Economic, socio-emotional, and food security conditions during COVID-19 pandemic among caregivers of young adolescents aged 10-12 yrs in a semi-urban setting in Ghana

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Mensah, Ebenezer Adjetey, Lois M.D. Aryee, Charles D. Arnold, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7215235/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Mar, 2026 Read the published version in BMC Public Health → Version 1 posted 17 You are reading this latest preprint version Abstract Background Few studies have described the consequences of the COVID − 19 pandemic among caregivers of young adolescents in sub-Saharan Africa. We aimed to explore the consequences of COVID-19 on economic, socio-emotional, and household food security conditions among caregivers of young adolescents in a semi-urban setting in the Eastern Region of Ghana. Methods In this cross-sectional study, caregivers of young adolescents aged 10-12yrs in the Somanya-Kpong area were enrolled. These participants were part of the second follow-up of the iLiNS-DYAD Ghana trial. A questionnaire designed from the PhenX Toolkit COVID-19 Protocol and the Food Access and Food Security During COVID-19 Survey (Version 2.1) was used to collect data over 8 months starting January 2022. We used descriptive statistics to summarize data and McNemar Chi-square tests to compare percentages of agreement to statements of household food security conditions “ one year before” versus “ since” the pandemic outbreak. Results Among 966 caregivers (94% females; 6% males), 89% reported decreased household income compared with the year before the pandemic. Although 72.5% of caregivers continued working during the pandemic, most said they had experienced a reduction in their work hours (72.6%), workload (78.8%) and salaries (63.4%). Many (65%) said their children engaged in educational activities when schools were closed, with 46% hiring private teachers. Caregivers most frequently cited financial concerns (83%) and negative impact on work (79%) as their greatest sources of stress because of COVID-19. Significantly more caregivers reported experiencing household food insecurity conditions “ since the outbreak ” compared to “ one year before the outbreak ” (55.4% vs 19.6%, P < 0.05). Conclusions In this setting, COVID-19 had negative consequences on the economic, socio-emotional, and household food security conditions of caregivers and their young adolescents. Trial registration: Clinical trial number not applicable. COVID-19 caregivers young adolescents economic education household food situation Ghana Figures Figure 1 Background The Coronavirus Disease 2019 (COVID-19) pandemic severely disrupted public health, economic, and social systems worldwide [ 1 , 2 , 3 ]. As of 31 December 2023, COVID-19 had been confirmed in over 773 million people worldwide, with over 7 million deaths and many more experiencing adverse longer-term health consequences after being infected [ 4 , 5 ]. In Ghana, the first official cases of COVID-19 were reported on 12 March 2020 [ 6 ]. The Government of Ghana quickly implemented containment measures, including border closures, partial lockdowns in major urban cities, bans on all public gatherings (e.g., conferences, workshops, funerals, festivals, political rallies, churches, mosques etc.), and closure of all educational institutions lasting for 10 months from March 2020 to January 2021 [ 6 , 7 , 8 , 9 ]. COVID-19 protocols such as wearing face masks, handwashing, use of sanitizer, and social distancing, were strictly enforced and/or adhered to in all public places [ 1 , 10 ]. The government declared on 28 May 2023 that the pandemic was no longer of significant threat [ 11 ]. By this time, countless livelihoods were altered, and the economic burden and hardships many experienced due to the pandemic had been immense [ 12 , 13 , 14 , 15 ]. For example, during the first two months of the pandemic, approximately 42,000 Ghanaians lost their jobs [ 12 ]. There was an increase in unemployment rate [ 12 , 13 ], a reduction in income [ 14 ], a reduction in per capita household consumption of food and non-food goods [ 14 , 16 ] and increased psychological distress [ 1 ]. Education was also significantly impacted. With the closure of schools for 10 months, nearly 9.2 million Ghanaian students in basic school (i.e., kindergarten, primary, and junior and senior high schools) and 0.5 million in tertiary institutions (i.e., college, university) had been affected. Although virtual platforms were largely launched to facilitate learning among school children and students, these were not accessible to all students [ 15 ]. These consequences of the pandemic disproportionately affected vulnerable populations, including children and their families, the poor, the elderly, and people living in rural areas [ 8 , 9 , 17 ]. The socioeconomic, emotional, and food security disruptions caused by the COVID-19 pandemic may be widespread, but the available evidence for people in various vulnerable settings in Africa is limited. A recent scoping review identified only 22 studies of the impacts of the pandemic on the well-being of families in Africa [ 18 ], with only a fraction of these considering adolescence specifically. In Ghana, the impact of the pandemic on households has predominantly been examined through nationwide statistics, which may mask substantial sub-national variations [ 7 , 9 , 14 , 19 ]. Additionally, most of these studies focused on areas included in the government’s COVID-19 lockdown [ 20 ], which were predominantly urban. Hence, the impacts of the pandemic on the wellbeing of more than 40% of Ghana’s families [ 21 ] remain unknown. Examining the impact of the COVID-19 pandemic among households in semi-urban settings in Ghana is of considerable importance for understanding the various challenges these communities faced. Such areas at the interface of urban and rural zones are increasingly common in Ghana, affecting the lifestyles of localities that previously subsisted primarily through farming [ 22 ]. Typically, such communities in Ghana have limited access to social amenities and employment opportunities, making it likely that many caregivers of children in these areas particularly vulnerable during the COVID-19 pandemic. This research leveraged an existing cohort of young adolescents enrolled in the second follow-up study of the International Lipid-Based Nutrient Supplements (iLiNS) DYAD Ghana trial in the Somanya-Kpong area [ 23 ] to focus on the caregivers of these young adolescents. The area is a semi-urban setting located approximately 70 km north of Accra [ 24 ]. It was likely that the impacts of the pandemic in this area reflected patterns in similar settings in Ghana, particularly in terms of economic stability, socio-emotional well-being, and food security. The pre-existing relationship between the families of these young adolescents and our research team provided an opportunity to engage with the caregivers who were amenable to discuss how the pandemic affected their livelihoods and families. Considering these circumstances, the present study aimed to explore the consequences of COVID-19 on the economic, socio-emotional, and household food security conditions of caregivers and their young adolescents living in a semi-urban setting in Ghana. Methods Study design, participants, and site This cross-sectional study was conducted in the Somanya-Kpong area in the Yilo Krobo and Lower Manya Krobo districts in the Eastern Region of Ghana, about 70 km north of Accra, the national capital. Participants were the primary caregivers of young adolescents aged 10–12 years who were taking part in the second follow-up study of the iLiNS DYAD Ghana randomized trial [ 23 ]. Most residents of the area were subsistence farmers or petty traders and were middle class, by Ghanaian living standards [ 24 ]. Their staple foods consisted of maize, cassava, rice, fish, and leafy vegetables. The area was not included in the 3-week COVID-19 total lockdown of parts of the country (i.e., the Greater Accra Metropolitan Area and the Greater Kumasi Metropolitan Area) from 30 March 2020 [ 25 , 26 ], but experienced other government-instituted COVID-19 prevention measures, including closure of basic schools [ 27 ] (from March 2020 until after January 2021), a ban on public gatherings [ 28 ] (e.g., sporting, funerals, festivals, and church activities from March to August 2020), fumigation of markets and schools (April to July 2020), and enforcement of social distancing and wearing of face masks throughout the pandemic [ 29 ]. The Government of Ghana also instituted measures across the country, including distance learning via radio, television, and online platforms to mitigate academic disruptions [ 30 ]; it was unlikely these measures were effective in the study area due to poor access to Information and Communication Technology infrastructure. Enrolment and data collection procedures Participant’s sociodemographic information were collected between December 2020 and December 2021 as part of the follow-up study they were participating in. From 28 January 2022 to 23 September 2022, field workers re-contacted the caregivers using the last-known telephone numbers and/or home addresses. We obtained written informed consent and assent from the caregivers and adolescents for the present study. Subsequently, field workers administered a COVID-19 related questionnaire, which we designed from the PhenX Toolkit COVID-19 Protocols ( https://www.phenxtoolkit.org/protocols ) [ 31 ] and the Food Access and Food Security During COVID-19 Survey Version 2.1 [ 32 ]. Specific questions were selected to cover relevant domains including household income, finances, and employment (n = 13), education (n = 13), emotional and social behavior (n = 14), and food access and security (n = 2) (see Supplemental Material 1). The questions were administered in three local languages ( Twi , Ewe , and Ga -A dangme ), and we asked participants to focus on one year before the COVID-19 outbreak as against the period since the COVID-19 outbreak . The COVID-19 questionnaire was programmed on tablets using the SurveyCTO software. SurveyCTO has in-built quality checks to minimize the entry of implausible values. Seven field workers were trained to administer the questionnaire, and a standard operating procedure manual was developed to ensure consistency in administering the questionnaire. The questionnaire was piloted among 20 caregivers in the study area who were not part of the iLiNS-DYAD follow-up study to assess feasibility, duration, and adaptation in the local context. Outcome variables First, we inquired about household and caregiver’s income situation during the COVID-19 pandemic, including (i) “ Has your household income changed since the COVID-19 outbreak?” , (ii) “Did you lose any jobs during the COVID-19 outbreak?” and (iii) “ Did you experience significant changes in your job because of or during the COVID-19 outbreak?” . Second, we inquired about children's learning conditions during the pandemic, including (i) “ During the time of school closure, were school children in this household doing educational activities at home?” , (ii) “What were the sources of educational or learning activities for children in this household during the school closures?”; (iii) “Who assisted the children with educational activities?” ; and (iv) “ How has the outbreak affected your childcare while school was suspended? ” Third, to collect caregiver’s report of changes in their children’s and their own emotional behavior and social connectedness before versus during the COVID-19 pandemic, we used (i) a Likert scale from 1 (much less often) to 5 (much more often) to measure the following questions a. “Indicate the extent to which young children in this household felt irritated, afraid, and sad before the COVID-19 and since the COVID-19 outbreak (during the school closure)” ,b. “Indicate the extent to you felt irritated, afraid, and sad before the COVID-19 and since the COVID-19 outbreak (during the school closure)” and (ii) a Likert scale from 1 (less socially connected) to 6 (much more socially connected) to measure the question, “ Indicate the extent to which the child seems socially connected to other people and his environment before the COVID-19 outbreak and during the COVID 19 (especially during the school closures) ”. In addition, we used a Likert scale from 1 (extremely negative) to 7 (extremely positive) to measure the question, “indicate the extent to which you view the COVID-19 outbreak as having either a positive or negative impact on your life”. We inquired about caregivers’ stress during the pandemic including a. “ What have been your greatest sources of stress from the COVID-19 outbreak? ” and b. “What have you done to cope with your stress related to the COVID-19 outbreak?” . Finally, caregivers reported household food security conditions (i) on a Likert scale from 1 (not at all worried) to 6 (extremely worried), measuring the question “On a scale from 1 (not at all worried) to 6 (extremely worried), what is your level of worry for your household about the following as it relates to COVID-19” , and (ii) agreement (“never true”, “sometimes true” and “often true”) with statements about their household’s food situation in the last year before the COVID-19 and since the COVID-19 outbreak Data analysis A statistical analysis plan was prepared prior to the data analysis. The data were analyzed using R version 4.2.1 supported by MS Excel 2016. Descriptive statistics were used to summarize participants’ background characteristics and the outcome variables. Due to low frequency of responses for certain categories across many of the Likert scale variables and to ensure uniformity and consistency in the presentation of results, we dichotomized the