Health and development-related priorities and challenges of adolescents and young people: findings from South Africa and Kenya prior to and during COVID-19 pandemic

ABSTRACT Growing evidence documents the effects of the COVID-19 pandemic on adolescents in East and Southern Africa. We present and explore the longitudinal health and development-related priorities and challenges of adolescent advisors in South Africa and Kenya, including prior to, and during the COVID-19 pandemic. Findings were co-generated with adolescent advisors in the Eastern Cape Province of South Africa (n=15, ages 18–22 in 2019) and Kisumu, Kenya (n=16, ages 10–14 in 2020). Prior to COVID-19, adolescent advisors engaged in a participatory exercise to share and explore their health and development-related priorities and challenges in 2019 and 2020. During the COVID-19 pandemic in 2020 and 2021, members of the same groups shared their experiences, challenges and coping strategies in semi-structured telephone interviews (Eastern Cape: n=14, aged 19–23; Kisumu n=12, aged 11–16) and group-based remote participatory social media activities (n=27 activities with n=12 advisors, Eastern Cape). We thematically analysed COVID-19 activities, considering them alongside pre-pandemic priorities and challenges. Many of the health and development-related priorities and challenges identified prior to COVID-19 remained issues of concern during COVID-19. These included education; victimization and violence; teenage pregnancy; substance use; household tension, conflict and inadequate family and caregiver support; health and medication concerns (South Africa) and water and food shortages (Kenya). Other issues such as financial insecurity, mental health, and crime were strong themes that emerged during COVID-19, which were not directly reported as priorities prior. Although almost all of adolescent advisors’ most pressing pandemic-related challenges were also priorities for them prior to COVID-19, these issues were often discussed as new, and caused by the onset of COVID-19. While demonstrating how COVID-19 has exacerbated pre-existing vulnerabilities, we also suggest that the pandemic may have brought about a new way for adolescents to make sense of, and articulate pre-existing challenges.


Introduction
Growing evidence documents the challenges brought about by the COVID-19 pandemic, including its indirect effects on adolescents and young people (AYP) in East and Southern Africa (Armbruster et al., 2020;Chauke & Chinyakata, 2020;UNICEF Office of Research, 2020). AYP in low-and middle-income countries are among those bearing the indirect effects of COVID-19, which exacerbated existing challenges faced by this group (Menendez et al., 2020;UNICEF Office of Research, 2020). Documented disruptions and indirect COVID-19 effects experienced by AYP include education, food insecurity and livelihoods (Álvarez-Iglesias et al., 2021;Chauke & Chinyakata, 2020;Douglas et al., 2020;UNICEF Office of Research, 2020). Health-related challenges include worsened pregnancy and sexual and reproductive health outcomes, violence, substance use, and mental and emotional health challenges (Armbruster et al., 2020;Banati et al., 2020;Dyer et al., 2021;Mambo et al., 2020;Murewanhema, 2020;Nearchou et al., 2020). Effects of COVID-19 disruptions on AYP might have lifelong implications given the sensitivity of adolescence as a developmental phase .
Although adolescence is a crucial life phase, this group is among those most left behind in international health and development initiatives (Lucie Cluver et al., 2019Lorraine Sherr et al., 2020). Prior to the COVID-19 pandemic, adolescent health and development in LMIC contexts was increasingly recognized as requiring further research and intervention, including through participatory approaches which can be transformative and catalyse social change (Mitchell & Sommer, 2016). AYP have been historically excluded from research and decision-making (Swartz & Nyamnjoh, 2018).
We present and explore longitudinal health and development-related challenges and priorities of two groups of adolescents -one in East Africa and the other in Southern Africa -generated using participatory approaches in 2019 and early 2020 prior to the COVID-19 pandemic.
We take stock of these alongside key themes that emerged from their COVID-19 priorities, experiences and challenges. In doing so, we consider emergent and persistent needs, priorities and challenges of this group longitudinally. We explore how COVID-19 may have shaped what is important to adolescents, and how they articulate and understand their priorities and challenges.

