Karen Austrian

Introduction: Climate change is shaping adolescent and young people’s (AYP) transitions to adulthood with significant and often compounding effects on their physical and mental health. The climate crisis is an intergenerational inequity, with the current generation of young people exposed to more climate events over their lifetime than any previous one. Despite this injustice, research and policy to date lacks AYP’s perspectives and active engagement. Methods: Participatory, youth co-led qualitative focus group discussions were held in Bangladesh, Guatemala and Nigeria in mid-2023. A total of 196 AYP ages 12–25 years participated. Open-ended questions elicited responses regarding AYP knowledge, experiences and perceptions of climate change. Using NVivo software, translated transcripts were coded to explore and synthesise key thematic areas. Results: Respondents discussed varied climate exposures and associated health risks, for example, how flooding events were impeding access to sexual and reproductive health commodities. Acute climate events like flooding and cyclones increased perceived risk of early marriage and gender-based violence in Bangladesh and Guatemala. In Nigeria, respondents discussed health effects of extreme heat, and how droughts were shifting women into more traditionally male roles in agriculture and income-generating activities, increasing the perceived risk of household tensions and gender-based violence. Commonly reported themes included perceived climate impacts on sexual and reproductive health including early marriage or gender-based violence. Another common theme was anxiety about climate change, its effects on economic and food insecurity in communities and feeling hopeless, lacking agency and not feeling supported by local institutions, all linked with worse mental health. Conclusion: Our results summarise how AYP perceive climate change is affecting their physical and mental health, finding similarities and differences across these three settings. Our results can inform the development of policies and programmes that directly address AYP needs in a way that is inclusive and responsive.

Objectives To illustrate the utility of unsupervised machine learning compared with traditional methods of analysis by identifying archetypes within the population that may be more or less likely to get the COVID-19 vaccine. Design A longitudinal prospective cohort study (n=2009 households) with recurring phone surveys from 2020 to 2022 to assess COVID-19 knowledge, attitudes and practices. Vaccine questions were added in 2021 (n=1117) and 2022 (n=1121) rounds. Setting Five informal settlements in Nairobi, Kenya. Participants Individuals from 2009 households included. Outcome measures and analysis Respondents were asked about COVID-19 vaccine acceptance (February 2021) and vaccine uptake (March 2022). Three distinct clusters were estimated using K-Means clustering and analysed against vaccine acceptance and vaccine uptake outcomes using regression forest analysis. Results Despite higher educational attainment and fewer concerns regarding the pandemic, young adults (cluster 3) were less likely to intend to get the vaccine compared with cluster 1 (41.5% vs 55.3%, respectively; pConclusions Findings suggest this methodology can be a useful tool to characterise populations, with utility for improving targeted policy, programmes and behavioural messaging to promote uptake of healthy behaviours and ensure equitable distribution of prevention measures.

The first case of COVID-19 was detected in Kenya in March 2020. Initial government responses included several containment measures such as school closures, movement limitations, and bans on public gatherings. These measures had many follow-on effects, in particular for the country’s vulnerable adolescents. Between June 2020 and February 2021 two round of quantitative data was collected in four counties in Kenya (Kilifi, Kisumu, Nairobi, and Wajir) via phone surveys (n = 3,921). In addition, qualitative in-depth interviews were conducted in person in November 2020 with adolescents, parents, and other key stakeholders (n = 234). Results showed that the pandemic’s effects on adolescents were wide-reaching and often differed by gender. While 85% of students reported doing some form of remote learning during school closures, 98% of them reported considerable challenges with less than one-third using technology (i.e., computers, phones, television, and radio) to support their learning. Over half of the adolescents reported depressive symptoms and over three-quarters reported skipping meals in the past week due to COVID-19. Twelve percent of girls and 9% of boys reported skipping healthcare services in the past one month, with the most common reason being lack of money to access the needed service. Once school had fully re-opened, 16% of girls and 8% of boys who were enrolled at the start of the pandemic had not re-enrolled. Given the wide, multi-sectoral nature of the impacts of the pandemic, a coordinated response involving education, health, and gender actors, as well as government and non-government partners, will be needed to mitigate the long-term negative impacts for Kenya’s adolescents, in particular girls and other marginalized groups.

Background: COVID-19 mitigation measures have major ramifications on all aspects of people’s livelihoods. Based on data collected in February 2021, we present an analysis of the socio-economic impacts of COVID-19 mitigation measures in three counties in Kenya. Methods: We conducted a cross-sectional phone-based survey in three counties in Kenya to assess the level of disruption across seven domains: income, food insecurity, schooling, domestic tension/violence, communal violence, mental health, and decision-making. An overall disruption index was computed from the seven domains using principal component analysis. We used a linear regression model to examine the determinants of vulnerability to disruptions as measured by the index. We used concentration curves and indices to assess inequality in the disruption domains and the overall disruption index. Results: The level of disruption in income was the highest (74%), while the level of disruption for domestic tension/violence was the lowest (30%). Factors associated with increased vulnerability to the overall disruption index included: older age, being married, belonging in the lowest socio-economic tertile and receiving COVID-19 related assistance. The concentration curves showed that all the seven domains of disruption were disproportionately concentrated among households in the lowest socio-economic tertile, a finding that was supported by the concentration index of the overall disruption index (CI = - 0.022; p = 0.074). Conclusion: The COVID-19 mitigation measures resulted in unintended socio-economic effects that unfairly affected certain vulnerable groups such as those in the lowest socio-economic group and the elderly. Measures to protect households against the adverse socio-economic effects of the pandemic should be scaled up and targeted to the most vulnerable, with attention to the constantly evolving nature of the pandemic.

Background: Early adolescence is a critical window for intervention when it is possible to lay a foundation for a safe transition to adulthood, before negative outcomes occur. The Adolescent Girls Initiative–Kenya randomized trial tested the effects of combinations of interventions for young adolescent girls in two sites – the Kibera informal settlement in Nairobi and rural Wajir County in the Northeastern region.Methods: The interventions included community dialogues on the role and value of girls (violence prevention), a conditional cash transfer (education), weekly group meetings for girls with health and life skills training (health), and training and incentives for financial literacy and savings activities (wealth creation). Participants were randomized to one of four study arms: 1) violence prevention only, 2) violence prevention and education, 3) violence prevention, education and health or 4) violence prevention, education, health and wealth creation. An intent-to-treat (ITT) analysis was conducted using longitudinal data to estimate the impact of each combination of interventions and various sensitivity analyses conducted addressing potential attrition bias and multiple hypothesis testing concerns.Results: In Kibera, the education conditional cash transfer had small effects on grade attainment but larger impacts on completion of primary school and the transition to secondary school in the most comprehensive arm; the health intervention improved sexual and reproductive health knowledge and condom self-efficacy; and the wealth intervention improved financial literacy and savings behavior. In Wajir, the education conditional cash transfer increased school enrollment and grade attainment, and the wealth intervention improved savings behavior.Conclusions: The results indicate that when trying to improve a range of outcomes related to adolescent wellbeing for young girls, a multisectoral intervention with components addressing household economic constraints is a promising approach.Trial registration: Trial Registry: ISRCTN,ISRCTN77455458. Registered 24/12/2015 - Retrospectively registered.