Likert scale ratings. The 5-point Likert scale ratings of the extent to which caregivers and children (by caregivers’ reports) felt irritated, afraid, anxious, and sad before and during the COVID-19 pandemic were dichotomized as “often” (if caregivers responded, “much more often”, “more often” or “somewhat often”) or “not often” (if caregivers responded, “much less often” and “less often” responses). We calculated the percentage of caregivers and children who reportedly “often” felt irritated, afraid, anxious, or sad before and during the COVID-19 pandemic. The 6-point Likert scale ratings of the extent to which children (by caregivers’ reports) were socially connected to other people and their environment before and during the COVID-19 pandemic were dichotomized as “socially connected” (if caregivers reported “much more socially connected”, “more socially connected” or “slightly more socially connected”) and “not socially connected” (if caregivers reported “much less socially connected”, “less socially connected” and “slightly less socially connected”). We calculated the percentage of children who reportedly were “socially connected” to other people in their environment before and during the COVID-19 pandemic. We calculated the mean (SD) score of the 6-point Likert scale ratings of caregivers’ level of worry about food situation during COVID-19 and dichotomized the 3-point Likert scale responses of caregiver’s agreement with statements about their household food situation to “yes” (for “sometimes true” and “often true”) or “no” (for “never true”). Finally, we used McNemar Chi-square tests to compare percentages of caregivers with agreement (“yes”) to the statements about their household food situation “ one year before the outbreak ” versus “ since the outbreak ”. A significance level of p < 0.05 was used. Results The background characteristics of the caregivers interviewed are shown in Table 1 . Of the 966 caregivers, 93.6% were females. Most were self-employed mainly as traders and shop owners before COVID-19 (83%), married or in an informal union (81%), and had education up to Junior High School (73%). The household members of respondents who were in school at the time of data collection (n = 2970) consisted predominantly of those in primary (56.6%) and Junior High (16.4%) schools. Table 1 Background characteristics of caregivers (n = 966) Characteristics n (%) Gender of caregivers Female 904 (93.6) Male 62 (6.4) Employment status of caregivers before COVID-19 Self-employed 802 (83.0) Salaried worker 132 (13.7) Unemployed 32 (3.3) Marital status of caregivers Married 509 (53.1) Informal/loose union 267 (27.9) Separated 77 (8.1) Widowed 54 (5.6) Divorced 28 (2.9) Single (never married or in an informal union) 23 (2.4) Level of education of caregivers Primary school 213 (22.2) Junior high school 487 (50.8) Senior high school 95 (9.9) None 90 (9.4) Other training institutions 38 (4.0) Tertiary 35 (3.7) Household members currently enrolled in school 1 Pre-school or day care 419 (14.1) Primary school 1680 (56.6) Junior high school 488 (16.4) Senior high school 299 (10.1) Tertiary 84 (2.8) 1 Multiple response questions Household income, caregivers' working situation, and children's learning conditions (by caregivers’ report) during the COVID-19 pandemic Table 2 summarizes the reported changes in household income, caregivers’ working situation, and children’s learning conditions (by caregivers’ report) during the COVID-19 pandemic. Most caregivers (88.5%) reported less household income due to the pandemic; 27.5% reportedly lost their jobs because of the pandemic. Changes in caregivers’ working conditions most frequently reported during the COVID-19 pandemic were decreased workload (reported by 79% of caregivers) and salary or wage cut (reported by 63% of caregivers). By contrast, increased workload and increased salary or wage were reported by only 2–6% of caregivers. Table 2 also shows that during school closures due to the pandemic, 64.7% of caregivers said their children engaged in educational activities at home. The sources of educational or learning activities most frequently reported by caregivers were private teachers (46.2% of caregivers); educational TV programs (32.6%); and sessions, meetings and/or assignments provided by the schoolteacher (26.1%). The most frequent helpers with children’s educational activities were caregivers (65.8%), followed by the children themselves (47.0%), then other household members (26.0%) such as older siblings. Regarding whether the outbreak had affected caregivers ’childcare while schools were suspended, the vast majority (81.8%) of caregivers reported no impact, except for a relatively small percentage who or whose partners reportedly changed their work schedule to care for their children (14.4%), had difficulty arranging for childcare (2.7%), or had to pay more for childcare (0.5%). Caregivers also reported that a greater percentage of their children were socially connected to other people and their environment before the pandemic (91.9%) versus during the pandemic (44.2%). Table 2 Caregivers' reported household income situation, and children's learning conditions (n = 966) Variable n (%) Has your household income changed substantially since the COVID 19 outbreak? My household income is less 855 (88.5) My household income is about the same 97 (10.0) My household income is more 14 (1.5) Did you lose any job(s) during the covid-19 outbreak? Continued working 661 (72.5) Lost job 251 (27.5) Did you experience significant changes with your job? 1 Decrease in workload 652 (78.8) Decrease in work hours 600 (72.6) Salary or wage decreased 525 (63.4) No significant change 62 (7.5) Increase in work hours 56 (6.8) Increase in workload 52 (6.3) Salary or wage increased 20 (2.4) During the time of school closure, were school children in this household doing educational activities at home? Yes 625 (64.7) No 341 (35.3) What were the sources of educational or learning activities for child(ren) in this household during the school closures? 1 Private lessons (Hired teacher) 290 (46.2) Watched educational TV programmes 205 (32.6) Session/meetings/ Completed assignments provided by schoolteacher 164 (26.1) E-learning 24 (3.8) Used mobile learning apps 14 (2.2) Listened to educational programmes on radio 11 (1.8) Other (group studies, parents/siblings, learning from old notes) 218 (34.7) Who assisted with the educational activities? 1 Caregiver or spouse/partner 413 (65.8) Child themselves 296 (47.0) Other household members 166 (26.0) The school 25 (4.0) Other (neighbors, friends, hired teachers) 52 (8.3) How has the outbreak affected your childcare while school was suspended? 1 My regular childcare has not been affected by the COVID-19 outbreak 792 (81.8) My spouse/partner or I had to change our work schedule to care for our children ourselves 138 (14.4) I had difficulty arranging for childcare 26 (2.7) I had to pay more for childcare 5 (0.5) Childrens’ social connectedness to other people and their environment “Socially connected” Before Pandemic “Socially connected” After Pandemic 888 (91.9) 427 (44.2) 1 Multiple response questions Changes in emotional behavior of caregivers and children During versus before the pandemic, greater percentages of children were reportedly “often irritated” (60.8% versus 21.5%), “often afraid” (66.6% versus 18.9%), “often anxious (50.7% versus 17.3%) and “often sad” (56.6% versus 21.1%) (Fig. 1 ) . Likewise, greater percentages of caregivers were reportedly “often irritated” (75.3% versus 29.5%), “often afraid” (76.8% versus 13.5%), “often anxious (67.9% versus 23.6%) and “often sad” (75.1% versus 32%) during the pandemic compared with before the pandemic (Fig. 1 ). Caregivers’ perceived impact of COVID-19 and coping strategies As shown in Table 3 , most (89.9%) caregivers perceived that the impact of COVID-19 on their lives was “extremely negative” (40.7%), “moderately negative” (30.2%) or “somewhat negative” (19.0%), compared with those who reported “no” (6.1%) or “slightly positive”, “moderately positive” or “extremely positive” (4.0%) impact. The most frequently reported sources of stress due to COVID-19 were financial concerns (83.0% of participants) and impact on work (79.0%), access to food (47.8%), impact on child (47.1%), health concerns (27.2%), and impact on family members (21.0%). Other less frequently cited concerns were impact on the community (1.9%) and access to medical care; only 5.5% of caregivers were reportedly not stressed about the COVID-19 outbreak. The coping strategies most frequently cited by caregivers for dealing with the stress related to COVID-19 were “meditation and/ or mindfulness practices” (81.4%), “talking with friends and family through phone, text or video” (46.0%), “increased television or other ‘screen time’ activities such as video games and social media (43.5%) and “engaging in family activities (11.0%). Table 3 Caregivers’ perceived impact of COVID-19 and coping strategies Variable n (%) Please indicate the extent to which you view the COVID-19 outbreak as having either a positive or negative impact on your life? Extremely negative 393 (40.7) Moderately negative 292 (30.2) Somewhat negative 184 (19.0) No impact 59 (6.1) Slightly positive 17 (1.8) Moderately positive 17 (1.8) Extremely positive 4 (0.4) What have been your greatest sources of stress from the COVID-19 outbreak? 1 Financial concerns 802 (83.0) Impact on work 763 (79.0) Access to food 462 (47.8) Impact on your child 455 (47.1) Health concerns 263 (27.2) Impact on family members 203 (21.0) Social distancing or being quarantined 145 (15.0) Access to baby supplies (e.g., formula, diapers, wipes) 43 (4.5) Access to personal care products or household supplies 30 (3.1) Impact on your community 18 (1.9) Access to medical care, including mental health care 9 (0.9) Other (includes loss of relative, accommodation, wear of mask) 14 (1.4) I am not stressed about the COVID-19 outbreak 53 (5.5) What have you done to cope with your stress related to the COVID-19 outbreak? 1 Meditation and/or mindfulness practices 786 (81.4) Talking with friends and family (e.g., by phone, text, or video) 444 (46.0) Increased television watching or other “screen time” activities (e.g., video games, social media) 420 (43.5) Engaging in more family activities (e.g., games, sports) 106 (11.0) Eating more often, including snacking 72 (7.5) Increasing time reading books, or doing activities like puzzles and crosswords 67 (6.9) Drinking alcohol 22 (2.3) Volunteer work 7 (0.7) Talking to my healthcare providers more frequently, including mental healthcare providers (e.g., therapist, psychologist, counselor) 2 (0.2) Using tobacco (e.g., smoking, vaping) 1 (0.1) Other (includes sleeping, medication, listening to music) 26 (2.7) I have not done any of these things to cope with the COVID-19 outbreak 54 (5.6) 1 Multiple response questions Caregivers’ response on indicators of household food insecurity Table 4 shows that the mean (SD) Likert scale scores were high for several items of the household food conditions during the pandemic, including “household will not have enough food at home and cannot go out due to quarantine or illness” (5.0 (1.2)); “food will be more expensive for my household” (4.8 (1.4)); “my household will lose so much income that they cannot afford enough food” (4.7 (1.4)); “there will not be enough food in the marketplace (4.0 (1.7); and “the country will not have enough food to feed everyone (4.0 (1.7)). For each of five statements of the household food situation, indicative of household food insecurity, the percentage of caregivers expressing agreement was significantly (p < 0.05) lower for “one year before outbreak” compared with “since outbreak” of COVID-19. These statements included “food the household bought did not last and there was no money to get more ” (19.6% for one year before outbreak vs 55.4% for since outbreak ); “ household could not afford to eat balanced meals ” (17.1% vs 48.8%); “ household members ate less food than they felt they should because there was not enough money for food ” (17.3% vs 42.7%); “ adults in the household ever cut the size of meals or skipped meals because there was not enough money for food ” (15% vs 41.4%); and “adults in the household were ever hungry but did not eat because there was not enough money for food” (6.0% vs 18.4%). Table 4 Caregivers’ reported household food situation during COVID-19 Item Mean (SD) or % p-value Likert scale “level of worry” about household food situation during the COVID-19**: My household will not have enough food if we have to stay at home and can’t go out at all (due to quarantine or illness) 5.0 (1.2) Food will become more expensive for my household 4.8 (1.4) My household will lose so much income that we cannot afford enough food 4.7 (1.4) There will not be enough food in the marketplace 4.0 (1.7) The country will not have enough food to feed everyone 4.0 (1.7) Food will become unsafe or contaminated 3.6 (1.8) Percentages of caregivers reporting agreement with statements on household food situation The food the household bought did not last, and there was no money to get more One year before outbreak 19.6 Since outbreak 55.4 < 0.001 My household could not afford to eat balanced meals One year before outbreak 17.1 Since outbreak 48.8 < 0.001 Household members ate less food than they felt they should because there was not enough money for food One year before outbreak 17.3 Since outbreak 42.7 < 0.001 Adults in the household ever cut the size of meals or skipped meals because there was not enough money for food One year before outbreak 15.0 Since outbreak 41.4 < 0.001 Adults in the household were ever hungry but did not eat because there was not enough money for food One year before outbreak 6.0 Since outbreak 18.4 < 0.001 ** The Likert scale ranged