Methods
Findings were co-generated with two adolescent advisory groups of the Accelerate Achievement for Africa's Adolescents Research Hub. Adolescent advisory groups engage artsbased and participatory approaches to gather context-specific information and explore the experiences and expertise of advisors to inform further research and policy. This approach is premised on the belief that when young people are meaningfully engaged, research, policy and programming are more responsive to their priorities and needs (Campbell et al., 2009;M Skovdal & Cornish, 2015). We engaged adolescents and young people with whom the research team have built rapport through in-person activities over the course of one to four years. Advisory group members were recruited from two cohort studies in the Eastern Cape Province of South Africa, and through schools with a community-based youth organisation in Kisumu, Kenya. Details of these groups and methods prior-to-COVID-19  and during COVID-19  are documented elsewhere.
Activities were premised on qualitative approaches in development-related research including participatory needs assessment and situational analysis (Skovdal & Cornish, 2015). The use of prioritisation exercises in particular can enable community membersincluding marginalised groups such as children -to participate and offer critical reflection of the conditions that compromise their well-being; to reflect upon and determine priorities; and provide insight into issues that they deem important (Skovdal & Cornish, 2015). We engaged a modified preference-ranking prioritisation exercise with adolescent advisors in order to gather information about their contextual environments, experiences and priorities to build upon in future research.
In Kenya, adolescent advisors responded to the prompt 'What issues are adolescents facing in my community?' using post-it notes (one response per note). Notes were then grouped into themes, and adolescent advisors were given five 'voting stickers' each to place on one or more of the issues to denote their priorities.
In South Africa, advisors were provided with the prompt 'What are the biggest issues facing youth?' (translated from isiXhosa) and chart paper to write individual responses. Following this, in groups they reviewed and grouped their priority responses into themes, presented these back to their group and in a later session explored using a variety of self-selected approaches which included singing, writing, poetry, storytelling, theatre and drawing.
Appendix 1 contains further details about these processes with each group.

COVID-19 activities
During the COVID-19 pandemic in 2020/2021, members of the same groups shared their experiences, challenges and coping strategies in semi-structured telephone interviews (Eastern Cape: n = 14, 19-23; Kisumu n = 12, 11-16) and group-based remote participatory social media activities (Eastern Cape: n = 27 activities, n = 12 advisors). Across the pre-COVID-19 workshops and COVID-19 activities, the main facilitator in each site remained consistent, ensuring continued rapport with adolescent advisors. The author team analysed advisors' COVID-19 responses using a remote group process, based on Braun and Clarke's (2006) thematic analysis approach and verified emerging themes with adolescent advisors telephonically and with written and visual prompts over social media. We then considered these themes against adolescent-generated pre-pandemic lists of their health and development priorities and challenges. To assist with this longitudinal exploration, we developed convergence coding matrices for each site (see Table A2), and across sites (see Table 1). Below, we explore and consider the priorities and challenges that adolescent advisors shared prior to COVID-19, alongside the themes that emerged from the COVID-19 activities. We note priorities and challenges that were consistently discussed prior-to, and following the onset of the COVID-19 pandemic, as well as areas of difference between and across sites. In doing so, we aim to provide insight into AYP priorities and challenges, and how these were experienced and discussed prior-to and during the COVID-19 pandemic. Exemplary quotes are provided in Table A3.
Activities were conducted in a mixture of English and isiXhosa (South Africa) and Dholuo (Kenya) and transcribed verbatim into English. Ethical approvals were provided by the University of Cape Town (HREC 226/2017, version 7.0), the University of Oxford (IDREC R48876/RE003) and the African Medical and Research Foundation (AMREF-ESRC P874/ 2021).

Results
In Kenya, adolescent advisors identified eight priorities pre-COVID-19: schooling, child labour, abuse and harassment, lack of food and water, early pregnancy, inadequate caregiver support, gender inequity and substance abuse. Of these, all but two (child labour and gender inequality) were themes that also emerged from in-depth semi-structured interviews during COVID-19. There were three themes present in COVID-19 that were not raised in their initial prioritisation exercise: household resource insecurity, crime (financially motivated), and isolation/mental health.
In South Africa, identified priorities prior to COVID-19 were substance abuse, unemployment and career concerns, health and medication challenges, pregnancy, peer pressure and bullying, education, and 'blessers' (age disparate transactional sexual partners). Of these, only blessers was not a strong theme during COVID-19. COVID-19-related challenge areas that were not in the initial exercise included household financial insecurity, mental health/emotional well-being and crime. Themes and priorities are presented and compared in Table 1.

