The coronavirus pandemic disease 2019 (COVID-19), has greatly impacted the social, economic and health wellbeing of individuals and communities across the world. In response, many nations, including those in Sub-Saharan Africa (SSA), imposed public health measures at the national level, such as mandatory masking and stay-at-home orders including school closures to reduce disease transmission. For children and adolescents, routine school is a key support and coping strategy because health education requirements, and free meals provided at schools are a benefit to young people from low-income families. Schools are also a safe haven, especially for adolescent girls who see school as a respite from burdensome family tasks, and are protective against risk behaviors. As a result, for many school-aged adolescent girls, the closure of schools during COVID-19 meant continued exposure and vulnerability to familial adversity, limited basic necessities such as contraceptives and food which adversely impacts their psychosocial wellbeing. The aim of this study is to examine the association between Covid-related experiences and the emotional and cognitive wellbeing of adolescent girls in Southern Uganda, a country that imposed the longest school closure lasting 2 years.
We analyzed data from a longitudinal randomized clinical trial (2017-2022) of high school adolescent girls in Southern Uganda. Covid-related data was collected from August 2020 to February 2021, a total of 1165 girls (ages 14-17). We conducted nested regression models to determine the effect of COVID-19 experience on emotional and cognitive well-being. Model 1 controlled for demographic and socioeconomic status characteristics, namely, age, Orphanhood status, number of people in a household, caregiver`s employment and total family assets. Model 2 controlled for COVID-19 related experiences, including the social distancing-related variables and the change and disruptions scale. We adjusted for clustering based on participants’ school given that randomization of study participants is based on the schools where they were recruited from.
Household socioeconomic status, assessed via household assets was positively associated with participants’ emotional wellbeing (β=0.41, 95% CI= 0.22, 0.59, p≤.0.0). When we added COVID-19 related experiences, household assets remained a significant predictor of emotional wellbeing (β= 0.31, 95% CI=0.12, 0.51, p≤.00). Household assets were positively associated with cognitive wellbeing (β= 0.17, 95% CI=-0.03, 0.3, p=.02), meaning the more assets the participants had, the better their cognitive wellbeing. When we added COVID-19-related experiences, social distancing related items (β=-2.18, 95% CI=-3.43, -0.92, p≤.00), being concerned about COVID-19 (β=-2.22, 95% CI= -4.04, -0.40, p≤.01) and resource changes and disruption due to COVID-19 (β=-0.39, 95% CI=0.48, 0.29, p≤.00) were all negatively associated with cognitive wellbeing.
There was a positive association between household socioeconomic status and participants` emotional wellbeing and cognitive wellbeing, however, when we adjusted for COVID-19 related experiences there was a negative association with the participants’ cognitive wellbeing. Understanding the experience of adolescent girls is important to the design and targeting of interventions after the pandemic. Given the increasing number of mental health cases among adolescents, it is critical that researchers explore alternative strategies to improve mental health outcomes for adolescent girls post the pandemic era.