from 1 (not at all worried) to 6 (extremely worried) Discussion Our findings reveal the negative consequences of COVID-19 among caregivers of young adolescents 10-12y of age in a semi-urban area in Ghana. Most of the caregivers interviewed reported a decrease in household income, with a few losing their jobs, while others experienced reduced workloads and salary cuts. During the school closures, young adolescents used various channels to learn; most caregivers engaged the services of private teachers for the children at home or allowed the children to watch educational TV programs. According to caregivers’ reports, higher percentages of caregivers and their young adolescents felt “often irritated”, “often afraid”, “often anxious”, and “often sad” during the COVID-19 than before the pandemic. Most caregivers perceived the pandemic negatively impacting their lives, often stressed by financial concerns, work, and poor access to food, and coped mainly by meditation, mindfulness practices, and communication with friends and family via phone or video. In our study, there also was a significant increase in the perceived household food situation since the COVID-19 outbreak compared to the year before, with these Ghanaian caregivers expressing high levels of concern about household food conditions. The reported decline in household income in our sample during the COVID-19 pandemic was consistent with reports from other studies in Ghana [ 16 , 20 , 33 ]; these reports highlighted the fact that informal self-employed workers typically experienced a fall in their household income during the COVID-19. The activities of self-employed workers, especially petty traders, mostly require physical contact; such workers mainly rely on daily sales as earnings, and this was massively affected by the pandemic [ 13 , 34 ]. Schotte et al. (2021) report that in Ghana, the earnings of self-employed women declined drastically during the pandemic, which may have further heightened the existing labor inequalities in the country [ 20 ]. Our findings corroborate those reported by Schotte et al. (2021). Although household incomes generally declined during the COVID-19 pandemic, most of the caregivers reportedly did not lose their jobs and continued to work during the pandemic. This may be because a majority of respondents were self-employed, and our study area had not been included in the partial lockdown that was instituted by the government of Ghana during the pandemic [ 27 ]. Durizzo et al. (2021) confirmed that in districts where there were no lockdowns, many workers in the informal self-employment sector continued to work and only few people lost their jobs [ 35 ]. The variety of learning channels used during school closures suggests that there is no “one size fits all” approach to learning. The high cost and poor connectivity of internet services [ 36 , 37 ] was a major problem in the study area; thus, it was not surprising that few people engaged in e-learning. The schools in the study area were mostly public schools, hence were not active in providing educational activities for children during the school closures. As such, parents and other family members had to take up much of the burden of providing their children with educational and learning resources during the pandemic. However, parents/caregivers may not have had the requisite educational background and skill set or be well equipped to teach their children at home [ 16 ]. This could partly explain why many of the respondents reported hiring a home teacher. Children from less privileged households without adequate means to engage home teachers may have faced difficulties in keeping up with their studies, potentially impacting their academic performance after school returned [ 16 ]. The increased prevalence of reported negative socio-emotional behavior (irritated, afraid, anxious, and sad) among caregivers and their young adolescents during the COVID-19 warrant discussion. Similar findings were reported among Ghanaian women and children [ 38 ] and Canadian families [ 39 ] as a result of the COVID-19 pandemic. Closures of schools and lockdowns caused children and caregivers to be confined at home, spending less time interacting and socialising with friends or people outside of their households. This social isolation may have contributed to the increased stress, anxiety, and even depression due to prolonged confinement and lack of social support. Constant close quarters with household members without external social interactions could have put a strain on family relationships, potentially leading to increased conflicts and tension at home, including excessive yelling and punishments from parents and other older family members [ 39 ]. For caregivers, additional stress may have resulted from financial difficulties, poor access to food, and possible work- and childcare-related problems due to the pandemic. It was not surprising that many participants reported being worried about their households’ food situation, which may likely have been the negative consequences of decreased household income and/or loss of employment because of the COVID-19 pandemic. During the lockdowns, demand for food appeared to exceed supply, thereby pushing food prices up [ 40 ], as many food markets were closed to enforce social distancing and/or allow for fumigation. As many of the respondent reportedly ate less frequently and had reduced variety and quality of food, those changes could have contributed to increased stress among the participants and their children [ 41 ]. Our study had several strengths. The caregivers’ participation in the ongoing iLiNS-DYAD follow-up study probably resulted in a high response rate from the participants. Participation in the follow-up study likely increased the caregivers' comfort with sharing their life experiences during the pandemic, potentially enhancing the reliability of the data collected. The interview questionnaire was administered in person, which likely helped maintain the depth and quality of the data. The study had a few limitations. First, we had only one round of data collection after the outbreak. Given the multiple waves of the pandemic, the changes we observed may have varied over time. We began data collection about 2 years after the outbreak of the pandemic, and the data collection took about 9 months to complete, by which time the reported COVID-19 cases had declined and many containment measures had been eased. It is possible that participants’ adaptations over time may have diluted the perceived impact of the pandemic. This time lag may have introduced some recall bias due to the self-reported nature of outcome measures. However, all data were collected while the pandemic was still active and therefore reflected the ongoing conditions and experiences of participants. In addition, to keep the survey from being burdensome for participants, we did not collect sociodemographic information that had been collected 1–2 years previously; hence, it is possible that family characteristics may have been somewhat different than described in the method section. Conclusion In this setting, COVID-19 had negative consequences on the economic, socio-emotional, and household food security conditions of caregivers of young adolescents. Our study findings contribute to understanding the impact of the pandemic in Ghana. The findings are comparable with other studies and add to the existing literature on the multiple disruptions and impact of the pandemic on livelihoods. This can help inform public health responses in future pandemics. To extend the findings of our study, further investigation on the long-term effect of the COVID-19 pandemic and how individuals and households recovered post COVID-19 can be conducted. Abbreviations COVID-19 Coronavirus Disease 2019 iLiNS International Lipid-Based Nutrient Supplement Declarations Ethics approval and consent to participate Ethics approval for the present study was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC: 027105119) and the Institutional Review Board of the University of California, Davis (IRB ID: 1489918). We obtained written informed consent from the caregivers for this study and assent from the adolescents as part of the follow-up study. The consenting procedure was done orally in any of the three local languages (Twi, Ewe, and Ga-Adangme) understood and spoken by the participants. Participants signed or thumb printed the consent and assent forms and were given a copy as evidence of consent. The study followed the principles outlined in the declaration of Helsinki. Consent for publication “Not applicable”. Availability of data and materials All the data underlying this study is available at https://osf.io/bmv9d/ Competing interests “The authors declare that they have no competing interests.” Funding This study was funded by grants from the National Institute of Health Sciences (R01HD099811) and the Bill & Melinda Gates Foundation (OPP49817) to the University of California, Davis and the University of Ghana. Registered at clinicaltrials.gov as NCT00970866 (Clinical trial number not applicable). https://clinicaltrials.gov/ct2/show/record/NCT00970866. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authors’ contributions ELP, SA-A, PDH, BMO, AG and MOM designed the research; SA-A, EA, MOM conducted the research; EA, CDA, MOM analyzed the data; MOM, EA and LMDA led the writing of the manuscript with review from SA-A, CDA, PDH, BMO, LMDA, HN, HJB, JF. All authors except ELP read and approved the final manuscript. ELP passed on during the preparation of the manuscript. Acknowledgment We are grateful to the caregivers and children who participated in the study. We also thank Mandy McCarthy, Sika Doris, Monica Matey, Phoebe Ametepey, Isaac Sackitey Baah, Mary Sackitey, Vivian Abayavor for the data collection, and Richard Azumah for support with project management. References Dai-Kosi AD, Acquaye VA, Pereko KKA, Blankson P-K, Ackom C. The impact of COVID-19 social restrictions on culture and psychosocial well-being: The Ghanaian experience. Mental Health Effects of COVID-19. 2021:103-15. Lewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID-19. The Lancet infectious diseases. 2020;20(6):631-3. Lin Q, Zhao S, Gao D, Lou Y, Yang S, Musa SS, et al. A conceptual model for the coronavirus disease 2019 (COVID-19) outbreak in Wuhan, China with individual reaction and governmental action. International journal of infectious diseases. 2020;93:211-6. World Health Organization. WHO Coronavirus (COVID-19) Dashboard: World Health Organization; 2023 [Available from: https://covid19.who.int/.] Bundervoet T, Dávalos ME, Garcia N. The short-term impacts of COVID-19 on households in developing countries: an overview based on a harmonized dataset of high-frequency surveys. World development. 2022:105844. Afriyie DK, Asare GA, Amponsah SK, Godman B. COVID-19 pandemic in resource-poor countries: challenges, experiences and opportunities in Ghana. The Journal of Infection in Developing Countries. 2020;14(08):838-43. Asante D, Twumasi MA, Sakyi ASK, Gyamerah S, Asante B. A socio-geographic perspective of health and economic impacts of COVID-19 on poor households in ghana. GeoJournal. 2022;87(5):4113-25. Gyasi RM. Fighting COVID-19: Fear and internal conflict among older adults in Ghana. Journal of Gerontological social work. 2020;63(6-7):688-90. Asante LA, Mills RO. Exploring the socio-economic impact of COVID-19 pandemic in marketplaces in urban Ghana. Africa Spectrum. 2020;55(2):170-81. Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. The Lancet Public Health. 2020;5(5):e256. Zurek K. President Akufo-Addo declares end of COVID-19 pandemic in Ghana. Graphic online. 2023. Aduhene DT, Osei-Assibey E. Socio-economic impact of COVID-19 on Ghana's economy: challenges and prospects. International Journal of Social Economics. 2021. Danquah M, Schotte S, Sen K. COVID-19 and Employment: Insights from the Sub-Saharan African Experience. The Indian Journal of Labour Economics. 2020;63(1):23-30. Bukari C, Essilfie G, Aning-Agyei MA, Otoo IC, Kyeremeh C, Owusu AA, et al. Impact of COVID-19 on poverty and living standards in Ghana: A micro-perspective. Cogent Economics & Finance. 2021;9(1):1879716. UNESCO, UNICEF. COVID-19: Socio-economic Impact in Ghana - Impact on Education 2020. UNICEF. Primary and secondary impacts of the COVID-19 pandemic on children in Ghana. UNICEF; 2021. World Bank, UNICEF. The Impact of COVID-19 on the Welfare of Households with Children. Washington, DC: World Bank; 2022. Chigeza S, Wilson Fadiji A, Matamela N. A Scoping Review of the Impact of the COVID-19 Pandemic on Family Wellbeing in Africa. The Family Journal. 2024; 28:10664807241269507. Karpati J, Elezaj E, Cebotari V, de Neubourg C. Primary and secondary impacts of the COVID-19 pandemic on children in Ghana. 2021. Schotte S, Danquah M, Osei RD, Sen K. The labour market impact of COVID-19 lockdowns: Evidence from Ghana. 2021. O’Neil, A. Urbanization in Ghana 2023. 2024. https://www.statista.com/statistics/455827/urbanization-in-ghana/. Abdulai IA, Ahmed A, Kuusaana ED. Secondary cities under siege: examining peri-urbanisation and farmer households’ livelihood diversification practices in Ghana. Heliyon. 2022;8(9). Prado EL, Adu-Afarwuah S, Arnold CD, Adjetey E, Amponsah B, Bentil H, Dewey KG, Guyer AE, Manu A, Mensah M, Oaks BM. Prenatal and postnatal small-quantity lipid-based nutrient supplements and children’s social–emotional difficulties at ages 9–11 y in Ghana: follow-up of a randomized controlled trial. The American Journal of Clinical Nutrition. 2023;118(2):433-42. Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Zeilani M, Peerson JM, et al. Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana2. The American Journal of Clinical Nutrition. 