Table 1.
Summary of COVID-19 vulnerabilities and strategies for promoting well-being among children and young people in Eastern and Southern Africa.
| COVID-19 related vulnerabilities | Levels at which prevention, care, and health promotion interventions are targeted | |||
|---|---|---|---|---|
| Individual behavioral strategies (prevention, self-monitoring and early detection) | School-based and community level strategies | Health systems level strategies | Legislation/policy strategies | |
| Existing health issues | ||||
| •Unsuppressed viral loads and low CD4 counts •Undiagnosed HIV and TB |
•Improve self-efficacy to adopt COVID-19 prevention behaviors (e.g., restriction of movement measures, hand washing, social distancing) •Improve self-efficacy for HIV viral load testing, TB testing, and SARS-CoV-2 testing •Self-identify COVID-19 symptoms and self-quarantine •Use self-support tools to promote medication adherence •Improve ability to monitor healthy levels of nutrition •Complete prescription refills early and obtain multi-month stocks of required medication |
•Support integrated community prevention, surveillance, and early detection of HIV/TB and SARS-CoV-2 by linking CYP to community social and health services •Increase family- and community-based support for YPLHIV through alternative avenues (e.g., social media groups, online ART adherence clubs and peer support) that comply with social distancing requirements •Telephonic counseling for those with high viral loads •Capacitate YPLHIV to fulfill curriculum-based learning away from school (e.g., online platforms, community library, home schooling) •Monitor stigma, discrimination, and human rights abuses of YPLHIV during lockdowns |
•Provide uninterrupted primary health care with intensified SARS-CoV-2 surveillance •Triage screening for SARS-CoV-2 and COVID-19 symptoms •Continue to allocate multi-month HIV and TB prescription refills, while monitoring for stock-outs •SARS-CoV-2 testing to include assessment of medication availability and adherence to medication among YPLHIV •Ensure pediatric high care facilities are available for severe COVID-19 patients •Monitor discharged and recovered COVID-19 patients |
•Increase budgets to ensure HIV, TB, and SARS-CoV-2 testing and treatment programs are stepped up and continued during lockdowns •SARS-CoV-2 surveillance should be integrated into existing HIV/TB programs •Increase legislative capacity to respond to human rights abuses against YPLHIV during lockdowns |
| Consequences of imposed restrictions and lockdowns | ||||
| Health complications of physical inactivity and restricted mobility | •Improve self-efficacy for engaging in appropriate physical activity within the confinements of regulated spaces •Improve self-efficacy for maintaining a nutritional diet |
•Caregivers and communities to support children with developing routines that incorporate physical activity and regular meals •Communities to support health and exercise activities when restrictions are eased •School-based information to emphasize and support weekly routines |
•Surveillance systems to monitor food shortages and health and nutrition needs of CYP | •Accommodate physical activity needs of CYP into stay-at-home orders or homebound policies, particularly for those without access to special equipment or who have limited space in the home to exercise |
| Psychological distress precipitated by confinement and fear of contracting SARS-CoV-2 | •Self-monitor psychological distress and seek appropriate support and services •Identify and utilize coping resources (e.g., friends, family, community leaders) •Maintain a routine and prioritize self-care |
•Support community outreach health workers with detecting mental health issues and delivering basic mental health services to families •Families and communities to provide CYP with access to health workers for psychosocial support •School-based information to emphasize detection and treatment of mental illness |
•Where possible, use innovative ways to provide mental health support to people during lockdown periods (e.g., telemedicine, web-based counseling and wellness services, SMS, information through cross-platform messaging and voice-over internet protocols [e.g., WhatsApp]) | •Mental health services should be classified as an essential primary health service •Public health interventions must be child-friendly and sensitive to the capacities and vulnerabilities of children |
| Immunization programming disruptions | •Caregivers to ensure that children are vaccinated in accordance with recommended immunization schedules | •Community outreach/door-to-door immunization for children during lockdowns | •Universal immunization should be integrated into the COVID-19 response and considered an essential service | •Accelerate research on the development of a safe and effective SARS-CoV-2 vaccine |
| •Caregivers to ensure neonatal BCG vaccination to be given to all infants in high TB burden settings •Caregivers to ensure infants who have not yet received immunization require a catch-up vaccination at the nearest health facility |
•Provide community-wide education on vaccination guidelines and immunization schedules •School-based immunization campaigns to reach older children and adolescents, even when schools are closed |