Consistent priorities and challenges (prior to and during COVID-19)
We present below consistent health and development-related priorities and challenges that were raised first by adolescent advisors in the participatory priority-setting exercise, which also emerged from COVID-19 activities as main themes. In both South Africa and Kenya, these included education and schooling; pregnancy; substance use; victimisation; and family tension and lack of support. Additional site-specific consistent priorities included medicine-taking and health (South Africa) and food and water insecurity (Kenya).

Education and schooling
A theme across sites -and over time -was that AYP prioritised education as a means for future opportunities. However, barriers to school attendance prior to COVID-19 were different across sites. Kenyan adolescent advisors -who were still in primary schooldescribed concerns about being able to access secondary education due to school fees (primary education is free). South African adolescent advisors' concerns centred around school dropout, but not fees (fees are not always required for public secondary education in South Africa). During COVID-19, adolescent advisors in both sites discussed challenges of COVID-19-related school closures, citing concerns about not being able to continue with studies, difficulties schooling remotely, as well as stress, boredom and social isolation. School closures also resulted in indirect social, material and emotional challenges, as well as adolescent advisors not being able to access other resources such as food through school feeding programmes, and social support services. When schools re-opened, changes to schooling routines (e.g., attending only on certain days and partial at-home learning) and protocols (e.g., physical distancing, requirements to wear masks and sanitise) were also reported as disruptive to both groups. Additionally, some Kenyan advisors were unable to return to school due to changes to household finances and an inability to pay school fees.

Pregnancy
Teenage pregnancy was another strong theme in both sites that emerged in priority setting and during COVID-19. In South Africa, concerns included difficulties in attending school after becoming a parent and strained relationships between young parents and their families. In Kenya, young advisors reported their perception that transactional relationships with older men, idleness, peer pressure and insufficient SRH support fuelled teen pregnancies. Despite being a priority issue before COVID-19, adolescent advisors expressed this as a COVID-19 concern, saying that they believed COVID-19 disruptions to health and social services caused an increase in young pregnancies. In both sites, adolescent advisors largely used distancing language, discussing it mostly as a challenge faced by 'other youth', other than in situations in which they or their partners became pregnant.

Substance use
Like pregnancy, substance use was a pre-COVID-19 issue of concern in both sites that was described as exacerbated by the pandemic. Like with pregnancy, adolescent advisors spoke about substance use using distancing language, referring to it primarily as affecting other youth. Across sites, alcohol was the primary substance discussed, alongside Dagga (South Africa) and Bhang (Kenya) (marijuana). Substance misuse was often discussed in relation to other priority issues and challenges including violence, peer pressure and coping with COVID-19 related-stressors. (see Figure 1).

Victimisation: abuse, harassment and peer pressure
Various forms of victimisation and abuse were described as concerning to adolescents before COVID-19. These included peer pressure and bullying (both sites); gender-based violence (GBV) (both sites), sexual harassment and rape (both sites); cyber bullying (South Africa); and femicide (South Africa). During COVID-19, adolescent advisors raised additional concerns. In Kenya, concerns included harassment by adolescent boys and young men who were spending more time together due to school closures. In South Africa, adolescent girls and young women described increased GBV and femicide, after a spate of high-profile cases during lockdown.

Family and caregivers: tension, conflict and lack of support
In both sites, household tension and lack of family and caregiver support were raised as priority areas and challenges prior to COVID-19. In South Africa, AYP discussed absent fathers and broken families, alongside related concerns over material resources. During COVID-19, adolescent advisors in both sites described finance-related tension and conflict within their families, alongside unequal distribution of resources (such as food and toiletries) and limited childcare. Strained home relationships varied from bickering to physical violence and more severe forms of conflict, which sometimes resulted in transient moving between households. While some AYP described spending positive time with family, increased sense of responsibility within homes and deepening family relationships, many also expressed concerns over inadequate care, poor treatment, and heavy expectations to carry chores and caring for younger children. (see Figure 1).

