Impact of COVID-19 on Young Children and Families in Jamaica

1

ABSTRACT

This study aimed to assess the vulnerabilities of young Jamaican children in the first few months after the COVID-19 pandemic emerged in Jamaica in March 2020. The study participants (n = 649) were identified from a sub-sample of 1,311 families from an existing national, population-based Jamaican birth cohort of 9,500 children and families. The birth cohort enrolled children and families at children’s birth in July to September 2011. Computer-assisted telephone interviews of parents or primary caregivers conducted April to June 2020 inquired about household and family characteristics, socio-economic status, and children’s wellbeing prior to and since the pandemic. Data were entered into SPSS and frequency and cross-tabulation analyses conducted. Participants reported increased financial difficulties; reduced access to children’s education, particularly for pre-school children; increased parenting demands, particularly for mothers; and increased levels of corporal punishment use. Children and families of lower socio-economic status were more economically vulnerable, and more academically vulnerable due to limited means of access to remote education, but were not at higher risk for harsh discipline. Participants prioritized the need for educational support for children over financial support and physical and mental health support for themselves. The information from this study may be used to inform similar situations of crisis.

KEYWORDS:

• Children
• COVID-19
• Jamaica

On 7 January 2020, Chinese authorities identified a novel coronavirus as the cause of a highly infectious pneumonia. The virus spread rapidly across the world and on 30 January 2020, the World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern; the name COVID-19 was assigned by the WHO on 11 February 2020. Some two years later, on 10 March 2022, the WHO reported more than 450 million confirmed cases and more than 6 million deaths, primarily adults.

The first COVID-19 case in Jamaica was identified on 10 March 2020. As in other regions of the world, the most immediate concern was the health and mortality of adults. Jamaica implemented public health responses to prevent transmission by reducing human contact. These included closure of international borders to prevent country to country transmission as well as a range of within-country lockdown mechanisms, including closure of all but essential services, establishment of work from home practices, closure of schools, prohibition of and limitations on social gatherings, and physical distancing and wearing of masks for those occasions when human contact did occur. With time, vaccines were developed, but the public health measures were still recommended. With recognition that these public health measures were likely to be a prolonged process, attention turned to the long-term impacts on the economy and the social effects on the population.

The effects of COVID-19 and the public health response were expected to disproportionately impact low- and middle-income countries (LMICs) with less stable economic and social security and, within these countries, to disproportionately impact the most vulnerable groups. Children are recognized as a vulnerable group disproportionately impacted by poverty. Prior to the pandemic, one in six children, or 356 million children in total, lived in extreme poverty, surviving on less than purchasing power parity (PPP) of US$1.90 per day, while 841 million (41.5%) of children worldwide live in households with income/consumption levels equivalent to moderate poverty, with a PPP of US$3.20 per day per person. This compared with 23.5% of adults age 18 and above (Silwal et al., 2020). International, regional, and national child development experts and advocates advised heightened concern for the health, development, education, and welfare of children during the COVID-19 pandemic and in the future, and particularly that of the very young. Young children have greater vulnerability due to their dependence on adults in the home and their limited social interaction outside of the home. Long-term developmental and educational impacts are also more likely if they affect the brain during the early childhood years, when brain development is maximal.

This article reports on research designed to rapidly assess the vulnerabilities of young Jamaican children and their families after the first few months of the COVID-19 pandemic.

Literature review

Violence has been shown to increase for children during periods of greater stress for adults, such as during pandemics. During the 2007–2009 recession in the United States, for example, there was an increase in violence against children (Schneider et al., 2017). Following school closures amid the West African Ebola epidemic, the rates of child labor, child neglect, sexual abuse, and adolescent pregnancies all spiked (Rothe et al., 2015). Early in the COVID-19 pandemic, news reports and websites of women’s organizations (Peterman et al., 2020) noted increased violence against women and children.

Children were also made vulnerable by the school closures. In March 2020, the United Nations Educational, Scientific and Cultural Organization (UNESCO) estimated that 1.5 billion children, or 87%, of previously enrolled learners at pre-school, primary, secondary, and tertiary levels were out of school across 165 countries. During the Ebola epidemic, many children did not return to school after the closures (Rothe et al., 2015).

