Khan Sundus, Kemigisha Elizabeth, Turyakira Eleanor, Chaput Kathleen, Kabakyenga Jerome, Kyomuhangi Teddy, Manalili Kimberly, Brenner Jennifer L
Indigenous, Local & Global Health Office, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Faculty of Interdisciplinary Studies, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Paediatr Child Health. 2022 May 3;27(Suppl 1):S40-S46. doi: 10.1093/pch/pxab107. eCollection 2022 Jun.
Youth (aged 10 to 24 years) comprise nearly one-third of Uganda's population and often face challenges accessing sexual and reproductive health (SRH) services, with a disproportionately high incidence of negative SRH outcomes. Responding to COVID-19, Uganda implemented strict public health measures including broad public transportation, schooling, and business shut-downs, causing mass reverse-migration of youth from urban schools and workplaces back to rural home villages. Our study aimed to qualitatively describe the perceived unintended impacts of COVID-19 health measures on youth SRH in two rural districts.
Semi-structured focus group discussions (FGD) and key informant interviews (KII) with purposively selected youth, parents, community leaders, community health worker (CHW) coordinators and supervisors, health providers, facility and district health managers, and district health officers were conducted to explore lived experiences and impressions of the impacts of COVID-19 measures on youth SRH. Interviews were recorded, transcribed, and coded using deductive thematic analysis.
Four COVID-19-related themes and three subthemes resulted from 15 FGDs and 2 KIIs (n=94). Public transportation shutdown and mandatory mask-wearing were barriers to youth SRH care-seeking. School/workplace closures and subsequent urban youth migration back to rural homes increased demand at ill-prepared, rural health facilities, further impeding care-seeking. Youth reported fear of discovery by parents, which deterred SRH service seeking. Lockdown led to family financial hardship, isolation, and overcrowding; youth mistreatment, gender-based violence, and forced marriage ensued with some youth reportedly entering partnerships as a means of escape. Idleness and increased social contact were perceived to lead to increased and earlier sexual activity. Reported SRH impacts included increased severity of infection and complications due to delayed care seeking, and surges in youth sexually transmitted infections, pregnancy, and abortion.
COVID-19 public health measures reportedly reduced youth care seeking while increasing risky behaviours and negative SRH outcomes. Investment in youth SRH programming is critical to reverse unintended pandemic effects and regain momentum toward youth SRH targets. Future pandemic management must consider social and health disparities, and mitigate unintended risks of public health measures to youth SRH.
青年（10至24岁）占乌干达人口近三分之一，他们在获取性与生殖健康（SRH）服务方面常面临挑战，且SRH负面结果的发生率高得不成比例。为应对新冠疫情，乌干达实施了严格的公共卫生措施，包括广泛的公共交通、学校和商业停业，导致青年大量从城市学校和工作场所逆向迁移回农村家乡。我们的研究旨在定性描述新冠疫情防控措施对两个农村地区青年SRH的意外影响。
与有目的地挑选出的青年、家长、社区领袖、社区卫生工作者（CHW）协调员和监督员、医疗服务提供者、医疗机构和地区卫生管理人员以及地区卫生官员进行了半结构化焦点小组讨论（FGD）和关键信息访谈（KII），以探讨新冠疫情防控措施对青年SRH影响的实际经历和印象。访谈进行了录音、转录，并采用演绎主题分析法进行编码。
15次FGD和2次KII（n = 94）产生了4个与新冠疫情相关的主题和3个子主题。公共交通停运和强制佩戴口罩是青年寻求SRH护理的障碍因素。学校/工作场所关闭以及随后城市青年迁移回农村家庭，使得准备不足的农村卫生设施需求增加，进一步阻碍了护理寻求。青年表示担心被父母发现，这阻碍了他们寻求SRH服务。封锁导致家庭经济困难、孤立和过度拥挤；随之而来的是青年受虐待、基于性别的暴力和强迫婚姻，据报道一些青年通过建立伴侣关系作为逃避手段。闲散和社交接触增加被认为会导致性活动增加和提前发生。报告的SRH影响包括因延迟寻求护理导致感染和并发症的严重程度增加，以及青年性传播感染、怀孕和堕胎激增。
据报道，新冠疫情防控公共卫生措施减少了青年寻求护理的行为，同时增加了危险行为和SRH负面结果。投资于青年SRH项目对于扭转疫情意外影响并重新朝着青年SRH目标迈进至关重要。未来的疫情管理必须考虑社会和健康差异，并减轻公共卫生措施对青年SRH的意外风险。