Site-specific longitudinal priority issues and challenges
There were also consistent priorities and challenges that were unique to each site. In Kenya, concerns over food and water were presented as a priority issue prior to COVID-19, and described as exacerbated by COVID-19. While food insecurity was related to concerns over household incomes (as discussed above), water concerns were discussed in relation to sanitation and exacerbated due to the imperative to practice increased hand-washing for COVID-19 prevention.
In South Africa, concerns over health and medicine-taking were expressed prior to, and during COVID-19. It is possible that this difference is due to a selection bias, as many South African adolescent advisors were recruited from a study of AYP living with HIV. Prior to COVID-19, South African advisors prioritised 'health challenges', 'not accepting an HIV-positive status', not going to the clinic, and adolescent deaths as concerns. During COVID, they spoke about long wait times, having to queue outside clinics, interruptions to health services  and increased concerns over illness and fear of death.

Emergent themes from COVID-19 activities
In both South Africa and Kenya, three themes emerged strongly from COVID-19 activities that were not raised as priority areas by adolescent advisors in either site prior. First, AYP described feeling isolated and alone, and many described feelings characteristic of mental health challenges.
Second, concerns over increased financially motivated crime such as theft and breakins were also presented as strong concerns. Third, AYP spoke directly about financial insecurity and livelihoods as related to COVID-19 shocks.
In Kenya, issues of financial insecurity and livelihoods were not directly discussed as priority issues prior to COVID-19, although they were implicit within other priorities, such as lack of school fees and food insecurity. In COVID-19 activities, a strong theme amongst Kenyan adolescent advisors was strained caregiver livelihoods, and household financial insecurity. They described how caregivers, many of whom had worked informally as traders and vendors were now at home, unable to earn money. The knock-on effects of this included food insecurity and inability to cover school fees. Similarly, in South Africa, adolescent advisors reported concerns prior to COVID-19 about their employment prospects within a context of high unemployment. However, household financial insecurity was not spoken about as a direct priority issue prior to COVID-19. During COVID-19, South African AYP similarly discussed concerns over caregiver livelihoods and lacking basic necessities.
There were other issues and challenges that differed between the priority-setting exercise and main themes from the COVID-19 activities. Gender inequality and concerns over child labour were priority issues in Kenya pre-COVID-19 but did not emerge as themes in COVID-19 activities. In South Africa, gender-based violence, rape, and femicide were discussed as common concerns during COVID-19 while not being listed as pre-COVID-19 priority issue. It is difficult to discern whether these differed due to actual changes in priorities, differences in activities, or if COVID-19 brought issues to the fore in different ways. Table 1 summarises results across sites.

