“Till How Long Will We Struggle?”: A qualitative exploration of the lingering mental toll of COVID-19 on young people in Sudan and Malawi

Abstract During the COVID-19 pandemic, various aspects of life were significantly disrupted due to ill health, economic instability, and reduced social interactions precipitated by pandemic related restrictions. These disruptions exacerbated stress among young populations across the globe. This qualitative study explores how the pandemic affected the mental health of young Africans aged 18 to 24 years residing in Malawi and Sudan. We conducted six focus group discussions (FGDs), with 25 participants from Malawi and Sudan. Participants were recruited through a poster posted on Facebook and X (previously Twitter). These FGDs were recorded, transcribed verbatim, and analysed using thematic analysis. Three key themes emerged from the analysis: (1) main challenges facing youth, including economic hardship, social pressures, and limited educational and employment opportunities; (2) stigma, lack of awareness, and limited availability of trained professionals as barriers to accessing mental health services; and (3) recommendations for improving mental health service delivery. Across these themes, participants voiced a need for community outreach, integrating mental health into primary care services, and providing culturally sensitive support tailored to the needs of young people. This study highlights key mental health challenges faced by young people in low-resource settings during the COVID-19 pandemic, emphasising the need for tailored policies to support youth mental health during and after pandemics. Results underscore the need for community-based approaches to enhance mental health literacy and develop youth-focused mental health services in Malawi and Sudan. This research also provides valuable insights into potential preventive measures and interventions needed to mitigate these effects. Competing Interest Statement The authors have declared no competing interest. Funding Statement Yes Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from of the Queen Mary Ethics of Research Committee on 14th December 2020, following the review of the study protocol and associated materials (Reference: QMERC2424a), before commencing the study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All relevant data are within the manuscript and its Supporting Information files.