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-007666
PMID35027438
OpenAlexW4206591050
LanguageEN
Citations received32
References cited31

INTRODUCTION: Secondary school closures aimed at limiting the number of infections and deaths due to COVID-19 may have amplified the negative sexual and reproductive health (SRH) and schooling outcomes of vulnerable adolescent girls. This study aimed to measure pandemic-related effects on adolescent pregnancy and school dropout among school-going girls in Kenya. METHODS: We report longitudinal findings of 910 girls in their last 2 years of secondary school. The study took place in 12 secondary day schools in rural western Kenya between 2018 and 2021. Using a causal-comparative design, we compared SRH and schooling outcomes among 403 girls who graduated after completion of their final school examinations in November 2019 pre-pandemic with 507 girls who experienced disrupted schooling due to COVID-19 and sat examinations in March 2021. Unadjusted and adjusted generalised linear mixed models were used to investigate the effect of COVID-19-related school closures and restrictions on all outcomes of interest and on incident pregnancy. RESULTS: At study initiation, the mean age of participants was 17.2 (IQR: 16.4-17.9) for girls in the pre-COVID-19 cohort and 17.5 (IQR: 16.5-18.4) for girls in the COVID-19 cohort. Girls experiencing COVID-19 containment measures had twice the risk of falling pregnant prior to completing secondary school after adjustment for age, household wealth and orphanhood status (adjusted risk ratio (aRR)=2.11; 95% CI:1.13 to 3.95, p=0.019); three times the risk of school dropout (aRR=3.03; 95% CI: 1.55 to 5.95, p=0.001) and 3.4 times the risk of school transfer prior to examinations (aRR=3.39; 95% CI: 1.70 to 6.77, p=0.001) relative to pre-COVID-19 learners. Girls in the COVID-19 cohort were more likely to be sexually active (aRR=1.28; 95% CI: 1.09 to 1.51, p=0.002) and less likely to report their first sex as desired (aRR=0.49; 95% CI: 0.37 to 0.65, p<0.001). These girls reported increased hours of non-school-related work (3.32 hours per day vs 2.63 hours per day in the pre-COVID-19 cohort, aRR=1.92; 95% CI: 1.92 to 2.99, p=0.004). In the COVID-19 cohort, 80.5% reported worsening household economic status and COVID-19-related stress was common. CONCLUSION: The COVID-19 pandemic deleteriously affected the SRH of girls and amplified school transfer and dropout. Appropriate programmes and interventions that help buffer the effects of population-level emergencies on school-going adolescents are warranted. TRIAL REGISTRATION NUMBER: NCT03051789

Adolescent health · Cohort · Cohort study · Disease · Pandemic · Pregnancy · Adolescent Sexual and Reproductive Health · COVID-19 and Mental Health · COVID-19 Impact on Reproduction · Demography · Medicine · Nursing · Pediatrics