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Impact of COVID-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya
  1. Garazi Zulaika1,
  2. Miriam Bulbarelli2,
  3. Elizabeth Nyothach3,
  4. Annemieke van Eijk1,
  5. Linda Mason1,
  6. Eunice Fwaya4,
  7. David Obor3,
  8. Daniel Kwaro3,
  9. Duolao Wang1,
  10. Supriya D Mehta5,
  11. Penelope A Phillips-Howard1
  1. 1Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  2. 2UNU-MERIT/MGSOG, Maastricht University, Maastricht, The Netherlands
  3. 3Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
  4. 4Siaya County, Kenya Ministry of Health, Siaya, Kenya
  5. 5Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Garazi Zulaika; Garazi.Zulaika{at}lstmed.ac.uk; Dr Penelope A Phillips-Howard; Penelope.Phillips-Howard{at}lstmed.ac.uk

Abstract

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.

  • COVID-19
  • health policy
  • maternal health
  • public health

Data availability statement

This study was conducted with approval from the Kenya Medical Research Institute (KEMRI) Scientific and Ethics Review Unit (SERU) which requires that data should be released from any KEMRI-based Kenyan study (including deidentified data) only after written approval for additional analyses. In accordance, data for this study will be available upon request, after obtaining written approval for the proposed analysis from the KEMRI SERU. Their application forms and guidelines can be accessed at https://www.kemri.org/seru-overview. To request these data, please contact the KEMRI SERU at seru@kemri.org.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/bmjgh-2021-007666

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    Data availability statement

    This study was conducted with approval from the Kenya Medical Research Institute (KEMRI) Scientific and Ethics Review Unit (SERU) which requires that data should be released from any KEMRI-based Kenyan study (including deidentified data) only after written approval for additional analyses. In accordance, data for this study will be available upon request, after obtaining written approval for the proposed analysis from the KEMRI SERU. Their application forms and guidelines can be accessed at https://www.kemri.org/seru-overview. To request these data, please contact the KEMRI SERU at seru@kemri.org.

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    Footnotes

    • GZ and MB are joint first authors.

    • Handling editor Seye Abimbola

    • Contributors GZ and PP-H led the conception and design of the study. GZ and MB did the statistical analysis, interpreted the data and wrote and revised the manuscript. AvE, DW, SDM and PP-H contributed to the study design, statistical analysis and interpretation and revised the manuscript. All other authors contributed to the implementation and data collection and reviewed the final manuscript. PP-H is the guarantor of the overall content of this manuscript.

    • Funding This work was supported as part of the Cups or Cash for Girls randomised-controlled trial funded by the Joint Global Health Trials Initiative (UK-Medical Research Council/Department for International Development/Wellcome Trust/Department of Health and Social Care) grant number #MR/N006046/1 (PI: PP-H). This work was also supported in part through the National Institutes of Health, #R01-HD093780 (PI: SDM) and the Medical Research Council, #MR/T04036X/1 (PI: PP-H). The sponsors had no role in the study design, data collection, analysis, interpretation or writing of this article.

    • Competing interests None declared.

    • Patient and public involvement statement Prior to the launch of this trial, a pilot feasibility study was conducted to understand the needs and viewpoints of adolescent school-going girls in Siaya County; their input served as the foundation for the current trial (Phillips-Howard, 2016). This current work engaged the Siaya County Ministries of Health and Education to design the larger trial and development of interventions. Community members, parents, and school staff were also consulted in the development and iteration of the project and the monitoring of its progress.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.