Kukaa Salama (Staying Safe): COVID-19 prevention practices with urban refugee and displaced adolescents in Uganda

Food insecurity (Fl) and water insecurity (WI) are linked with HIV vulnerabilities, yet how these resource insecurities shape HIV prevention needs is understudied. We assessed associations between FI and WI and HIV vulnerabilities among urban refugee youth aged 16-24 in Kampala, Uganda through individual in-depth interviews (IDI) (n=24), focus groups (n=4), and a cross-sectional survey (n=340) with refugee youth, and IDI with key informants (n= 15). Multi-method findings reveal FI and WI are linked with HIV vulnerabilities, underscoring the need for HIV prevention to address co-occurring resource insecurities with refugee youth.

Displaced populations in resource-constrained settings require tailored COVID-19 prevention strategies and mobile health (mHealth) emerges as a cost-effective approach. This study aimed to evaluate engagement and learning outcomes of the Kukaa Salama – Staying Safe – mHealth intervention for enhancing COVID-19 prevention practices among urban refugee youth. This mixed-methods analysis used cross-sectional data from refugee youth aged 16-24 in Kampala, Uganda. Standardized questionnaires were used to collect mHealth engagement data and socio-demographic information. Participants shared learning experiences through responses to SMS check-ins and weekly informational messages. Findings offer insights into characteristics of engagement and specific learning outcomes from the Kukaa Salama intervention. Future mHealth programmes can leverage community-based and age-sensitive approaches to enhance mental health support for your urban refugees.

With over 82.4 million forcibly displaced persons worldwide, there remains an urgent need to better describe culturally, contextually, and age-tailored strategies for preventing COVID-19 in humanitarian contexts. Knowledge gaps are particularly pronounced for urban refugees who experience poverty, overcrowded living conditions and poor sanitation access that constrain the ability to practise COVID-19 mitigation strategies such as physical distancing and frequent hand washing. With over 1.4 million refugees, Uganda is sub-Saharan Africa's largest refugee hosting nation. More than 90 000 of Uganda's refugees live in Kampala, most in informal settlements, and 27% are aged 15-24 years old. There is an urgent need for tailored COVID-19 responses with urban refugee adolescents and youth. In this study we developed and evaluated the effectiveness of an 8-week interactive informational mobile health intervention on COVID-19 prevention practices among refugee and displaced youth aged 16-24 years in Kampala, Uganda.

Robust policy- and decision-making are key to safeguarding existing gains and spearheading further advances towards gender equality and health equity. However, exclusionary practices stand in the way of inclusive, informed, and impactful policy, with intersecting colonial constructs of gender and youth driving the continued devaluation and dismissal of youth expertise. This paper traces how coloniality - overarching structures rooted in domination, extraction, and exploitation - has systematically barred youth voices and their lived experience from discussions and debates about their own health and well-being. Grounded in a decolonial feminist approach, we advocate for the recognition of youth feminists as key experts in global health. Three case studies are presented in which youth expertise was integrated into policy- and decision-making processes: 1) a peer navigator model for displaced and refugee youth in Kampala, Uganda; 2) youth feminists in Kenya leading community input into the East African Legislative Assembly (EALA) bill on sexual and reproductive health rights (SRHR); and 3) the Amenah intervention on early marriage, mutually designed and implemented with Syrian refugee peer educators and adolescent girls in Lebanon. These studies emphasise that for youth voices to be acknowledged as policy experts, we must recognise that everyone is capable of holding expertise, support networks that encourage and empower young people, and reimagine policymaking systems such that "nothing about us without us" becomes a standard. We argue that power asymmetries lie at the root of inequality and inequity and that efforts to attain gender equality and health equity for all must leverage the full might of collective action. Until and unless the default understanding of "collective" includes intergenerational collaboration, with an appreciation for youth activists' skills, expertise and energy, the attainment of gender equality and health equity for all will remain unrealised.

Tailored COVID-19 prevention strategies are needed for urban refugee youth in resource-constrained contexts. We developed an 8-week interactive informational mobile health intervention focused on COVID-19 prevention practices informed by the Risk, Attitude, Norms, Ability, Self-regulation – or RANAS – approach. We conducted a pre-post trial with a community-recruited sample of refugee youth aged 16-24 years in Kampala, Uganda. Data were collected before (T1) and immediately following (T2) the intervention, and at the 16-week follow up (T3), to examine changes in primary (COVID-19 prevention self-efficacy) and secondary outcomes (COVID-19 risk awareness, attitudes, norms and self-regulation practices; depression; sexual and reproductive health access; food/water security; COVID-19 vaccine acceptability. Digital approaches for behaviour change hold promise with urban refugee youth but may need booster messaging and complementary programming for sustained effects.