Discussion
Most of the health and development-related challenges identified by adolescent advisors as priority issues prior to COVID-19 remained issues of concern for them during the COVID-19 pandemic. These included access to, and retention in education; victimization and violence; teenage pregnancy; substance use; tense home environments including conflict and inadequate family and caregiver support; health and medication concerns (South Africa) and water and food shortages (Kenya).
Other issues such as financial insecurity, mental health, and crime were strong themes that emerged as challenges during COVID-19, which were not directly reported as priority issues prior to COVID-19. We suggest two separate, yet related phenomena to explain how adolescents reported on the COVID-19 challenges facing youth in their communities. First, they articulate how the COVID-19 pandemic has exacerbated pre-existing vulnerabilities, a finding that has been well documented in the literature. Indeed, the negative effects of COVID-19 on adolescents globally across domains of education (Chauke & Chinyakata, 2020; UNICEF Office of Research, 2020), livelihoods and food insecurity (Álvarez-Iglesias et al., 2021;Chauke & Chinyakata, 2020), worsened pregnancy and sexual and reproductive health outcomes (Armbruster et al., 2020;Dyer et al., 2021;Mambo et al., 2020;Murewanhema, 2020), violence and substance use (Banati et al., 2020;Bhatia et al., 2021) are indisputable.
Second, we argue that the COVID-19 pandemic has brought about a new awareness of, and language to discuss pre-existing health and development-related challenges. Almost all of adolescent advisors' most pressing pandemic-related challenges were also issues that they presented as priority issues prior to COVID-19. These priorities mapped clearly onto well-documented pre-COVID-19 health and development-related challenges.
That COVID-19 may have brought about a new paradigm for adolescents to make sense of and articulate their challenges aligns with a literature on how people engage narrative to make sense of and find meaning in difficult experiences. For example, Colvin (2018) documents how a community group engaged storytelling following apartheid in South Africa as a personally, socially, and politically significant process that enabled new understandings of possibility and self-identities. Similarly, Bury's (1982) theory of biographical disruption suggests that illness results in a disruption to narratives of how people understand themselves and their life trajectories. The advent of the COVID-19 pandemic may have fundamentally shifted how AYP understand and speak about their lives and challenges. In other words, AYP may leverage forms of COVID-19 narratives to make sense of their experiences and form new understandings of themselves, their lives and possibilities. This was sometimes explicit within some AYP's narratives. As put by one South African adolescent advisor 'The problem, there is no food . . . So, COVID started, we already did not have food, okay. But then it affected my mother because she also did not work . . . '. (Female, Age 21).
More often, however, this was implicit and gleaned from exploratory, close longitudinal work through which researchers and advisors built longstanding relationships. This could also be seen in demographic studies in each of the respective regions, and in the case of South Africa, cohort studies by the research team from which adolescent advisors were recruited. For example, both the Eastern Cape and Kisumu see high levels of poverty, HIV and adolescent pregnancies. Challenges with health facility access and retention in care, violence victimisation, and teenage pregnancy, and substance use have been documented by the research team with the same cohort studies in South Africa that adolescent advisors were recruited from (L L Cluver et al., 2018;Hodes et al., 2016). Yet, many of these were discussed as new or severely worsened challenges. Similarly, in another paper in this issue, South African adolescent advisors' accounts of scolding nurses and inadequate health services are detailed as COVID-19-related stressors, alongside a body of evidence documenting similar barriers prior to COVID-19 . While these issues were likely exacerbated by COVID-19, they were not altogether new. That they were spoken about openly in mass media and became part of daily parlance during COVID-19may have provided new language and space for AYP to speak about these pre-existing issues differently, and in more open ways.
Adolescent advisors discussed previously identified issues as new, caused by the onset of COVID-19. In doing so, they leveraged new narratives to make sense of, and articulate their experiences. Drawing on dominant discourse, AYP spoke about things going 'back to normal', despite having also previously articulated serious deficits in their daily lives and opportunities. While access to education with school closures and changes to hours, remote learning and protocols was described as an explicit change due to COVID-19 prevention measures, other previously documented priority issues such victimisation, substance use, pregnancy and inadequate family support were described as caused by the indirect effects of the COVID-19 pandemic on financial, social and health systems. Adolescent advisors articulated these challenges as either severely worsened or new, despite having identified them previously as issues of concern.