2015;101(4):835-46. Assan A, Hussein H, Agyeman-Duah DNK. COVID-19 lockdown implementation in Ghana: lessons learned and hurdles to overcome. Journal of Public Health Policy. 2022;43(1):129-39. Sen K, Danquah M, Osei RD, Schotte S. Ghana’s lockdown hit vulnerable workers hard: what needs to happen next time. The Conversation https://theconversation com/ghanas-lockdown-hit-vulnerable-workers-hard-what-needs-to-happen-next-time-156876. 2021. Lartey NL. SHS, JHS first-years to resume in January 2021; kids in KG, primary to also return in new year. Citi newsroom [Internet]. 2020 1st February 2024. Available from: https://citinewsroom.com/2020/08/shs-jhs-first-years-to-resume-in-january-2021-kids-in-kg-primary-to-also-return-in-new-year/. Hansen GM. Ghana reinstates ban on concerts, public gatherings. Music in Africa [Internet]. 2021 1st February 2024. Available from: https://www.musicinafrica.net/magazine/ghana-reinstates-ban-concerts-public-gatherings. Kenu E, Frimpong JA, Koram KA. Responding to the COVID-19 pandemic in Ghana. Ghana Medical Journal. 2020;54(2):72-3. Education Mo. COVID-19 coordinated education response plan for Ghana ministry of education 2020. Available from: https://ges.gov.gh/wp-content/uploads/2020/04/EDUCATION-RESPONSE-PLAN-TO-COVID-19-IN-GHANA-APRIL-2020-1.pdf. Hamilton CM, Strader LC, Pratt JG, Maiese D, Hendershot T, Kwok RK, et al. The PhenX Toolkit: get the most from your measures. American Journal of Epidemiology. 2011;174(3):253-60. Niles MT, Neff R, Biehl E, Bertmann F, Belarmino EH, Acciai F, et al. Food Access and Food Security during COVID-19 Survey-Version 2.1. Harvard Dataverse. 2020;3. Inovation for Poverty Action (IPA). The Effects of COVID-19 on Business and Employment in Ghana. 2020. Balde R, Boly M, Avenyo EK. Labour market effects of COVID-19 in sub-Saharan Africa: An informality lens from Burkina Faso, Mali and Senegal: Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT); 2020 May 25. Durizzo K, Asiedu E, Van der Merwe A, Van Niekerk A, Günther I. Managing the COVID-19 pandemic in poor urban neighborhoods: The case of Accra and Johannesburg. World Development. 2021;137:105175. UNICEF. Primary and secondary impacts of the COVID-19 on women and children in Ghana. UNICEF; 2021. Gadermann AC, Thomson KC, Richardson CG, Gagné M, McAuliffe C, Hirani S, et al. Examining the impacts of the COVID-19 pandemic on family mental health in Canada: findings from a national cross-sectional study. BMJ Open. 2021;11(1):e042871. Kawakatsu Y, Damptey O, Sitor J, Situma R, Aballo J, Shetye M, et al. Impact of COVID-19 pandemic on food availability and affordability: an interrupted time series analysis in Ghana. BMC Public Health. 2024;24(1):1268. Jafri A, Mathe N, Aglago EK, Konyole SO, Ouedraogo M, Audain K, et al. Food availability, accessibility and dietary practices during the COVID-19 pandemic: A Multi-country Survey. Public Health Nutr. 2021;24(7):1798-805. Wireko, J. K., Brenya, B., & Doshi, R. (2021, September). Financial impact of internet access infrastructure of online learning mode on tertiary students in COVID-19 era in Ghana. In 2021 International Conference on Computing, Communication and Green Engineering (CCGE) (pp. 1-7). IEEE. Tahiru, F., Tei Asare, B., Asante, G., & Agbesi, S. (2020, December). Internet Access and Cost and Its Impact on Citizens Engagement on E-Government Services. In TPRC48: The 48th Research Conference on Communication, Information and Internet Policy. Additional Declarations No competing interests reported. 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As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7215235","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502539715,"identity":"d72f2693-2b05-4983-8e79-8103f17151be","order_by":0,"name":"Mavis O. 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Arnold","email":"","orcid":"","institution":"University of California-Davis","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"D.","lastName":"Arnold","suffix":""},{"id":502539719,"identity":"05803701-0355-4f53-8d73-f15a04aaf533","order_by":4,"name":"Elizabeth L Prado","email":"","orcid":"","institution":"University of California-Davis","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"L","lastName":"Prado","suffix":""},{"id":502539720,"identity":"a2e11083-1c89-4226-a0f6-ffb6f51d0ca6","order_by":5,"name":"Paul D. 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Oaks","email":"","orcid":"","institution":"University of Rhode Island","correspondingAuthor":false,"prefix":"","firstName":"Brietta","middleName":"M.","lastName":"Oaks","suffix":""},{"id":502539723,"identity":"14f49546-f869-4217-bd38-eee6157b8581","order_by":8,"name":"Helena Nti","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Helena","middleName":"","lastName":"Nti","suffix":""},{"id":502539724,"identity":"6d002c77-105f-4925-b9e4-cf81bb82bdb6","order_by":9,"name":"Helena J. Bentil","email":"","orcid":"","institution":"University of California-Davis","correspondingAuthor":false,"prefix":"","firstName":"Helena","middleName":"J.","lastName":"Bentil","suffix":""},{"id":502539725,"identity":"daf651df-887a-461d-b2ec-79effee956dc","order_by":10,"name":"Jonnatan Fajardo","email":"","orcid":"","institution":"University of California-Davis","correspondingAuthor":false,"prefix":"","firstName":"Jonnatan","middleName":"","lastName":"Fajardo","suffix":""},{"id":502539726,"identity":"b538575f-d884-45a4-b0ff-63a5a27ac25e","order_by":11,"name":"Seth Adu-Afarwuah","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Seth","middleName":"","lastName":"Adu-Afarwuah","suffix":""}],"badges":[],"createdAt":"2025-07-25 14:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7215235/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7215235/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-026-26873-9","type":"published","date":"2026-03-03T15:59:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89573932,"identity":"824db6e5-d687-4f69-9702-0d603b17468a","added_by":"auto","created_at":"2025-08-21 12:50:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79611,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePercentage of children and caregivers feelings before and during the COVID-19 pandemic, by caregiver report.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7215235/v1/501aad09e358bc39d2d88ecb.jpg"},{"id":104251534,"identity":"f9ac8cf1-14b7-4f7a-a5f5-54f4333ab9c3","added_by":"auto","created_at":"2026-03-09 16:13:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1733704,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7215235/v1/a563a1d5-daad-4479-952b-40c97ed4d205.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Economic, socio-emotional, and food security conditions during COVID-19 pandemic among caregivers of young adolescents aged 10-12 yrs in a semi-urban setting in Ghana","fulltext":[{"header":"Background","content":"\u003cp\u003eThe Coronavirus Disease 2019 (COVID-19) pandemic severely disrupted public health, economic, and social systems worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As of 31 December 2023, COVID-19 had been confirmed in over 773\u0026nbsp;million people worldwide, with over 7\u0026nbsp;million deaths and many more experiencing adverse longer-term health consequences after being infected [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Ghana, the first official cases of COVID-19 were reported on 12 March 2020 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The Government of Ghana quickly implemented containment measures, including border closures, partial lockdowns in major urban cities, bans on all public gatherings (e.g., conferences, workshops, funerals, festivals, political rallies, churches, mosques etc.), and closure of all educational institutions lasting for 10 months from March 2020 to January 2021 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. COVID-19 protocols such as wearing face masks, handwashing, use of sanitizer, and social distancing, were strictly enforced and/or adhered to in all public places [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe government declared on 28 May 2023 that the pandemic was no longer of significant threat [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. By this time, countless livelihoods were altered, and the economic burden and hardships many experienced due to the pandemic had been immense [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. For example, during the first two months of the pandemic, approximately 42,000 Ghanaians lost their jobs [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. There was an increase in unemployment rate [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], a reduction in income [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], a reduction in per capita household consumption of food and non-food goods [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and increased psychological distress [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Education was also significantly impacted. With the closure of schools for 10 months, nearly 9.2\u0026nbsp;million Ghanaian students in basic school (i.e., kindergarten, primary, and junior and senior high schools) and 0.5\u0026nbsp;million in tertiary institutions (i.e., college, university) had been affected. Although virtual platforms were largely launched to facilitate learning among school children and students, these were not accessible to all students [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These consequences of the pandemic disproportionately affected vulnerable populations, including children and their families, the poor, the elderly, and people living in rural areas [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe socioeconomic, emotional, and food security disruptions caused by the COVID-19 pandemic may be widespread, but the available evidence for people in various vulnerable settings in Africa is limited. A recent scoping review identified only 22 studies of the impacts of the pandemic on the well-being of families in Africa [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], with only a fraction of these considering adolescence specifically. In Ghana, the impact of the pandemic on households has predominantly been examined through nationwide statistics, which may mask substantial sub-national variations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Additionally, most of these studies focused on areas included in the government’s COVID-19 lockdown [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which were predominantly urban. Hence, the impacts of the pandemic on the wellbeing of more than 40% of Ghana’s families [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] remain unknown.\u003c/p\u003e\u003cp\u003eExamining the impact of the COVID-19 pandemic among households in semi-urban settings in Ghana is of considerable importance for understanding the various challenges these communities faced. Such areas at the interface of urban and rural zones are increasingly common in Ghana, affecting the lifestyles of localities that previously subsisted primarily through farming [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Typically, such communities in Ghana have limited access to social amenities and employment opportunities, making it likely that many caregivers of children in these areas particularly vulnerable during the COVID-19 pandemic.\u003c/p\u003e\u003cp\u003eThis research leveraged an existing cohort of young adolescents enrolled in the second follow-up study of the International Lipid-Based Nutrient Supplements (iLiNS) DYAD Ghana trial in the Somanya-Kpong area [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] to focus on the caregivers of these young adolescents. The area is a semi-urban setting located approximately 70 km north of Accra [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. It was likely that the impacts of the pandemic in this area reflected patterns in similar settings in Ghana, particularly in terms of economic stability, socio-emotional well-being, and food security. The pre-existing relationship between the families of these young adolescents and our research team provided an opportunity to engage with the caregivers who were amenable to discuss how the pandemic affected their livelihoods and families.\u003c/p\u003e\u003cp\u003eConsidering these circumstances, the present study aimed to explore the consequences of COVID-19 on the economic, socio-emotional, and household food security conditions of caregivers and their young adolescents living in a semi-urban setting in Ghana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy design, participants, and site\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThis cross-sectional study was conducted in the Somanya-Kpong area in the Yilo Krobo and Lower Manya Krobo districts in the Eastern Region of Ghana, about 70 km north of Accra, the national capital. Participants were the primary caregivers of young adolescents aged 10–12 years who were taking part in the second follow-up study of the iLiNS DYAD Ghana randomized trial [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMost residents of the area were subsistence farmers or petty traders and were middle class, by Ghanaian living standards [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Their staple foods consisted of maize, cassava, rice, fish, and leafy vegetables. The area was not included in the 3-week COVID-19 total lockdown of parts of the country (i.e., the Greater Accra Metropolitan Area and the Greater Kumasi Metropolitan Area) from 30 March 2020 [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], but experienced other government-instituted COVID-19 prevention measures, including closure of basic schools [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] (from March 2020 until after January 2021), a ban on public gatherings [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] (e.g., sporting, funerals, festivals, and church activities from March to August 2020), fumigation of markets and schools (April to July 2020), and enforcement of social distancing and wearing of face masks throughout the pandemic [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The Government of Ghana also instituted measures across the country, including distance learning via radio, television, and online platforms to mitigate academic disruptions [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]; it was unlikely these measures were effective in the study area due to poor access to Information and Communication Technology infrastructure.