Browsing by Author "Chukwu, Angela"
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Item The Continued Impacts of the COVID-19 Pandemic on Education and Mental Health Among Sub-Saharan African Adolescents(Elsevier, 2022) Wang, Dongqing; Adedokun, Olufemi A; Millogo, Ourohiré; Madzorera, Isabel; Hemler, Elena C; Workneh, Firehiwot; Mapendo, Frank; Lankoandev, Bruno; Ismail, Abbas; Chukwu, Angela; Assefa, Nega; Watara, Sulemana; Lyatuu, Isaac; Okpara, Daniel; Abdullahi, Yasir Y; Zabre, Pascal; Vuai, Said; Soura, Abdramane BassiahiThis multicountry survey assessed the levels and the determinants of the impacts of the pandemic on education and mental health among adolescents in sub-Saharan Africa and the potential factors that may exacerbate these adverse impacts. A phone survey was conducted among adolescents in nine diverse areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania between July and December 2021. Approximately 300 adolescents per area and 2,803 adolescents in total were included. The survey collected information on adolescents’ sociodemographic characteristics, current COVID-19 preventive measures, and the impacts of the pandemic on daily activities, education, and mental health. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) for determinants of education and mental health outcomes. Overall, 17% of the adolescents were not receiving any education. Compared to boys, girls were 15% more likely than boys to lack fully in-person education (aPR: 1.15; 95% confidence interval [CI]: 1.02, 1.30). Rural residence was associated with 2.7 times the prevalence of not currently receiving any education (aPR: 2.68; 95% CI: 2.23, 3.22). Self-reported experience of the current impacts of the pandemic on daily activities was associated with a higher prevalence of possible psychological distress (aPR: 1.86; 95% CI: 1.55, 2.24), high anxiety level (aPR: 3.37; 95% CI: 2.25, 5.06), and high depression level (aPR: 3.01; 95% CI: 2.05, 4.41). The COVID-19 pandemic presents continued challenges to adolescents’ education and mental health. Multisectoral efforts are needed to ensure that adolescents in sub-Saharan Africa do not fall further behind due to the pandemicItem Covid-19 preventive practices, psychological distress, and reported barriers to healthcare access during the pandemic among adult community members in sub-Saharan Africa: a phone survey(American Society of Tropical Medicine and Hygiene, 2022) Assefa, Nega; Abdullahi, Yasir Y.; Hemler, Elena C.; Lankoande, Bruno; Madzorera, Isabel; Wang, Dongqing; Ismail, Abbas; Chukwu, Angela; Workneh, Firehiwot; Mapendo, Frank; Millogo, Ourohire; Abubakari, Sulemana Watara; Febir, Lawrence Gyabaa; Lyatuu, Isaac; Dianou, Kassoum; Baernighausen, Till; Soura, Abdramane; Asante, Kwaku Poku; Smith, Emily; Vuai, Said; Worku, Alemayehu; Killewo, Japhet; Mwanyika-Sando, Mary; Berhane, Yemane; Sie, Ali; Tajudeen, Raji; Oduola, Ayo; Fawzi, Wafaie W.The COVID-19 pandemic has had serious negative health and economic impacts in sub-Saharan Africa. Continuous monitoring of these impacts is crucial to formulate interventions to minimize the consequences of COVID-19. This study surveyed 2,829 adults in urban and rural sites among five sub-Saharan African countries: Burkina Faso, Ethiopia, Nigeria, Tanzania, and Ghana. Participants completed a mobile phone survey that assessed self-reported sociodemographic, COVID-19 preventive practices, psychological distress, and barriers to healthcare access. A modified Poisson regression model was used to estimate adjusted prevalence ratios (aPRs) and 95% CIs to investigate potential factors related to psychological distress and barriers to reduced healthcare access. At least 15.6% of adults reported experiencing any psychological distress in the previous 2 weeks, and 10.5% reported that at least one essential healthcare service was difficult to access 2 years into the pandemic. The majority of participants reported using several COVID-19 preventive methods, with varying proportions across the sites. Participants in the urban site of Ouagadougou, Burkina Faso (aPR: 2.29; 95% CI: 1.74–3.03) and