Three exceptions to the longitudinal consistency of adolescent priority issues were (1) mental health; (2) crime; and (3) directly articulated household financial insecurity. In both sites, adolescent advisors described feeling isolated, alone, down and stressed, with many describing feelings characteristic of mental and emotional health challenges, findings of which have been reported in more depth elsewhere ). Adolescent mental health-related challenges brought about and exacerbated by the COVID-19 pandemic are documented in a growing literature (Álvarez-Iglesias et al., 2021;Banati et al., 2020;Nearchou et al., 2020;L. L. Sherr et al., 2021). (see Figure 2).
Whereas South African AYP shared concerns over finding work prior to COVID-19, issues of livelihoods and household financial insecurity only emerged directly as themes during COVID-19. Given well-documented COVID-19 pandemic shocks (Darmody, Smyth, Russell, 2021;Chauke & Chinyakata, 2020), this finding is notable although not surprising. Despite this, many concerns related to household resources including lack of food (Kenya), money for school fees (Kenya) and inability to find work (South Africa) were reported and welldocumented prior to the pandemic. It is likely that COVID created new spaces and language to discuss these existing challenges.
In both sites, a new issue linked directly to COVID-19 included crime, exacerbated by financial challenges. While crime is certainly not new -especially within the South African context, which has been ranked amongst the highest-crime countries in the world due to inequality, poverty, unemployment, social exclusion and normalisation of violence (World Population Review, 2022) -various stages of COVID-19 lock-downs saw fluctuations in crime (Greyling et al., 2021;Kriegler, 2021).
In an earlier study exploring South African AYP experiences at the beginning of the COVID-19 pandemic , we suggested that while exacerbating existing challenges, COVID-19 lockdown provided AYP with additional clarity of, and language to speak about existing difficulties. Through this additional analysis, it is clear indeed that the issues reported on during COVID-19 were mostly not new or completely attributable to COVID-19 lockdowns and their effects. While not diminishing the severity of adolescent COVID-19 experiences, or their understandings of their experiences, we suggest that it is crucial not to lose sight of the existence of significant health and social challenges experienced by adolescents prior to the COVID-19 pandemic. Considering such challenges through a longitudinal lens comes with the possibility of not only responding and 'recovering from' the urgent harmful effects of COVID-19 but also improving the socio-structural and material conditions of a highly vulnerable and important population of people. Such a longitudinal and structural lens will no doubt also support pandemic and disaster preparedness for future emergency situations.
This research has some limitations. First, activities were conducted with two demographically different groups of AYP, limiting close comparisons across these groups. Further, approaches differed slightly across sites (see Appendix 1): (1) we were unable to conduct a follow-up to explore Kenyan adolescents' priorities in more depth due to the onset of the COVID-19 pandemic; (2) COVID-19 reported experiences were not generated from the same priority-setting exercise, but rather from exploratory activities to understand adolescent experiences, coping and challenges; (3) although the COVID-19 call scripts were similar across sites, Kenyan advisors had significantly less technology access and relied more heavily on caregiver phones which undoubtedly shaped their responses; and (4) in South Africa, AYP additionally took part in closed online group activities which generated further insights. Given these limitations, longitudinal activities using consistent methods may be better placed to compare aspects of AYP's experiences. Despite these, the longitudinal nature of engagements with adolescents spanning the periods before and immediately after the start of the COVID-19 pandemic, combined with the depth of participatory and adolescent-driven insights provide rich and important insight into adolescent experiences, challenges and priority issues across time. These were possible due to long-standing relationships and rapport between researchers and adolescent advisors.
Findings presented in this paper also demonstrate the ability of AYP in different LMIC contexts to identify and articulate their health and development-related priorities when given the opportunities to do so, and the possibilities of participatory and arts-based methods to support priority-setting. Such methods including in-person (Lucie Cluver et al., 2020;Lesley Gittings et al., 2022) and remote ., Toska, E., Medley, S., Cluver, L., Logie, H., Ralayo, N., Chen, J, Mbithi, n.d.; L.  approaches set the ground for developing rapport and trust with adolescent advisors, and encouraging their confidence. These participatory prioritisation approaches -in-person and remotely -have relevance beyond research. They can equally be tools to engage adolescents in co-generating priorities and rich contextual information to inform health and development-related policy, program and intervention initiatives. As demonstrated here, such groundwork can be leveraged in pandemic and emergency contexts to generate rich and rigorous experiential data to understand the needs of this important, and often leftbehind group.

