Real-Time Monitoring of COVID-19 Impacts Among Adolescents and Young People, Their Families and Communities in Southern Highlands Regions in Tanzania

This report provides findings from a study examining effects of the COVID-19 pandemic on livelihoods and health-related well-being among adolescents and youth in Tanzania. The study leverages a cohort of adolescents in poor households from an existing impact evaluation in the Mbeya and Iringa regions of Tanzania.

University at Buffalo (State University of New York), and EDI Global, in collaboration with TASAF, and UNICEF Tanzania, designed and carried out mobile phone surveys to understand knowledge, information sources and prevention practices related to COVID-19, as well as the effects of COVID-19 on youth well-being; outcomes examined include livelihoods, food and water security, schooling, time use, violence, health and care seeking, and coping strategies.

The cohort leveraged for this study of COVID-19 impacts comes from the evaluation of the Ujana Salama: A Cash Plus Model for Safe Transitions to a Healthy and Productive Adulthood pilot being implemented within the Government of the Republic of Tanzania’s Productive Social Safety Net (PSSN), by the Tanzania Social Action Fund (TASAF) in collaboration with TACAIDS, and with technical assistance from UNICEF. However, the current report does not discuss impacts of that intervention.

The findings discussed in this report come from a sample of 760 adolescents, 542 households, 83 health facilities, and 16 community leaders in this cohort surveyed across 5 rounds and 130 villages in two regions of Tanzania (Iringa and Mbeya). Interviews were conducted in Swahili between September 2020 and January 2021 over mobile phones and comprise both quantitative surveys (with youth, households and health facilities) and qualitative interviews (with a sub-sample of youth and community leaders).

Below we highlight some key findings from these mobile surveys.

COVID-19 knowledge, attitudes, and practices

• Most youth are informed to some extent about COVID-19 symptoms and transmission.
• Airborne transmission of the virus is readily acknowledged; however, average knowledge was 3.39 out of scale of 10.
• Males reported higher COVID-19 knowledge than females, on average.
• Youth reported that they most commonly received messages on COVID-19 from the media, public health officers, and the government.
• The majority of youth knew to avoid gatherings, wash hands with soap and water, and wear a face mask.
• The prevention practices actually implemented by this sample mostly include washing hands and wearing a face mask.
• Males enacted prevention measures more commonly than females.

Health-seeking

• Among those youth or household members with a sickness in the previous month, the most commonly reported symptoms included fever, aches, and headache.
• Most of those who were sick reported seeking care.
• Those not seeking care when needed reported barriers related to costs, distance, and fear of COVID-19.
• Reported changes in caseload by health facilities was mixed: 37% reported a decrease in caseload, while 29% reported an increase, and 38% reported no change.
• Most facilities (71%) reported no change in their ability to provide regular services (including well-baby check-ups, vaccinations, maternal health, family planning, etc.) compared to before March 2020. However, 29% of facilities were negatively impacted and attended fewer patients due to limited staffing, funding, or supplies or increased COVID-19-related caseloads.
• Thirty-one percent of households reported being enrolled in the community health fund (CHF). When we examine the smaller panel sample of households who responded to the SMS surveys over time (n=95), reported CHF enrolment increased from 28% to 52% between September and November 2020. This may be due to the fact that households received their first PSSN payments of 2020 in September after long delays, and therefore with more available funds, households may have chosen to use these PSSN payments to enroll in CHF.

Impacts of COVID-19 on livelihoods, food and water security, time use, and schooling

• Most youth reported major economic impacts in their households resulting from COVID-19.
• Factors that affected livelihoods include fear of large gatherings and crowds, closures of businesses, and reduced transport of goods and resources.
• Most individuals reported no changes in their standard of living since March 2020; however, females were more likely than males to report improvements in their standard of living.
• Changes to livelihoods attributed to COVID-19 triggered cascading impacts on household provisions, including food.
• COVID-19 impacts on food security were more often reported by females than males, though many participants reported market changes that affected food access.
• Over time, youth reported increasing food security in SMS surveys.
• Water insecurity also proved problematic for a small percentage of households that did not have reliable access to water for washing.
• Compared to the time period prior to the COVID-19 pandemic, youth reported spending more time caring for elderly or sick household members and gathering firewood or nuts.
• Females reported spending twice as much time caring and working on domestic chores than males.
• Through strong community efforts, most of the youth who were attending school in March 2020 had returned to school, according to qualitative interviews of community leaders, though only 14% of the adolescents and youth in the cohort studied were attending pre-COVID.
• Fifteen percent of households lacked the financial resources to send their youth to school in the preceding four weeks.
• Negative coping mechanisms were quite common in response to the shocks from COVID-19.
• Households engaged in an average of one negative coping strategy, such as selling land or livestock, in the past six months.

Mental health

• Adverse mental health outcomes such as fear, anxiety, isolation, frustration, and trouble sleeping emerged in qualitative interviews and quantitative surveys.
• Males reported worse sleep in the preceding week than females.

Pregnancy, violence, and exploitation

• Physical and emotional violence was reported by 9 and 12% of the sample, respectively, and did not change significantly over time, compared to one year prior.
• Females were less likely to report starting a sexual relationship for financial reasons when compared to a year prior.
• Unintended pregnancies during school closures, possibly due to changes to health care provisions, were speculated by participants to affect girls’ return to schools during re-opening.

Tia Palermo, Stephanie Zuilkowski, Sarah Quiñones, Graca Marwerwe, Hassan Kihanzah, Leah Prencipe, and Lusajo Kajula. (2021). “Real-time monitoring of COVID-19 impact among adolescents and young people, their families, and communities in Southern Highlands regions in Tanzania.” UNICEF Tanzania and University at Buffalo: Dar es Salaam and Buffalo.

Tia Palermo - Associate Professor, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY

Stephanie Zuilkowski - College of Education and Learning Systems Institute, Florida State University, Tallahassee, FL

Sarah Quiñones, Department of Social and Preventive Medicine, University at Buffalo, Buffalo, NY

Graca Marwerwe, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY

Hassan Kihanzah, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY

Leah Prencipe, Erasmus MC, Rotterdam, Netherlands

Lusajo Kajula, Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY