Abstract
While reflecting on the realities of school closure during COVID-19 and their implications for the mental health of school-attending adolescents in sub-Saharan Africa, we have seen a few recently published reflective papers on the effects of school closure during COVID-19 on health outcomes among young people, particularly, in high-income contexts (Clemens et al., 2020; Lee, 2020; Viner et al., 2020). Some of the reported outcomes appear to have cross-cultural significance on the health of adolescents, including those in sub-Saharan Africa. However, we also believe that the peculiar social, political, economic and cultural realities of most countries in sub-Saharan Africa present unique experiences for adolescents in the subregion, and this warrants some illumination and further reflections.
Sub-Saharan Africa, the home of 15% of the world’s young people, is among the most impoverished regions of the world – it records the highest global disease burden (Population Reference Bureau, 2013; The Commonwealth, 2016). The sub-region continues to have the lowest ranking in terms of the human development of young people (The Commonwealth, 2016; UNDP, 2018). Adolescents within sub-Saharan Africa continue to face multiple challenges, including child labour, child marriage and early births, illiteracy and educational inequality, exploitation, neglect, abuses, poverty, sexual and reproductive health challenges, and mental health problems (Blum, 2007; Cortina et al., 2012; Kabiru et al., 2013; McLean, 2020; Quarshie et al., 2020). Most adolescents in the subregion do not receive the needed professional mental health care and treatment. For example, across the general population, only 2.8% of the mentally unwell in Ghana and 10% in Uganda are able to access professional care (Molodynski et al., 2017; Roberts et al., 2014).
Clearly, these glaring realities imply that the COVID-19 related restrictions, including school closures and stay-at-home policy, with their attendant family and parent-child stressors threaten and weaken the few available physical, social, economic and familial resources that provide some form of safety net for young people in sub-Saharan Africa. It is common knowledge, for example, in Ghana that routine school is a critical support and coping mechanism for pupils with health education needs, and free meals given at schools represent a relief for young people from poor homes (Ghana Education Service, 2012). In sub-Saharan Africa, schools also represent a refuge for young people experiencing domestic abuse and discrimination; many regular school attending girls find the school as a place of relief from overwhelming domestic chores and care responsibilities. Thus, for many school-attending adolescents in the subregion, the closure of schools during COVID-19 means continuous exposure and vulnerability to domestic abuse and familial adversity, with girls being the most disadvantaged, including not receiving the routine free information on menstrual hygiene and management products (e.g. sanitary pads) from key government agencies and non-governmental organisations (Ameade & Majeed, 2015; Montgomery et al., 2012).
Additionally, recent anecdotal reports have implicated the suspension of sub regional and country-wide school-leaving examinations, for anxiety and increased sense of uncertainty among final year secondary/high school students. It is also possible that while confined at home, many school-attending adolescents could experience eating disorders, sleep problems, and unhealthy increased screen time (Lee, 2020). Additionally, the ‘new consciousness’ of staying safe in order to avoid contracting the coronavirus could potentially be a stressor.
As governments across sub-Saharan Africa strengthen their response measures against COVID-19, child and adolescent mental health researchers need to roll out ethically sound, rigorous studies to help us understand better the vulnerability and extent of mental health challenges experienced by adolescents while schools remain closed (Holmes et al., 2020; Townsend et al., 2020). Evidence from such studies should inform actionable strategies towards mitigating the adverse mental health effects of school closures and stay-at-home restrictions on adolescents. Some governments, schools, and not-for-profit organisations have collaborated to provide online and other e-learning modules broadcast through television to pupils at home. While this is a timely intervention, the problem remains that household access to internet and television is still a challenge even in many urban areas within sub-Saharan Africa. Enhancing national efforts towards improving and expanding internet penetration and electronic media and communication infrastructure are an obvious response, but also allowing internet access to poor families and rural communities at subsidised cost will ensure a fair and wider coverage of these e-learning initiatives, during COVID-19. Quite apart from the educational needs that can be met, access to internet connectivity can help adolescents exploit the positive aspects of social media for reconnecting with friends. It is recommended also that adolescents work out a screen-time schedule with parents to curb the potential negative outcomes of social media. (UNICEF, 2020). Besides these suggestions, contents related to self-care, good personal hygiene, and mental health promotion materials must be included in these broadcast e-learning programmes.
Adolescence is characterised by spending more time with friends and peers than parents and family (Viner et al., 2012). Thus, the stay-at-home restriction during COVID-19, which is affecting more than 47 million pre-tertiary pupils in Ghana and Nigerian alone (UNESCO, 2020), underscores the need for parents to build friendship with their teenage children; the restriction warrants good parenting characterised by open and empathic communication, as adolescents remain confined at home. Such recommendations are critical because socialisation, particularly, within (patriarchal) communal societies in the sub-Saharan African region creates social hierarchies, which impedes harmonious parent-child dyads, unlike what pertains in Western contexts.
Undoubtedly, the COVID-19 school closures have significantly affected several domains of adolescents’ life and (mental) health. Ensuring the mental well-being of adolescents in sub-Saharan Africa during COVID-19 should be a critical concern for national governments and everyone, particularly, parents and guardians who are required to exude resilience and be empathic allies of their adolescents confined at home.