in the rural site of Kintampo, Ghana (aPR: 1.68; 95% CI: 1.21–2.34) had a higher likelihood of experiencing any psychological distress compared with those in the rural area of Nouna, Burkina Faso. Loss of employment due to COVID-19 (aPR: 1.77; 95% CI: 1.47–2.11) was also associated with an increased prevalence of psychological distress. The number of children under 5 years in the household (aPR: 1.23; 95% CI: 1.14–1.33) and participant self-reported psychological distress (aPR: 1.83; 95% CI: 1.48–2.27) were associated with an increased prevalence of reporting barriers to accessing health services, whereas wage employment (aPR: 0.67; 95% CI: 0.49–0.90) was associated with decreased prevalence of reporting barriers to accessing health services. Overall, we found a high prevalence of psychological distress and interruptions in access to healthcare services 2 years into the pandemic across five sub-Saharan African countries. Increased effort and attention should be given to addressing the negative impacts of COVID-19 on psychological distress. An equitable and collaborative approach to new and existing preventive measures for COVID-19 is crucial to limit the consequences of COVID-19 on the health of adults in sub-Saharan Africa.Item COVID-19 vaccine hesitancy and its determinants among Sub-Saharan African adolescents(PLOS, 2022) Wang, Dongqing; Chukwu, Angela; Mwanyika-Sando, Mary; Abubakar, Sulemana Watara; Assef, Nega; Madzorera, Isabel; Hemler, Elena C.; Ismai, Abbas; Lankoande, Bruno; Mapendo, Frank; Millogo, Ourohire´; Workneh, Firehiwot; Azemraw, Temesgen; Febir, Lawrence Gyabaa; James, Christabel; Tinkasimile, Amani; Asant, Kwaku Poku; Baernighausen, Till; Berhane, Yemane; Killewo, Japhet; Oduola, Ayoade M. J.; Sie, Ali; Smith, Emily R.; Soura, Abdramane Bassiahi; Raj, Tajudeen; Vuai, Said; Fawzi, Wafaie W.COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2662 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between potential determinants and COVID-19 vaccine hesitancy. The percentage of COVID-19 vaccine hesitancy was 14% in rural Kersa, 23% in rural Ibadan, 31% in rural Nouna, 32% in urban Ouagadougou, 37% in urban Addis Ababa, 48% in rural Kintampo, 65% in urban Lagos, 76% in urban Dar es Salaam, and 88% in rural Dodoma. Perceived low necessity, concerns about vaccine safety, and concerns about vaccine effectiveness were the leading reasons for hesitancy. Healthcare workers, parents or family members, and schoolteachers had the greatest impacts on vaccine willingness. Perceived lack of safety (aPR: 3.52; 95% CI: 3.00, 4.13) and lack of effectiveness (aPR: 3.46; 95% CI: 2.97, 4.03) were associated with greater vaccine hesitancy. The prevalence of COVID-19 vaccine hesitancy among adolescents is alarmingly high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents should address their concerns and misconceptions about vaccine safety and effectiveness.Item Depressive symptoms among adolescents in six sub-Saharan African countries: A pooled analysis of associated factors(Elsevier BV, 2023) Partap, Uttara; Nyundo, Azan; Manu, Adom; Regan, Mathilda; Ismail, Abbas; Chukwu, Angela; Dessie, Yadeta; Njau, Tasiana; Kaaya, Sylvia F.; Fawzi, Wafaie W.There is a need to identify risk factors, including nutrition-related factors, for depressive disorders among sub- Saharan African (SSA) adolescents. We examined the association of multiple measures with depressive symptoms among adolescents living across six SSA countries. Building on previous analyses, we used data from a cross-sectional study conducted from 2015 to 2017 among adolescents aged 10–19 years in six SSA countries (N = 7512). Depressive symptoms were defined as highest tertile of the 6-item Kutcher Adolescent Depression Scale score. Using mixed-effects Poisson regression models, we pooled data across sites and examined the association of sociodemographic, nutrition, and other indices with depressive symptoms. We additionally assessed effect modification by sex, age, and school-going status. We observed higher risk of depressive symptoms among girls (adjusted risk ratio [RR]: 1.29, 95 % confidence