Acknowledgments
Foremost thanks to the adolescents and young people of the Eastern Cape and Kisumu, Kenya, Teen Advisory Groups for generously sharing their experiences and challenges before and during COVID-19 lockdown in South Africa with us. Authors thank and acknowledge the crucial support of the research and support teams based at the Universities of Cape Town and Oxford. Thank you to Ms Nosiphiwo Lawrence and Mr Nabeen Petersen who supported study design and data collection, and to Dr Megan Wainwright who provided valuable guidance to the research analysis process. We acknowledge and thank Dr Rebecca Hodes, Ms Mildred Thabeng, Dr Jenny Doubt, Dr Inge Wessels and Dr Carine Asnong for their long-term involvement and support of the Teen Advisory Groups study on which this work builds. Teen advisors were recruited from the Young Carers, Mzantsi Wakho and HEY BABY studies, and we are grateful to the research teams from these research studies. We are grateful to the anonymous reviewers who commented on previous drafts of this article.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Funding
This study was possible due to funding from: the UKRI GCRF Accelerating Achievement for Africa's Adolescents  Sherr, L., Cluver, L., Tomlinson, M., Idele, P., Banait, P., Antony, D., and Hunt, X. (2021)  Education and schooling 'When Corona came we were told to stay at home, the nine months has affected our education, where we were told that we have to learn online which I didn't have a smart phone so I couldn't access internet. In our school people had WhatsApp group which they were using. Unfortunately I didn't use it because I didn't have a phone. This affected me but I will try all my best . . . ' (Male, 16) 'when we came back (to school) you find that some parents cannot afford the fees, so children are just at home stressed and growing thin. They do not have a good life. Some also delivered during that corona period and were not able to come back and some parents are now mistreating them'. (Female, 16) "I am trying but now I am at home due to school fees. My Mum is struggling to make ends meet since she is a single mother and she is taking care of me, my two brothers, my uncle and one of my cousins who are living with us. They are in school one is in class four while our last born brother is not going to school due to school fees problems, while the remaining two, my cousin and my uncle are still in school". (Male, 12) 'I was stressed because of books because I couldn't study some of us in this online thing and we didn't have data so that makes me stressed because in the studies I was getting behind a lot'. , what some teenagers are going through made them stay at home since they don't want to be told to do this and that. This has made them stay away so that they can find peace. Some of the people let's say situation where girls are sexually abused by their fathers." (Male, 16) ' . . . some (adolescent girls who become pregnant) of them have been raped by men from the streets or some of them their parents, their fathers or some of them by their friends or boyfriends . . . some girls kill themselves when they hear that they are pregnant. So we should tell the boys that they should stop being violent and take responsibility for the child'. (Female, 11) 'One of the most experiences that youth is experiencing is that they are the kind of people who are women. Women during this time were killed. 'I will have peer pressure because my friends are smoking, and I will want to smoke, and these are not right things. I do not know how I will be helped. If there could be people -and from government -who would advise and help the children. It is not nice to see children smoking drugs. Sometimes when others are smoking the drugs is because there is something that is stressing them. I won't smoke them because there is something that is stressing me.
I would smoke because of peer pressure and deluded that one has beautiful eyes after smoking therefore I would also want to. And other children are facing painful things. For instance, others lost their parents and they were hurt -broken -and decided to alcohol abuse or use drugs'. (Female,21,phone interview) 'When someone is sober they'd never do illegal things. When they are drunk or on drugs, people have the guts to do things such as decapitation, rape and a general increase in crime. The government and the police must have stricter laws around the sale of drugs and alcohol. People who sell alcohol must be monitored and there should be a limit of how much alcohol they sell to decrease the amount of fights'. (Male, 19, phone interview) (Continued) 'As the man of the house I tried to make means to get some groceries. My life is really bad. I've also got to pay school fees. I live with my mother and we both depend on her pension fund. I told my uncle. I was supposed to sleep at school till 15 December 2020 so I told him I wouldn't be able to go as R600 is too much and I'm also looking after the house. He spoke to the principal and the event got cancelled. Now they will be putting money together for food so that the students can eat till 7pm. We will also attend Saturdays. I did struggle with food but was saved by the fact that my mother recently got paid'. (Male, 19, phone interview) 'We the youth that lives now, especially Black people neh -when we have to look at school or think about your life we do not have people that support us. We have to do things for ourselves. You have to do things for yourself and take decisions . . . and in all of that you have to wake up and hustle and study. We have to look for schools for ourselves and think of the transport fare amount and not eat the whole day at school . . . and have to study at the same time because one has to pass. So there is too much that is happening to youth and we do not get the support'. (Female, 22, phone interview) (Continued) Crime 'In our community boys have formed many groups. There is more theft cases due to boys who have dropped out of school. Even during this Corona period some boys broke into our house and took some of our belongings. It has also increased crime and theft. You see, most of the boys are engaged in drug abuse'. (Male, 16) 'There were a lot of accidents like some people were being arrested because they work at night and some people kill each other and a lot of them usually take drugs. we saw on the news like someone killed someone because of a remote control TV'. (Female, 11) 'On level 3 when alcohol was reinstated we were affected because the crime levels went up. There were break-ins and it wasn't safe. My area has had many cases of old people being murdered so I was scared as my mother is Exemplar of how priorities were discussed in relation to COVID-19: ' . . . I would say the young people are going through hard times, let's say for example, the girls, there are some girls that cannot even afford pads so they get involved in some behaviours that can later spoil their lives, and the boys you can find some can't afford school fees so some drop out of school . . . So that is also a challenge . . . another one is that the youth are getting involved in drug abuse. You find that during that corona period, when they went to school and saw people have stayed for a long time without going back to school and they said ooh! We are tired and they decided just to drink and get involved in drugs so that they can forget about school. Some girls have also gotten married so they have not come back to school . . . also you will find when we went for corona, when we came back you find that some parents cannot afford the fees, so children are just at home stressed and growing thin. They do not have a good life . . . Some also delivered (had babies) during that corona period and were not able to come back and some parents are now mistreating them . . . ' (Female, 16) "So COVID started, we already did not have food, okay. But then it affected my mother because she also did not work . . . ' (Female,22,phone interview