Knowledge, attitudes, practices, and the effects of COVID-19 among the youth in Kenya

A set of 40 questions were adopted from previous COVID-19 related studies in Kenya [23]. Six Kenyan enumerators were trained remotely on the survey instrument using Zoom platform. The survey instrument was piloted with young people who were not part of the Y-ACT platform. The questionnaire was then administered among the youth networks. Before administering the questionnaires, the content of the study and the eligibility criteria were explained through various platforms, including SMS, the survey email, and online discussions. Thereafter a link with the tool, which included an online written consent section, was circulated to all participants in various platforms including Y-ACT’s and other social media platforms. Once the online link was circulated, the team of six trained research assistants (RA) followed up with phone-based interviews to urge the youth to complete the survey. The RAs also interviewed those who were not able to complete the online tool on their own – a total of 118 respondents were interviewed on phone. The RAs were selected from a team that had extensive experience working with vulnerable populations. A written online consent to participate in the study was included in the survey tool, for participants to give consent prior to responding to the questions. The informed consent for the phone interviews was provided verbally by the respondents and transferred to the written consent section of the survey tool on their behalf alongside their survey responses. The same survey questionnaire was used for the phone interviews. During data collection, participants had an option of terminating the study at any time. No financial or other incentives were given for taking part in the study.

The survey aimed to collect information on the level of knowledge on signs and symptoms of COVID-19, commonly used channels of information on COVID-19, adoption of preventive practices, and the effects of COVID-19 among the youth, focusing on access to specific health care services and other social and economic effects of the pandemic, as informed by literature review of other epidemics/pandemics and effects on SRH, health service delivery and socio-economic factors. The tool also covered the youth’ perceived risk of infection, fears or concerns regarding the outbreak. (See supplementary file 1). We received expedited ethical approval for the rapid survey, to provide timely evidence that was needed to guide community engagement activities. The survey was approved by Amref Health Africa Ethics and Scientific Review Committee (ESRC) under the reference: Amref-ESRC P798/2020.

The collected data was exported to Stata version 15 for analysis. The data was cleaned in preparation for descriptive analysis. All survey responses were tabulated by gender, age and education level to generate basic descriptive tables, and tested for differences by category using chi-square tests or t-test where applicable with a significance level of 0.05. Where applicable, multivariate linear and logistic regression analysis was conducted comparing various outcome indicators with covariates such as employment status, gender, and education level. All datasets analyzed during this study are included in the supplementary files (see supplementary file 2).

A total of 2177 youth were reached through the online survey. Twenty-one (21) did not complete all the questions, hence data for a total of 2156 youth was used for the analysis. Table 1 shows the characteristics of the study respondents. The average age of participating youth was 26 years. Most of the respondents were aged between 25 and 29 years and 74.2% had completed higher education. In terms of marital status, 69.9% were single and nearly half of the respondents (49.7%) were not employed.

A multivariate linear regression analysis was conducted to examine whether gender, education level and employment status predicts the level of awareness of signs and symptoms measured by total scores achieved. Female respondents had on average higher levels of awareness than males in identifying signs and symptoms compared to the male respondents [Coeff: 0.36; (p < 0.001), CI (0.19, 0.53)]. Those with college education had higher level of awareness of identifying signs and symptoms compared to those with lower levels of education [Coeff: 0.29; (p = 0.03), CI (0.10, 0.49)]. Consequently, young people in formal employment had higher levels of awareness of signs and symptoms compared to the unemployed [Coeff: 0.35; (p = 0.001), CI (0.15, 0.55)]. Notably, those who were in self-employment had on average lower levels of awareness of identifying signs and symptoms of COVID-19 compared to those in formal employment [Coeff: -0.15; (P = 0.191), CI (− 0.37, 0.07)].

In terms of knowledge of preventive measures, the most common preventive measures mentioned by the respondents were: washing hands with soap and running water (98.1%), use of hand sanitizers (95.6%), use of masks (93.1%), maintaining social distance of 1–2 m (88.0%) and staying home unless for urgent reasons (87.5%). On average, the youth mentioned at least 11 preventive measures correctly out of the 14 examined, with no significant differences by gender. When we examined the relationship between ability to identify preventive measures using multivariate linear regression analysis, there were no associations between gender, education, and employment status. However, young people in formal employment had on average higher levels of awareness of preventive measures compared to those without employment: [Coeff: 0.38, (P = 0.037) CI (0.02 0.74)]. Table 2 shows an analysis of knowledge levels of COVID-19 symptoms and preventive measures by the study respondents, and association with respondents’ characteristics.

Among the young people, the perception of people at risk of infection with COVID-19 was varied, as illustrated on Table 3. Nearly 63.7 and 59.7% indicated that the elderly and those with weak immunity were at risk of infection. However, only 7.1% of young people reported that everyone was at risk of infection. When asked what the chances were of getting infected with COVID-19, about 29.0% perceived themselves to be at low risk, 38.9% at medium risk, and 2.7% reported no risk at all. Overall, 31.6% reported low or no risk at all with no differences between gender. Those who reported low or no risk gave various reasons for their responses, including: that they had not travelled (43.3%) or that God protects them (24.4%).

We computed multiple logistic regression analysis by examining the odds of those reporting being at any risk compared to those who did not perceive themselves to be at risk. There were no associations between those who reported any risk with gender [OR: 1.1, (P = 0.416) 95% CI (0.89, 1.30)] and education [OR: 0.85, (P = 0.174) 95% CI (0.68, 1.1)]. However, those in formal employment and those self-employed were less likely to report any risk compared to the unemployed [OR: 0.77, (P = 0.028), 95% CI (0.62, 0.97)] and [OR 0.76, (P = 0.033), 95% CI (0.58, 0.97)] respectively. Table 3 shows young people’s perception of risk of COVID-19 infection and an analysis of association with their characteristics.

About 91.6% of the respondents (n = 1948) reported that they would be very concerned if they became infected with COVID-19. Similarly, almost all respondents (95.9%) reported higher levels of concern (n = 2042) if any of their household members was infected with the virus. Figure 1 shows the level of concern among youth on infection with COVID-19.

Young people were asked how often they used various sources of information to stay informed about COVID-19. The response was on a scale of 1–4 with 1 being none, 2 - rarely, 3 - sometimes and 4 - all the times. Table 4 shows the proportion of young people who mentioned using each of the channels as sources of information for COVID-19. The most common sources which were used were social media sources (66.4%), followed by television programs (62.2%) and friends and internet at 49.8 and 49.3% respectively. The least used channels were community health workers (8.2%), church (5.8%), pharmacy and community meetings at 5.0 and 3.4% respectively.

To assess adoption of preventive behaviors, young people were asked what they were doing differently since they started receiving messages about COVID-19. Figure 2 shows that most young people were adopting behavior necessary to slow down the infection rates. For example, nearly all respondents (99.3%) avoided unnecessary travel, 97.8% washed hands more frequently and 97.2% avoided crowded places. Among those that reported that they do not always wash hands with soap and water more frequently (n = 397), the main barriers mentioned were: they could not afford extra water (21.4%), or there was no water in the community (16.4%) or in the house (13.1%). Notably, 192 of those who reported not always washing hands with soap and water, reported no barrier at all, representing 48.4%.

The other important preventive measure was use of masks, with 97.7% reporting wearing masks while going out. When asked the type of mask they owned, 42.3% reported using surgical masks with more female reporting using such masks compared to men (P = 0.009) while majority (67.7%) use cloth masks. The key barriers to owning masks among those who mentioned that they do not own any were: ability to afford (51.1%), not knowing where to get one (35.6%) and discomfort (28.9%). Only 6.7% reported that they did not think masks work, while 2.2% indicated that they were not allowed to wear one. The third preventive measure that was assessed was the use of hand sanitizer if respondents could not access water and soap for hand-washing. This was reported among 80.2% of the youth. Among those who did not use a hand sanitizer (n = 420), 86.9% reported that they did not use it because it is very expensive, 19.8% said that hand sanitizers were not available in shops and less than 2.4% said they did not think hand sanitizers work. Figure 2 shows the preventive behaviors adopted by the youth as a result of receiving COVID-19 information.

The study sought to find out the effects of COVID-19 on access to health care services and on the social and economic status of the youth, as illustrated on Table 5.

Young people were asked what health care services or medicines they were not able to access due to the COVID-19 pandemic. There were generally very low reported levels of inability to access certain services linked to SRH. For example, only 4.1% of the female respondents reported being unable to access emergency contraception (E-pills) and other contraceptives, 5.4% were not able to access sanitary towels while 8.4% were not able to access condoms. Additionally, only 2.3% were not able to access antiretroviral drugs (ARVs) while 7.9% were not able to access medication to relieve anxiety or depression.

In terms of social effects, 40.6% reported seeing friends less or family less (35.9%). Nearly a third (30.0%) reported living in fear, while 26.5% reported feeling stressed. Only 2.8% reported experiencing some form of stigma. However, COVID-19 was reported to have affected the youth economically with half of them (50.0%) reporting significant reduction in income with more male reporting this reduction in income compared to female (p < 0.001). About a third of the respondents reported increased expenses in their house (34.3%) or increased food prices (33.6%). Table 5 shows the effects of COVID-19 on access to health care services, and on the social and economic status of the youth.