interval [95 % CI]: 1.05–1.58, P = 0.016), older adolescents (RR for 18–19 years: 1.59, 95 % CI: 1.44–1.76, P < 0.001), and adolescents experiencing bullying (RR: 1.43, 95 % CI: 1.26–1.62, P < 0.001) or violence (RR: 1.34, 95 % CI: 1.24–1.45, P < 0.001). Adolescents experiencing food insecurity also had a higher risk of depressive symptoms (RR: 1.90, 95 % CI: 1.64–2.19, P < 0.001) along with those consuming ≥ 5 servings of fruit and vegetables per day (RR: 1.18, 95 % CI: 1.03–1.34, P = 0.015); conversely, those who consumed grains, roots and tubers in the past day were at decreased risk (RR: 0.73, 95 % CI: 0.69–0.77, P < 0.001). There was no strong evidence of effect modification of associations. This study reinforces the potential role of multiple sociodemographic and nutrition-related measures on risk of depressive symptoms in these populations.Item Determinants of COVID-19 vaccine readiness and hesitancy among adults in sub-Saharan Africa(PLOS Global Public Healt, 2023) Abubakari, Sulemana Watara; Workneh, Firehiwot; Asante, Kwaku Poku; Hemler, Elena C.; Madzorera, Isabel; Wang, Dongqing; Ismai, Abbas; Nega Assefa; Azemraw, Temesgen; Lankoande, Bruno; Nuhu, Abdul Razak; Chukwu, Angela; Mapendo, Frank; Millogo, Ourohiré; Olufemi, Adedokun A.; Okpara, Daniel; Boudo, Valentin; Mwanyika-Sando, Mary; Berhane, Yemane; Baernighause, Till; Oduola, Ayoade; Vuai, Said; Sie, Ali; Soura, Abdramane; Killewo, Japhet; Tajudeen, Raji; Fawz, Wafaie W.; Smith, Emily R.There is very limited data on the extent and determinants of COVID-19 vaccine hesitancy among adults living in sub-Saharan Africa since the global roll-out of vaccines began in 2021. This multi-country survey sought to investigate COVID-19 vaccine hesitancy and other predictors of readiness to get vaccinated. We conducted surveys among adults residing in nine urban and rural areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania in late 2021. Log binomial regression models were used to identify prevalence and factors associated with vaccine hesitancy and beliefs around COVID-19 misinformation. We completed a total of 2,833 interviews. Among all respondents, 9% had never heard of a COVID-19 vaccine, 12% had been vaccinated, and 20% knew someone else who had been vaccinated. The prevalence of vaccine hesitancy varied by country (Ethiopia 29%, Burkina Faso 33%, Nigeria 34%, Ghana 42%, Tanzania 65%), but not by rural or urban context. People who did not think the vaccine was safe or effective, or who were unsure about it, were more likely to be vaccine hesitant. Those who reported they did not have a trusted source of information about the vaccine (aPR: 1.25, 95% CI: 1.18,1.31) and those who thought the vaccine would not be made available to them within the year were more likely to be vaccine hesitant. Women were more likely to be vaccine hesitant (aPR: 1.31, 95% CI: 1.19,1.43) and believe COVID-19 falsehoods (aPR: 1.05, 95% CI: 1.02,1.08). The most commonly believed falsehoods were that the vaccine was developed too fast and that there was not enough information about whether the vaccine was effective or not. Educational campaigns targeted at misinformation and tailored to suit each country are recommended to build trust in COVID-19 vaccines and reduce hesitancy.Item Factors associated with depressive symptoms and suicidal ideation and behaviours amongst sub-Saharan African adolescents aged 10-19 years: Cross-sectional study(Wiley, 2020) Nyundo, Azan; Manu, Adom; Regan, Mathilda; Ismail, Abbas; Chukwu, Angela; Dessie, Yadeta; Njau, Tasiana; Kaaya, Sylvia F; Fawzi, Mary C SmithObjective: This study aimed to determine the burden of depression, suicidal ideation and suicidal behaviour amongst adolescents at sites in six sub-Saharan African countries and examine associated risk and protective factors. Methods: Household-based cross-sectional study involving male and female adolescents ages 10-19 years. A total of 7,662 adolescents from eight sites in six countries participated in the survey. Three sites were urban: Dar es Salaam (Tanzania), Harar (Ethiopia) and Ibadan (Nigeria); five were rural: Dodoma (Tanzania), Iganga/Mayuge (Uganda), Kersa (Ethiopia), Ningo Prampram (Ghana) and Nouna (Burkina Faso). Log-binomials models were used to estimate relative risks and confidence intervals for factors associated with depression and suicidal behaviour. This was supplemented using log-Poisson models as needed. Results: The prevalence of suicidal behaviour over the last 12 months ranged between 1.2% and 12.4% in the eight sites. Depressive symptoms and suicidal ideation/behaviours were associated with older age, female sex, food insecurity, poor access to health care and substance use. Depression was strongly associated with increased risk of suicidal behaviour at two sites where the multivariate model converged: Harar, Ethiopia (RR = 3.5, 95% CI 1.8, 7.0, P < 0.05) and Ibadan, Nigeria (RR = 3.7, 95% CI 2.2, 6.3, P < 0.0001). Conclusions: Depressive symptoms and suicidal behaviour are common amongst sub-Saharan African adolescents at these 8 sites. Most factors associated with depressive symptoms are modifiable and preventable. Routine screening for depressive symptoms in services frequented by adolescents in these and similar communities would be crucial in early detection and prompt intervention.Item Impact of COVID-19 on nutrition, food security and dietary diversity and quality in Burkina Faso, Ethiopia and Nigeria(Oxford University Press, 2021) Madzorera, Isabel; Ismail, Abbas; Hemler, Elena; Korte, Michelle; Olufemi, Adedokun; Wang, Dongqing; Assefa, Nega; Workneh, Firehiwot; Lankoande, Bruno; Chukwu, Angela; Ourohire, Millogo; Mattei, Josiemer; Soura, Abdramane; Berhane, Yemane; Sie, Ali; Oduola, Ayoade; Fawzi, WafaieCOVID-19 has far-reaching consequences for developing countries through the combined effects of infection and mortality and unintended consequences from mitigation measures. COVID-19 can adversely impact food systems and dietary diversity for populations. This cross-sectional study evaluated, using a mobile platform, the effect of COVID-19 on food prices and dietary diversity and quality, among 1797 households in Nouna and Ouagadougou (Burkina Faso), Addis Ababa and Kersa (Ethiopia), and Lagos and Ibadan. Methods: Dietary intake was assessed as the frequency of consumption of 20 food groups over the previous 7 days. Dietary diversity scores (DDS; range: 0–10) and Prime Diet Quality Score (PDQS; range: 0–40) assessed dietary diversity and quality. Linear regression models were used to evaluate associations between changes in the prices of staples, pulses, vegetables, fruits, and animal source foods (ASF) with DDS and PDQS during COVID-19. Most households reported increases in prices of staples, pulses, fruits, vegetables and ASF, and ≥40% reported decreased consumption of staples, legumes, ASF, other vitamin A rich vegetables, other vegetables and other fruits, and lower DDS and PDQS compared to the period before the COVID-19 emergency. Increases in pulse prices were associated with lower DDS (estimate − 0.35, 95% CI: −0.61, −0.09). Lower crop production (estimate − 0.70, 95% CI: −1.02, −0.37), and skipping meals (estimate − 0.39, 95% CI: −0.56, −0.21) or not eating for a whole day (estimate − 0.23, 95% CI: −0.43, −0.03) were also associated with lower DDS. The price increases and worsening dietary diversity and quality call for social protection and other strategies to increase the availability and affordability of nutrient-rich foods during the COVID19 pandemic and other public health emergencies.Item Impact of COVID-19 on nutrition, food security and dietary diversity and quality in Burkina Faso, Ethiopia and Nigeria(OXFORD ACADEMIC, 2021) Madzorera, Isabel; Ismail, Abbas; Hemler, Elena; Korte, Michelle; Olufemi, Adedokun; Wang, Dongqing; Assefa, Nega; Workneh, Firehiwot; Lankoande, Bruno; Chukwu, Angela; Ourohire, Millogo; Mattei, Josiemer; Soura, Abdramane; Berhane, Yemane; Sie, Ali; Oduola, Ayoade; Fawzi, WafaieCOVID-19 has far-reaching consequences for developing countries through the combined effects of infection and mortality and unintended consequences from mitigation measures. COVID-19 can adversely impact food systems and dietary diversity for