•Ensure equitable access to COVID-19 vaccine once available | ||
| Learning during school closures | •Improve basic skills needed to access online and distance learning modalities •Make use of available educational material delivered through various multimedia services (e.g., radio, television, local community center where social distancing in place) |
•Schools to consider ways of making learning materials easily accessible to students •Launch multi-media learner support initiatives (e.g., radio and television educational programming) •Where possible, teachers to be trained on conducting remote-based learning and encouraged to stay in contact with learners (e.g., radio, television) •Caregivers to assist with essential home-based learning skills (e.g., reading, writing, mathematics) •Communities to support remote learning through exchange of information on where materials can be accessed •Create safe spaces (e.g., community centers where social distancing is in place) to collect educational material |
NA | •Implement a national policy to mitigate the immediate impact of school closures and facilitate continuity of education for all students through remote learning •Provide household grants to support out-of-pocket costs to access learning material |
| Re-opening of schools | •Improve education on prevention, detection, management, and treatment of COVID-19 | •Support schools to institute and adhere to COVID-19 safety and risk mitigation measures | •Capacitate local health systems to be responsive to COVID-19 outbreaks in schools | •Decisions on re-opening of schools should consider context-specific issues in combination: SARS-CoV-2 epidemic trajectory among CYP, SARS-CoV-2 transmission rates, prevalence of severity of COVID-19 related illness and mortality rates among CYP, ongoing negative impacts on immunization programs, school feeding programs and other public health programs, capacity of schools to adhere to COVID-19 risk mitigation and safety measures, and evaluation of the benefits of classroom-based instruction vis-à-vis remote learning |
| Human rights violations | •Improve self-efficacy to access to helplines and self-help empowerment information •Encourage members of young key populations to keep in “social contact groups” to monitor victimization and abuse and have knowledge on how to access support services |
•Communities and local NGOs to ramp up information campaigns on monitoring and reporting of human rights violations during lockdowns •Community and NGO services to ramp up messaging campaigns on access to safe spaces, shelters, and support groups •Deliver family-integrated protective behaviors education to children and caregivers through television and radio •Advocacy groups to educate sex workers and other vulnerable groups of their human rights and where to report violations of human rights •Provide helpline contact details for reporting child abuse and seeking support |
•During lockdowns, child protection services and workers must be designated as essential services and resourced to access and support children with age-appropriate services, safe e-education platforms, and cost-free child helplines for children to report the occurrence of abuse or violence •Integrate human rights programming into the COVID-19 health systems response •Strengthen case management and multi-sectoral referrals to holistically support at-risk and vulnerable children |
•Parliamentary process and civil society organizations to serve as “watch dogs” to monitor law enforcement misconduct and helping to ensure offenders are held accountable for acts of discrimination and violence •Provide extra legislative capacity to communities that need assistance dealing with human rights violations (e.g., victims discrimination, xenophobia, violence, imprisonment) during lockdowns •Shelters and psychosocial support services for marginalized populations must be considered an essential service in every country |
| Financial and food insecurity of households | •Caregivers of households to monitor and report food shortages and lack of funds to purchase essentials (e.g., medicine, hygienic products) | •Communities and local NGOs need to support impoverished families with accessing social relief funds and food distribution programs •Impoverished families to be linked with appropriate social and development services, with NGOs and communities monitoring for bottlenecks and breakdowns in service access and delivery |
•Health workers to identify children at risk of hunger/malnutrition and support them through rapid linkage to community food distribution and feeding programs | •Increase government spending on social grants to improve household food security •Roll-out large-scale food assistance programs (e.g., food banks) in both urban and rural areas •Keep food supply chains open and accessible to communities during lockdowns •Parliamentary process and civil society organizations to serve as “watch dogs” to monitor corruption in distribution of resources |
BCG, Bacille Calmette-Guérin; COVID-19, coronavirus disease 2019; CYP, children and young people; NGO, non-governmental organization; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SMS, short message service; TB, tuberculosis; YPLHIV, young people living with HIV.