\u003c/p\u003e\u003cp\u003e\u003cem\u003eEnrolment and data collection procedures\u003c/em\u003e\u003c/p\u003e\u003cp\u003eParticipant’s sociodemographic information were collected between December 2020 and December 2021 as part of the follow-up study they were participating in. From 28 January 2022 to 23 September 2022, field workers re-contacted the caregivers using the last-known telephone numbers and/or home addresses. We obtained written informed consent and assent from the caregivers and adolescents for the present study. Subsequently, field workers administered a COVID-19 related questionnaire, which we designed from the PhenX Toolkit COVID-19 Protocols (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.phenxtoolkit.org/protocols\u003c/span\u003e\u003cspan address=\"https://www.phenxtoolkit.org/protocols\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and the Food Access and Food Security During COVID-19 Survey Version 2.1 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Specific questions were selected to cover relevant domains including household income, finances, and employment (n = 13), education (n = 13), emotional and social behavior (n = 14), and food access and security (n = 2) (see Supplemental Material 1). The questions were administered in three local languages (\u003cem\u003eTwi\u003c/em\u003e, \u003cem\u003eEwe\u003c/em\u003e, and \u003cem\u003eGa\u003c/em\u003e-A\u003cem\u003edangme\u003c/em\u003e), and we asked participants to focus on \u003cem\u003eone year before the COVID-19 outbreak\u003c/em\u003e as against the \u003cem\u003eperiod since the COVID-19 outbreak\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eThe COVID-19 questionnaire was programmed on tablets using the SurveyCTO software. SurveyCTO has in-built quality checks to minimize the entry of implausible values. Seven field workers were trained to administer the questionnaire, and a standard operating procedure manual was developed to ensure consistency in administering the questionnaire. The questionnaire was piloted among 20 caregivers in the study area who were not part of the iLiNS-DYAD follow-up study to assess feasibility, duration, and adaptation in the local context.\u003c/p\u003e\u003cp\u003e\u003cem\u003eOutcome variables\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFirst, we inquired about household and caregiver’s income situation during the COVID-19 pandemic, including (i) “\u003cem\u003eHas your household income changed since the COVID-19 outbreak?”\u003c/em\u003e, (ii) \u003cem\u003e“Did you lose any jobs during the COVID-19 outbreak?”\u003c/em\u003e and (iii) “\u003cem\u003eDid you experience significant changes in your job because of or during the COVID-19 outbreak?”\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eSecond, we inquired about children's learning conditions during the pandemic, including (i) “\u003cem\u003eDuring the time of school closure, were school children in this household doing educational activities at home?”\u003c/em\u003e, (ii)\u003cem\u003e“What were the sources of educational or learning activities for children in this household during the school closures?”;\u003c/em\u003e (iii) \u003cem\u003e“Who assisted the children with educational activities?”\u003c/em\u003e; and (iv) “\u003cem\u003eHow has the outbreak affected your childcare while school was suspended?\u003c/em\u003e”\u003c/p\u003e\u003cp\u003eThird, to collect caregiver’s report of changes in their children’s and their own emotional behavior and social connectedness before versus during the COVID-19 pandemic, we used (i) a Likert scale from 1 (much less often) to 5 (much more often) to measure the following questions a. \u003cem\u003e“Indicate the extent to which young children in this household felt irritated, afraid, and sad before the COVID-19 and since the COVID-19 outbreak (during the school closure)”\u003c/em\u003e,b. \u003cem\u003e“Indicate the extent to you felt irritated, afraid, and sad before the COVID-19 and since the COVID-19 outbreak (during the school closure)”\u003c/em\u003e and (ii) a Likert scale from 1 (less socially connected) to 6 (much more socially connected) to measure the question, “\u003cem\u003eIndicate the extent to which the child seems socially connected to other people and his environment before the COVID-19 outbreak and during the COVID 19 (especially during the school closures)\u003c/em\u003e”. In addition, we used a Likert scale from 1 (extremely negative) to 7 (extremely positive) to measure the question, \u003cem\u003e“indicate the extent to which you view the COVID-19 outbreak as having either a positive or negative impact on your life”.\u003c/em\u003e We inquired about caregivers’ stress during the pandemic including a. “\u003cem\u003eWhat have been your greatest sources of stress from the COVID-19 outbreak?\u003c/em\u003e” and b. \u003cem\u003e“What have you done to cope with your stress related to the COVID-19 outbreak?”\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eFinally, caregivers reported household food security conditions (i) on a Likert scale from 1 (not at all worried) to 6 (extremely worried), measuring the question \u003cem\u003e“On a scale from 1 (not at all worried) to 6 (extremely worried), what is your level of worry for your household about the following as it relates to COVID-19”\u003c/em\u003e, and (ii) agreement (“never true”, “sometimes true” and “often true”) with statements about their household’s food situation in the last year before the COVID-19 and since the COVID-19 outbreak\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eA statistical analysis plan was prepared prior to the data analysis. The data were analyzed using R version 4.2.1 supported by MS Excel 2016. Descriptive statistics were used to summarize participants’ background characteristics and the outcome variables.\u003c/p\u003e\u003cp\u003eDue to low frequency of responses for certain categories across many of the Likert scale variables and to ensure uniformity and consistency in the presentation of results, we dichotomized the Likert scale ratings. The 5-point Likert scale ratings of the extent to which caregivers and children (by caregivers’ reports) felt irritated, afraid, anxious, and sad before and during the COVID-19 pandemic were dichotomized as “often” (if caregivers responded, “much more often”, “more often” or “somewhat often”) or “not often” (if caregivers responded, “much less often” and “less often” responses). We calculated the percentage of caregivers and children who reportedly “often” felt irritated, afraid, anxious, or sad before and during the COVID-19 pandemic.\u003c/p\u003e\u003cp\u003eThe 6-point Likert scale ratings of the extent to which children (by caregivers’ reports) were socially connected to other people and their environment before and during the COVID-19 pandemic were dichotomized as “socially connected” (if caregivers reported “much more socially connected”, “more socially connected” or “slightly more socially connected”) and “not socially connected” (if caregivers reported “much less socially connected”, “less socially connected” and “slightly less socially connected”). We calculated the percentage of children who reportedly were “socially connected” to other people in their environment before and during the COVID-19 pandemic.\u003c/p\u003e\u003cp\u003eWe calculated the mean (SD) score of the 6-point Likert scale ratings of caregivers’ level of worry about food situation during COVID-19 and dichotomized the 3-point Likert scale responses of caregiver’s agreement with statements about their household food situation to “yes” (for “sometimes true” and “often true”) or “no” (for “never true”). Finally, we used McNemar Chi-square tests to compare percentages of caregivers with agreement (“yes”) to the statements about their household food situation “\u003cem\u003eone year before the outbreak\u003c/em\u003e” versus “\u003cem\u003esince the outbreak\u003c/em\u003e”. A significance level of p \u0026lt; 0.05 was used.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe background characteristics of the caregivers interviewed are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Of the 966 caregivers, 93.6% were females. Most were self-employed mainly as traders and shop owners before COVID-19 (83%), married or in an informal union (81%), and had education up to Junior High School (73%). The household members of respondents who were in school at the time of data collection (n\u0026thinsp;=\u0026thinsp;2970) consisted predominantly of those in primary (56.6%) and Junior High (16.4%) schools.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBackground characteristics of caregivers (n\u0026thinsp;=\u0026thinsp;966)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender of caregivers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e904 (93.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (6.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmployment status of caregivers before COVID-19\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e802 (83.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSalaried worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e132 (13.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32 (3.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status of caregivers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e509 (53.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformal/loose union\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e267 (27.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeparated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (8.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (2.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle (never married or in an informal union)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (2.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of education of caregivers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e213 (22.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e487 (50.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95 (9.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (9.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther training institutions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (4.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (3.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHousehold members currently enrolled in school\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-school or day care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e419 (14.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1680 (56.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e488 (16.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e299 (10.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e84 (2.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e1\u003c/sup\u003e Multiple response questions\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eHousehold income, caregivers' working situation, and children's learning conditions (by caregivers\u0026rsquo; report) during the COVID-19 pandemic\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the reported changes in household income, caregivers\u0026rsquo; working situation, and children\u0026rsquo;s learning conditions \u003cem\u003e(by caregivers\u0026rsquo; report)\u003c/em\u003e during the COVID-19 pandemic. Most caregivers (88.5%) reported less household income due to the pandemic; 27.5% reportedly lost their jobs because of the pandemic. Changes in caregivers\u0026rsquo; working conditions most frequently reported during the COVID-19 pandemic were decreased workload (reported by 79% of caregivers) and salary or wage cut (reported by 63% of caregivers). By contrast, increased workload and increased salary or wage were reported by only 2\u0026ndash;6% of caregivers.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e also shows that during school closures due to the pandemic, 64.7% of caregivers said their children engaged in educational activities at home. The sources of educational or learning activities most frequently reported by caregivers were private teachers (46.2% of caregivers); educational TV programs (32.6%); and sessions, meetings and/or assignments provided by the schoolteacher (26.1%). The most frequent helpers with children\u0026rsquo;s educational activities were caregivers (65.8%), followed by the children themselves (47.0%), then other household members (26.0%) such as older siblings. Regarding whether the outbreak had affected caregivers \u0026rsquo;childcare while schools were suspended, the vast majority (81.8%) of caregivers reported no impact, except for a relatively small percentage who or whose partners reportedly changed their work schedule to care for their children (14.4%), had difficulty arranging for childcare (2.7%), or had to pay more for childcare (0.5%). Caregivers also reported that a greater percentage of their children were socially connected to other people and their environment before the pandemic (91.9%) versus during the pandemic (44.2%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCaregivers' reported household income situation, and children's learning conditions (n\u0026thinsp;=\u0026thinsp;966)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eHas your household income changed substantially since the COVID 19 outbreak?