populations. This cross-sectional study evaluated, using a mobile platform, the effect of COVID-19 on food prices and dietary diversity and quality, among 1797 households in Nouna and Ouagadougou (Burkina Faso), Addis Ababa and Kersa (Ethiopia), and Lagos and Ibadan (Nigeria). Dietary intake was assessed as the frequency of consumption of 20 food groups over the previous 7 days. Dietary diversity scores (DDS; range: 0–10) and Prime Diet Quality Score (PDQS; range: 0–40) assessed dietary diversity and quality. Linear regression models were used to evaluate associations between changes in the prices of staples, pulses, vegetables, fruits, and animal source foods (ASF) with DDS and PDQS during COVID-19. Most households reported increases in prices of staples, pulses, fruits, vegetables and ASF, and ≥40% reported decreased consumption of staples, legumes, ASF, other vitamin A rich vegetables, other vegetables and other fruits, and lower DDS and PDQS compared to the period before the COVID-19 emergency. Increases in pulse prices were associated with lower DDS (estimate − 0.35, 95% CI: −0.61, −0.09). Lower crop production (estimate − 0.70, 95% CI: −1.02, −0.37), and skipping meals (estimate − 0.39, 95% CI: −0.56, −0.21) or not eating for a whole day (estimate − 0.23, 95% CI: −0.43, −0.03) were also associated with lower DDS. The price increases and worsening dietary diversity and quality call for social protection and other strategies to increase the availability and affordability of nutrient-rich foods during the COVID-19 pandemic and other public health emergencies. The Bill and Melinda Gates Foundation Grant as well as institutional support from the Heidelberg Institute of Global Health, Germany and the Harvard T.H. Chan School of Public Health, USA, supported this work.Item The COVID-19 pandemic and its prolonged impacts on food prices, food consumption and diet quality in sub-Saharan Africa(Cold Spring Harbor Laboratory, 2022) Ismail, Abbas; Madzorera, Isabel; Apraku, Edward A.; Tinkasimile, Amani; Dasmane, Dielbeogo; Zabre, Pascal; Ourohire, Millogo; Assefa, Nega; Chukwu, Angela; Workneh, Firehiwot; Mapendo, Frank; Lankoande, Bruno; Hemler, Elena; Wang, Dongqing; Abubakari, Sulemana W.; Asante, Kwaku P.; Baernighausen, Till; Killewo, Japhet; Oduola, Ayoade; Sie, Ali; Soura, Abdramane; Vuai, Said; Smith, Emily; Berhane, Yemane; Fawzi, Wafaie W.Background Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods, nutrition, and food security, with recovery slowed down by lagging vaccination progress. Objective This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. Methods We conducted a repeated cross-sectional study and used a mobile platform to collect data. Data collected from round 1 (July-November, 2020) and round 2 (July-December, 2021) were considered. We assessed participants’ dietary intake of 20 food groups over the previous seven days. The study’s primary outcome was the Prime Diet Quality Score (PDQS), with higher scores indicating better dietary quality. We used linear regression and generalized estimating equations to assess factors associated with diet quality during COVID-19. Results Most of the respondents were male and the mean age (±SD) was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.1 (±3.8) before COVID-19, 18.6(±3.4) in Round 1, and 19.4(±3.8) in Round 2. A majority of respondents (80%) reported higher than expected prices for all food groups during the pandemic. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), older age (estimate: 30-39 years: 0.77, 95% CI: 0.35, 1.19, or 40 years or older: 0.72, 95% CI: 0.30, 1.13), and medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81) were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, - 0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) associated with lower PDQS. Conclusion Diet quality which had declined early in the pandemic had started to improve. However, consumption of healthy diets remained low, and food prices remained high. Efforts should continue to improve diet quality for sustained nutrition recovery through mitigation measures, including social protection.