COVID-19 pandemic related stress and Bacterial vaginosis infection among Secondary school girls in western Kenya

Background: COVID-19 had a disproportionate effect on the health of adolescent girls in Kenya. With the closure of schools and ongoing economic crisis, girls were left susceptible to risk of sexual exposure and violence. In this study, we focused on understanding the socioeconomic and behavioral impact of COVID-19, and how these related to subsequent risk of BV.

Methods: 436 secondary school girls in western Kenya were followed longitudinally every six months from March 2018 through June 2021 (36 months), to measure BV and demographic and behavioral information. To understand how COVID-19 stress (measured via adapted Coronavirus Impact Scale) could be mediating BV status, we used structural equation modelling (SEM) to demonstrate the relationship of latrine type and water access (as a proxy for SES), home safety, depressive symptoms (Personal Health Questionnaire), sexual exposures, and BV positivity before and after COVID-19. BV was measured from self-collected vaginal swabs via Nugent score. We report coefficients and the SEM diagram.

Results: The baseline median age was 16.9 years. The average prevalence of BV increased from 12.2% before COVID-19 to 22.7% during COVID-19. Increased COVID-related stress was associated with elevated depressive symptoms (0.07) and girls feeling less safe at home (0.24). Lower SES was more strongly associated with having a boyfriend (0.07) or transactional sex (0.09) during COVID-19 vs. 0.034 and 0.005 pre-COVID, respectively. Feeling unsafe inside was associated with increased likelihood of engaging in transactional sex (0.14) or having a boyfriend (0.11). Having a boyfriend (0.16) was proximal to having BV. Most of the relationships remained stable across time, but the participants experiencing depressive symptoms were more likely to have a boyfriend during COVID-19 than before COVID-19.

Conclusion: Among these secondary school girls, those experiencing increased COVID-19 related stress were more likely to have BV, mediated by economic and behavioral factors. Indicator of greater economic distress effects was found to be associated with higher sexual risk. Future disaster and emergency response measures should consider how to mitigate the indirect effects of stress, depressive symptoms, and economic distress on sexual exposures.