\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy household income is less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e855 (88.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy household income is about the same\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97 (10.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy household income is more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (1.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDid you lose any job(s) during the covid-19 outbreak?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eContinued working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e661 (72.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLost job\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e251 (27.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDid you experience significant changes with your job?\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDecrease in workload\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e652 (78.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDecrease in work hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e600 (72.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSalary or wage decreased\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e525 (63.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo significant change\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (7.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncrease in work hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56 (6.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncrease in workload\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (6.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSalary or wage increased\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (2.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuring the time of school closure, were school children in this household doing educational activities at home?\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e625 (64.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e341 (35.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhat were the sources of educational or learning activities for child(ren) in this household during the school closures?\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate lessons (Hired teacher)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e290 (46.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWatched educational TV programmes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e205 (32.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSession/meetings/ Completed assignments provided by schoolteacher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164 (26.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE-learning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (3.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUsed mobile learning apps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (2.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eListened to educational programmes on radio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (1.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (group studies, parents/siblings, learning from old notes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e218 (34.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWho assisted with the educational activities?\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver or spouse/partner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e413 (65.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChild themselves\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e296 (47.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther household members\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e166 (26.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (4.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (neighbors, friends, hired teachers)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (8.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHow has the outbreak affected your childcare while school was suspended?\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy regular childcare has not been affected by the COVID-19 outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e792 (81.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMy spouse/partner or I had to change our work schedule to care for our children ourselves\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138 (14.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI had difficulty arranging for childcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (2.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI had to pay more for childcare\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (0.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChildrens\u0026rsquo; social connectedness to other people and their environment\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u0026ldquo;Socially connected\u0026rdquo; Before Pandemic\u003c/p\u003e\u003cp\u003e\u0026ldquo;Socially connected\u0026rdquo; After Pandemic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e888 (91.9)\u003c/p\u003e\u003cp\u003e427 (44.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e1\u003c/sup\u003e Multiple response questions\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eChanges in emotional behavior of caregivers and children\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eDuring\u003c/em\u003e versus \u003cem\u003ebefore\u003c/em\u003e the pandemic, greater percentages of children were reportedly \u0026ldquo;often irritated\u0026rdquo; (60.8% versus 21.5%), \u0026ldquo;often afraid\u0026rdquo; (66.6% versus 18.9%), \u0026ldquo;often anxious (50.7% versus 17.3%) and \u0026ldquo;often sad\u0026rdquo; (56.6% versus 21.1%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Likewise, greater percentages of caregivers were reportedly \u0026ldquo;often irritated\u0026rdquo; (75.3% versus 29.5%), \u0026ldquo;often afraid\u0026rdquo; (76.8% versus 13.5%), \u0026ldquo;often anxious (67.9% versus 23.6%) and \u0026ldquo;often sad\u0026rdquo; (75.1% versus 32%) \u003cem\u003eduring\u003c/em\u003e the pandemic compared with \u003cem\u003ebefore\u003c/em\u003e the pandemic (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eCaregivers\u0026rsquo; perceived impact of COVID-19 and coping strategies\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, most (89.9%) caregivers perceived that the impact of COVID-19 on their lives was \u0026ldquo;extremely negative\u0026rdquo; (40.7%), \u0026ldquo;moderately negative\u0026rdquo; (30.2%) or \u0026ldquo;somewhat negative\u0026rdquo; (19.0%), compared with those who reported \u0026ldquo;no\u0026rdquo; (6.1%) or \u0026ldquo;slightly positive\u0026rdquo;, \u0026ldquo;moderately positive\u0026rdquo; or \u0026ldquo;extremely positive\u0026rdquo; (4.0%) impact. The most frequently reported sources of stress due to COVID-19 were financial concerns (83.0% of participants) and impact on work (79.0%), access to food (47.8%), impact on child (47.1%), health concerns (27.2%), and impact on family members (21.0%). Other less frequently cited concerns were impact on the community (1.9%) and access to medical care; only 5.5% of caregivers were reportedly not stressed about the COVID-19 outbreak.\u003c/p\u003e\u003cp\u003eThe coping strategies most frequently cited by caregivers for dealing with the stress related to COVID-19 were \u0026ldquo;meditation and/ or mindfulness practices\u0026rdquo; (81.4%), \u0026ldquo;talking with friends and family through phone, text or video\u0026rdquo; (46.0%), \u0026ldquo;increased television or other \u0026lsquo;screen time\u0026rsquo; activities such as video games and social media (43.5%) and \u0026ldquo;engaging in family activities (11.0%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCaregivers\u0026rsquo; perceived impact of COVID-19 and coping strategies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePlease indicate the extent to which you view the COVID-19 outbreak as having either a positive or negative impact on your life?\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtremely negative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e393 (40.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerately negative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e292 (30.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSomewhat negative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e184 (19.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo impact\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (6.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSlightly positive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (1.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerately positive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (1.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtremely positive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (0.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhat have been your greatest sources of stress from the COVID-19 outbreak?\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinancial concerns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e802 (83.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpact on work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e763 (79.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to food\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e462 (47.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpact on your child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e455 (47.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth concerns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e263 (27.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpact on family members\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e203 (21.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial distancing or being quarantined\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e145 (15.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to baby supplies (e.g., formula, diapers, wipes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to personal care products or household supplies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpact on your community\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (1.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAccess to medical care, including mental health care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (0.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (includes loss of relative, accommodation, wear of mask)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am not stressed about the COVID-19 outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53 (5.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWhat have you done to cope with your stress related to the COVID-19 outbreak?\u003c/b\u003e\u003csup\u003e\u003cb\u003e1\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeditation and/or mindfulness practices\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e786 (81.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTalking with friends and family (e.g., by phone, text, or video)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e444 (46.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncreased television watching or other \u0026ldquo;screen time\u0026rdquo; activities (e.g., video games, social media)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e420 (43.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEngaging in more family activities (e.g., games, sports)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106 (11.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEating more often, including snacking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72 (7.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncreasing time reading books, or doing activities like puzzles and crosswords\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (6.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDrinking alcohol\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (2.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVolunteer work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (0.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTalking to my healthcare providers more frequently, including mental healthcare providers (e.g., therapist, psychologist, counselor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUsing tobacco (e.g., smoking, vaping)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther (includes sleeping, medication, listening to music)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (2.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI have not done any of these things to cope with the COVID-19 outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (5.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e1\u003c/sup\u003e Multiple response questions\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eCaregivers\u0026rsquo; response on indicators of household food insecurity\u003c/em\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that the mean (SD) Likert scale scores were high for several items of the household food conditions during the pandemic, including \u0026ldquo;household will not have enough food at home and cannot go out due to quarantine or illness\u0026rdquo; (5.0 (1.2)); \u0026ldquo;food will be more expensive for my household\u0026rdquo; (4.8 (1.4)); \u0026ldquo;my household will lose so much income that they cannot afford enough food\u0026rdquo; (4.7 (1.4)); \u0026ldquo;there will not be enough food in the marketplace (4.0 (1.7); and \u0026ldquo;the country will not have enough food to feed everyone (4.0 (1.7)).\u003c/p\u003e\u003cp\u003eFor each of five statements of the household food situation, indicative of household food insecurity, the percentage of caregivers expressing agreement was significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) lower for \u003cem\u003e\u0026ldquo;one year before outbreak\u0026rdquo;\u003c/em\u003e compared with \u003cem\u003e\u0026ldquo;since outbreak\u0026rdquo;\u003c/em\u003e of COVID-19. These statements included \u003cem\u003e\u0026ldquo;food the household bought did not last and there was no money to get more\u003c/em\u003e\u0026rdquo; (19.6% for \u003cem\u003eone year before outbreak\u003c/em\u003e vs 55.4% for \u003cem\u003esince outbreak\u003c/em\u003e); \u0026ldquo;\u003cem\u003ehousehold could not afford to eat balanced meals\u003c/em\u003e\u0026rdquo; (17.1% vs 48.8%); \u0026ldquo;\u003cem\u003ehousehold members ate less food than they felt they should because there was not enough money for food\u003c/em\u003e\u0026rdquo; (17.3% vs 42.7%); \u0026ldquo;\u003cem\u003eadults in the household ever cut the size of meals or skipped meals because there was not enough money for food\u003c/em\u003e\u0026rdquo; (15% vs 41.4%); and \u0026ldquo;adults in the household were ever hungry but did not eat because there was not enough money for food\u0026rdquo; (6.0% vs 18.4%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCaregivers\u0026rsquo; reported household food situation during COVID-19\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (SD) or %\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLikert scale \u0026ldquo;level of worry\u0026rdquo; about household food situation during the COVID-19**:\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMy household will not have enough food if we have to stay at home and can\u0026rsquo;t go out at all (due to quarantine or illness)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.0 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFood will become more expensive for my household\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.8 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMy household will lose so much income that we cannot afford enough food\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.7 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eThere will not be enough food in the marketplace\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.0 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eThe country will not have enough food to feed everyone\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.0 (1.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFood will become unsafe or contaminated\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.6 (1.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePercentages of caregivers reporting agreement with statements on household food situation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eThe food the household bought did not last, and there was no money to get more\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne year before outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSince outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e55.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMy household could not afford to eat balanced meals\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne year before outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSince outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHousehold members ate less food than they felt they should because there was not enough money for food\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne year before outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSince outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e42.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdults in the household ever cut the size of meals or skipped meals because there was not enough money for food\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne year before outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSince outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAdults in the household were ever hungry but did not eat because there was not enough money for food\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOne year before outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSince outbreak\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e** The Likert scale ranged from 1 (not at all worried) to 6 (extremely worried)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings reveal the negative consequences of COVID-19 among caregivers of young adolescents 10-12y of age in a semi-urban area in Ghana. Most of the caregivers interviewed reported a decrease in household income, with a few losing their jobs, while others experienced reduced workloads and salary cuts. During the school closures, young adolescents used various channels to learn; most caregivers engaged the services of private teachers for the children at home or allowed the children to watch educational TV programs. According to caregivers\u0026rsquo; reports, higher percentages of caregivers and their young adolescents felt \u0026ldquo;often irritated\u0026rdquo;, \u0026ldquo;often afraid\u0026rdquo;, \u0026ldquo;often anxious\u0026rdquo;, and \u0026ldquo;often sad\u0026rdquo; during the COVID-19 than before the pandemic. Most caregivers perceived the pandemic negatively impacting their lives, often stressed by financial concerns, work, and poor access to food, and coped mainly by meditation, mindfulness practices, and communication with friends and family via phone or video. In our study, there also was a significant increase in the perceived household food situation since the COVID-19 outbreak compared to the year before, with these Ghanaian caregivers expressing high levels of concern about household food conditions.\u003c/p\u003e\u003cp\u003eThe reported decline in household income in our sample during the COVID-19 pandemic was consistent with reports from other studies in Ghana [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]; these reports highlighted the fact that informal self-employed workers typically experienced a fall in their household income during the COVID-19. The activities of self-employed workers, especially petty traders, mostly require physical contact; such workers mainly rely on daily sales as earnings, and this was massively affected by the pandemic [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Schotte et al. (2021) report that in Ghana, the earnings of self-employed women declined drastically during the pandemic, which may have further heightened the existing labor inequalities in the country [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our findings corroborate those reported by Schotte et al. (2021). Although household incomes generally declined during the COVID-19 pandemic, most of the caregivers reportedly did not lose their jobs and continued to work during the pandemic. This may be because a majority of respondents were self-employed, and our study area had not been included in the partial lockdown that was instituted by the government of Ghana during the pandemic [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Durizzo et al. (2021) confirmed that in districts where there were no lockdowns, many workers in the informal self-employment sector continued to work and only few people lost their jobs [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe variety of learning channels used during school closures suggests that there is no \u0026ldquo;one size fits all\u0026rdquo; approach to learning. The high cost and poor connectivity of internet services [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] was a major problem in the study area; thus, it was not surprising that few people engaged in e-learning. The schools in the study area were mostly public schools, hence were not active in providing educational activities for children during the school closures. As such, parents and other family members had to take up much of the burden of providing their children with educational and learning resources during the pandemic. However, parents/caregivers may not have had the requisite educational background and skill set or be well equipped to teach their children at home [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This could partly explain why many of the respondents reported hiring a home teacher. Children from less privileged households without adequate means to engage home teachers may have faced difficulties in keeping up with their studies, potentially impacting their academic performance after school returned [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe increased prevalence of reported negative socio-emotional behavior (irritated, afraid, anxious, and sad) among caregivers and their young adolescents during the COVID-19 warrant discussion. Similar findings were reported among Ghanaian women and children [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] and Canadian families [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] as a result of the COVID-19 pandemic. Closures of schools and lockdowns caused children and caregivers to be confined at home, spending less time interacting and socialising with friends or people outside of their households. This social isolation may have contributed to the increased stress, anxiety, and even depression due to prolonged confinement and lack of social support. Constant close quarters with household members without external social interactions could have put a strain on family relationships, potentially leading to increased conflicts and tension at home, including excessive yelling and punishments from parents and other older family members [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. For caregivers, additional stress may have resulted from financial difficulties, poor access to food, and possible work- and childcare-related problems due to the pandemic.\u003c/p\u003e\u003cp\u003eIt was not surprising that many participants reported being worried about their households\u0026rsquo; food situation, which may likely have been the negative consequences of decreased household income and/or loss of employment because of the COVID-19 pandemic. During the lockdowns, demand for food appeared to exceed supply, thereby pushing food prices up [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], as many food markets were closed to enforce social distancing and/or allow for fumigation. As many of the respondent reportedly ate less frequently and had reduced variety and quality of food, those changes could have contributed to increased stress among the participants and their children [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study had several strengths. The caregivers\u0026rsquo; participation in the ongoing iLiNS-DYAD follow-up study probably resulted in a high response rate from the participants. Participation in the follow-up study likely increased the caregivers' comfort with sharing their life experiences during the pandemic, potentially enhancing the reliability of the data collected. The interview questionnaire was administered in person, which likely helped maintain the depth and quality of the data.\u003c/p\u003e\u003cp\u003eThe study had a few limitations. First, we had only one round of data collection after the outbreak. Given the multiple waves of the pandemic, the changes we observed may have varied over time. We began data collection about 2 years after the outbreak of the pandemic, and the data collection took about 9 months to complete, by which time the reported COVID-19 cases had declined and many containment measures had been eased. It is possible that participants\u0026rsquo; adaptations over time may have diluted the perceived impact of the pandemic. This time lag may have introduced some recall bias due to the self-reported nature of outcome measures. However, all data were collected while the pandemic was still active and therefore reflected the ongoing conditions and experiences of participants. In addition, to keep the survey from being burdensome for participants, we did not collect sociodemographic information that had been collected 1\u0026ndash;2 years previously; hence, it is possible that family characteristics may have been somewhat different than described in the method section.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this setting, COVID-19 had negative consequences on the economic, socio-emotional, and household food security conditions of caregivers of young adolescents. Our study findings contribute to understanding the impact of the pandemic in Ghana. The findings are comparable with other studies and add to the existing literature on the multiple disruptions and impact of the pandemic on livelihoods. This can help inform public health responses in future pandemics. To extend the findings of our study, further investigation on the long-term effect of the COVID-19 pandemic and how individuals and households recovered post COVID-19 can be conducted.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOVID-19 \u0026nbsp;Coronavirus Disease 2019\u003c/p\u003e\n\u003cp\u003eiLiNS \u0026nbsp;International Lipid-Based Nutrient Supplement\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for the present study was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC: 027105119) and the Institutional Review Board of the University of California, Davis (IRB ID: 1489918). We obtained written informed consent from the caregivers for this study and assent from the adolescents as part of the follow-up study. The consenting procedure was done orally in any of the three local languages (Twi, Ewe, and Ga-Adangme) understood and spoken by the participants. Participants signed or thumb printed the consent and assent forms and were given a copy as evidence of consent. The study followed the principles outlined in the declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Not applicable\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data underlying this study is available at https://osf.io/bmv9d/\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The authors declare that they have no competing interests.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by grants from the National Institute of Health Sciences (R01HD099811) and the Bill \u0026amp; Melinda Gates Foundation (OPP49817) to the University of California, Davis and the University of Ghana. Registered at clinicaltrials.gov as NCT00970866 (Clinical trial number not applicable). https://clinicaltrials.gov/ct2/show/record/NCT00970866. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eELP, SA-A, PDH, BMO, AG and MOM designed the research; SA-A, EA, MOM conducted the research; EA, CDA, MOM analyzed the data; MOM, EA and LMDA led the writing of the manuscript with review from SA-A, CDA, PDH, BMO, LMDA, HN, HJB, JF. All authors except ELP read and approved the final manuscript. ELP passed on during the preparation of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the caregivers and children who participated in the study. We also thank Mandy McCarthy, Sika Doris, Monica Matey, Phoebe Ametepey, Isaac Sackitey Baah, Mary Sackitey, Vivian Abayavor for the data collection, and Richard Azumah for support with project management.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDai-Kosi AD, Acquaye VA, Pereko KKA, Blankson P-K, Ackom C. The impact of COVID-19 social restrictions on culture and psychosocial well-being: The Ghanaian experience. Mental Health Effects of COVID-19. 2021:103-15.\u003c/li\u003e\n\u003cli\u003eLewnard JA, Lo NC. Scientific and ethical basis for social-distancing interventions against COVID-19. The Lancet infectious diseases. 2020;20(6):631-3.\u003c/li\u003e\n\u003cli\u003eLin Q, Zhao S, Gao D, Lou Y, Yang S, Musa SS, et al. A conceptual model for the coronavirus disease 2019 (COVID-19) outbreak in Wuhan, China with individual reaction and governmental action. 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The Indian Journal of Labour Economics. 2020;63(1):23-30.\u003c/li\u003e\n\u003cli\u003eBukari C, Essilfie G, Aning-Agyei MA, Otoo IC, Kyeremeh C, Owusu AA, et al. Impact of COVID-19 on poverty and living standards in Ghana: A micro-perspective. Cogent Economics \u0026amp; Finance. 2021;9(1):1879716.\u003c/li\u003e\n\u003cli\u003eUNESCO, UNICEF. COVID-19: Socio-economic Impact in Ghana - Impact on Education 2020.\u003c/li\u003e\n\u003cli\u003eUNICEF. Primary and secondary impacts of the COVID-19 pandemic on children in Ghana. UNICEF; 2021.\u003c/li\u003e\n\u003cli\u003eWorld Bank, UNICEF. The Impact of COVID-19 on the Welfare of Households with Children. Washington, DC: World Bank; 2022.\u003c/li\u003e\n\u003cli\u003eChigeza S, Wilson Fadiji A, Matamela N. A Scoping Review of the Impact of the COVID-19 Pandemic on Family Wellbeing in Africa. The Family Journal. 2024; 28:10664807241269507.\u003c/li\u003e\n\u003cli\u003eKarpati J, Elezaj E, Cebotari V, de Neubourg C. Primary and secondary impacts of the COVID-19 pandemic on children in Ghana. 2021.\u003c/li\u003e\n\u003cli\u003eSchotte S, Danquah M, Osei RD, Sen K. The labour market impact of COVID-19 lockdowns: Evidence from Ghana. 2021.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Neil, A. Urbanization in Ghana 2023. 2024. https://www.statista.com/statistics/455827/urbanization-in-ghana/.\u003c/li\u003e\n\u003cli\u003eAbdulai IA, Ahmed A, Kuusaana ED. Secondary cities under siege: examining peri-urbanisation and farmer households\u0026rsquo; livelihood diversification practices in Ghana. Heliyon. 2022;8(9).\u003c/li\u003e\n\u003cli\u003ePrado EL, Adu-Afarwuah S, Arnold CD, Adjetey E, Amponsah B, Bentil H, Dewey KG, Guyer AE, Manu A, Mensah M, Oaks BM. Prenatal and postnatal small-quantity lipid-based nutrient supplements and children\u0026rsquo;s social\u0026ndash;emotional difficulties at ages 9\u0026ndash;11 y in Ghana: follow-up of a randomized controlled trial. The American Journal of Clinical Nutrition. 2023;118(2):433-42.\u003c/li\u003e\n\u003cli\u003eAdu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Zeilani M, Peerson JM, et al. Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana2. The American Journal of Clinical Nutrition. 2015;101(4):835-46. \u003c/li\u003e\n\u003cli\u003eAssan A, Hussein H, Agyeman-Duah DNK. COVID-19 lockdown implementation in Ghana: lessons learned and hurdles to overcome. Journal of Public Health Policy. 2022;43(1):129-39.\u003c/li\u003e\n\u003cli\u003eSen K, Danquah M, Osei RD, Schotte S. Ghana\u0026rsquo;s lockdown hit vulnerable workers hard: what needs to happen next time. The Conversation https://theconversation com/ghanas-lockdown-hit-vulnerable-workers-hard-what-needs-to-happen-next-time-156876. 2021.\u003c/li\u003e\n\u003cli\u003eLartey NL. SHS, JHS first-years to resume in January 2021; kids in KG, primary to also return in new year. Citi newsroom [Internet]. 2020 1st February 2024. Available from: https://citinewsroom.com/2020/08/shs-jhs-first-years-to-resume-in-january-2021-kids-in-kg-primary-to-also-return-in-new-year/.\u003c/li\u003e\n\u003cli\u003eHansen GM. Ghana reinstates ban on concerts, public gatherings. Music in Africa [Internet]. 2021 1st February 2024. Available from: https://www.musicinafrica.net/magazine/ghana-reinstates-ban-concerts-public-gatherings.\u003c/li\u003e\n\u003cli\u003eKenu E, Frimpong JA, Koram KA. Responding to the COVID-19 pandemic in Ghana. Ghana Medical Journal. 2020;54(2):72-3.\u003c/li\u003e\n\u003cli\u003eEducation Mo. COVID-19 coordinated education response plan for Ghana ministry of education 2020. Available from: https://ges.gov.gh/wp-content/uploads/2020/04/EDUCATION-RESPONSE-PLAN-TO-COVID-19-IN-GHANA-APRIL-2020-1.pdf.\u003c/li\u003e\n\u003cli\u003eHamilton CM, Strader LC, Pratt JG, Maiese D, Hendershot T, Kwok RK, et al. The PhenX Toolkit: get the most from your measures. American Journal of Epidemiology. 2011;174(3):253-60.\u003c/li\u003e\n\u003cli\u003eNiles MT, Neff R, Biehl E, Bertmann F, Belarmino EH, Acciai F, et al. Food Access and Food Security during COVID-19 Survey-Version 2.1. Harvard Dataverse. 2020;3.\u003c/li\u003e\n\u003cli\u003eInovation for Poverty Action (IPA). The Effects of COVID-19 on Business and Employment in Ghana. 2020.\u003c/li\u003e\n\u003cli\u003eBalde R, Boly M, Avenyo EK. Labour market effects of COVID-19 in sub-Saharan Africa: An informality lens from Burkina Faso, Mali and Senegal: Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT); 2020 May 25.\u003c/li\u003e\n\u003cli\u003eDurizzo K, Asiedu E, Van der Merwe A, Van Niekerk A, G\u0026uuml;nther I. Managing the COVID-19 pandemic in poor urban neighborhoods: The case of Accra and Johannesburg. World Development. 2021;137:105175.\u003c/li\u003e\n\u003cli\u003eUNICEF. Primary and secondary impacts of the COVID-19 on women and children in Ghana. UNICEF; 2021.\u003c/li\u003e\n\u003cli\u003eGadermann AC, Thomson KC, Richardson CG, Gagn\u0026eacute; M, McAuliffe C, Hirani S, et al. Examining the impacts of the COVID-19 pandemic on family mental health in Canada: findings from a national cross-sectional study. BMJ Open. 2021;11(1):e042871.\u003c/li\u003e\n\u003cli\u003eKawakatsu Y, Damptey O, Sitor J, Situma R, Aballo J, Shetye M, et al. Impact of COVID-19 pandemic on food availability and affordability: an interrupted time series analysis in Ghana. BMC Public Health. 2024;24(1):1268.\u003c/li\u003e\n\u003cli\u003eJafri A, Mathe N, Aglago EK, Konyole SO, Ouedraogo M, Audain K, et al. Food availability, accessibility and dietary practices during the COVID-19 pandemic: A Multi-country Survey. Public Health Nutr. 2021;24(7):1798-805.\u003c/li\u003e\n\u003cli\u003eWireko, J. K., Brenya, B., \u0026amp; Doshi, R. (2021, September). Financial impact of internet access infrastructure of online learning mode on tertiary students in COVID-19 era in Ghana. In 2021 International Conference on Computing, Communication and Green Engineering (CCGE) (pp. 1-7). IEEE.\u003c/li\u003e\n\u003cli\u003eTahiru, F., Tei Asare, B., Asante, G., \u0026amp; Agbesi, S. (2020, December). Internet Access and Cost and Its Impact on Citizens Engagement on E-Government Services. In TPRC48: The 48th Research Conference on Communication, Information and Internet Policy.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, caregivers, young adolescents, economic, education, household food situation, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-7215235/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7215235/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFew studies have described the consequences of the COVID \u0026minus;\u0026thinsp;19 pandemic among caregivers of young adolescents in sub-Saharan Africa. We aimed to explore the consequences of COVID-19 on economic, socio-emotional, and household food security conditions among caregivers of young adolescents in a semi-urban setting in the Eastern Region of Ghana.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eIn this cross-sectional study, caregivers of young adolescents aged 10-12yrs in the Somanya-Kpong area were enrolled. These participants were part of the second follow-up of the iLiNS-DYAD Ghana trial. A questionnaire designed from the PhenX Toolkit COVID-19 Protocol and the Food Access and Food Security During COVID-19 Survey (Version 2.1) was used to collect data over 8 months starting January 2022. We used descriptive statistics to summarize data and McNemar Chi-square tests to compare percentages of agreement to statements of household food security conditions \u0026ldquo;\u003cem\u003eone year before\u0026rdquo;\u003c/em\u003e versus \u0026ldquo;\u003cem\u003esince\u0026rdquo;\u003c/em\u003e the pandemic outbreak.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong 966 caregivers (94% females; 6% males), 89% reported decreased household income compared with the year before the pandemic. Although 72.5% of caregivers continued working during the pandemic, most said they had experienced a reduction in their work hours (72.6%), workload (78.8%) and salaries (63.4%). Many (65%) said their children engaged in educational activities when schools were closed, with 46% hiring private teachers. Caregivers most frequently cited financial concerns (83%) and negative impact on work (79%) as their greatest sources of stress because of COVID-19. Significantly more caregivers reported experiencing household food insecurity conditions \u0026ldquo;\u003cem\u003esince the outbreak\u003c/em\u003e\u0026rdquo; compared to \u0026ldquo;\u003cem\u003eone year before the outbreak\u003c/em\u003e\u0026rdquo; (55.4% vs 19.6%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eIn this setting, COVID-19 had negative consequences on the economic, socio-emotional, and household food security conditions of caregivers and their young adolescents.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eClinical trial number not applicable.\u003c/p\u003e","manuscriptTitle":"Economic, socio-emotional, and food security conditions during COVID-19 pandemic among caregivers of young adolescents aged 10-12 yrs in a semi-urban setting in Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 12:49:57","doi":"10.21203/rs.3.rs-7215235/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-06T09:11:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T10:07:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-29T14:39:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328604933449337270200072487326925768681","date":"2025-09-21T19:11:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16970605190568139039271857715915298202","date":"2025-09-21T09:34:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136871700419844122974095671237379063500","date":"2025-09-18T14:22:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-25T18:39:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33605579360912982313209252068135903664","date":"2025-08-19T08:38:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189854297104467506077973193242891754588","date":"2025-08-19T05:50:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220960821970052723938620087796707620796","date":"2025-08-14T16:46:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"222106905184481731467544193387968636880","date":"2025-08-14T08:31:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337770146723711987683352927207656317265","date":"2025-08-14T07:52:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-14T01:41:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-01T11:41:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-01T05:28:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-01T05:28:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-07-25T14:24:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf274ce4-55c6-40f1-a54f-0915af7c2b33","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:09:23+00:00","versionOfRecord":{"articleIdentity":"rs-7215235","link":"https://doi.org/10.1186/s12889-026-26873-9","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2026-03-03 15:59:51","publishedOnDateReadable":"March 3rd, 2026"},"versionCreatedAt":"2025-08-21 12:49:57","video":"","vorDoi":"10.1186/s12889-026-26873-9","vorDoiUrl":"https://doi.org/10.1186/s12889-026-26873-9","workflowStages":[]},"version":"v1","identity":"rs-7215235","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7215235","identity":"rs-7215235","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}