During the COVID-19 pandemic, children across the world had limited access to play, leisure, and extra-curricular activities due to government restrictions on movement and group activities. Parents faced the responsibility of educating and facilitating leisure activities for children in their homes, while also working from home. For many, keeping children busy and safe at home every day was a daunting prospect; these challenges were exacerbated for those living in low-income and crowded households (Cluver et al., 2020). Parents and children were living with increased stress and fear, all challenging their capacity for tolerance and long-term thinking (Cluver et al., 2020).

Research on the impact of COVID-19 on households with children in 35 LMICs was conducted between April and September 2020, through telephone interviews with participants from previous nationally representative surveys or through random digit dialing (World Bank & UNICEF, 2022). The survey showed the many ways in which children were affected by the pandemic, but also that households with many children (i.e., three or more) were more severely affected. Some 76% of households with many children suffered income loss, compared with 55% of households with no children. Additionally, 24% of households with many children reported food insecurity, compared with 14% of households with no children. Only 4% of households with many children reported accessing mobile learning applications, compared with 11% of households with few children. Among households with children who attended school before school closure, less than 60% reported children participating in any educational activities after the school closure due to the COVID-19 outbreak. However, households with many children were also more likely to receive social assistance (26%) than households with no children (12%).

As time went on, further waves of the study found that households with many children continued to experience higher rates of income loss than households with no children, although the differences between groups were not statistically significant. Similarly, higher rates of food insecurity continued to be experienced among households with many children compared with those with no children, though moderate and severe food security indicators showed decreasing trends for all households. Households with more children continued to be more likely to receive government assistance, with the share of households receiving government assistance increasing for all households 6–9 months after the peak stringency of the government response.

Children were affected concurrently by vulnerabilities. UNICEF derived a multi-dimensional poverty measure, based on the ability to access health, education, nutrition, water and sanitation, and housing services (UNICEF & Save the Children, 2020). Prior to the COVID-19 pandemic, analysis of data from MICS and DHS surveys from more than 70 countries showed that 45% of children were severely deprived of at least one of these critical services and 75% were moderately deprived (UNICEF & Save the Children, 2020). Deprivation of just two of these services, health and education, increased from 47% to 56% within the first 6 months of the pandemic. This translated to approximately 150 million additional children estimated to be living in multidimensional poverty since the start of the pandemic.

As the pandemic progressed, further studies on the impact of COVID-19 on children and families in LMICs emerged. The Early Childhood Development Action Network (ECDAN) documented 411 such peer-reviewed studies up to October 2021 (Hackett et al., 2021). The majority of studies (84%, n = 346) assessed the impact on maternal and child physical and mental health and nutrition; nutrition accounted for only 7% (n = 29). Some 9% (n = 36) of studies addressed education and caregiving and 7% (n = 31) addressed safety and security. Most studies included children up to 18 years; less than 10% focused on children 8 years and younger. Study participants were primarily mothers, health-care and social sector workers, and educators; only one study focused on fathers.

Health studies were primarily in two categories – mental health and access and utilization of health services – each accounting for over 25% of the 411 studies. Mental health study findings were consistent, identifying increased stress, anxiety, and depression among pregnant women and mothers, and increased mental health and behavioral problems among children and adolescents. For example, in a study of 6,894 pregnant and postpartum women across 64 countries, 43% of women scored above cut points for post-traumatic stress disorder and 23% above cut points for anxiety/depression (Basu et al., 2021). In a study of children’s emotional and behavioral state in Jordan following the onset of COVID-19, 77.5% of parents of children 5–11 years reported increased boredom, 66% reported increased irritability, 60.7% reported increased arguments, and approximately 50% of parents reported increased nervousness, reluctance, loneliness, and anger (Al-Rahamneh et al., 2021). Children also spent less time at physical activity and had increased screen time (Al-Rahamneh et al., 2021).

Studies on access and utilization of health services identified reduced access to a wide range of maternal and child health services. For example, in Ethiopia, there was a reduction in family planning visits, mean utilization of antenatal care, health facility births, and newborn immunization (Kassie et al., 2021). There was also an increase in the proportion of teen pregnancies and teenage abortion care. Additionally, child outcomes worsened with increases in institutional still births (14% vs 21.8%) and neonatal deaths (33.1% vs. 46.2%). A systematic review showed there was a reduction in childhood vaccination coverage and a decline in the total number of vaccines administered (Lassi et al., 2021). Access to services for chronic health conditions, such as cardiovascular surgery, was also affected (Rodríguez et al., 2021).

Nutritional studies identified increased food insecurity. In the favelas of Brazil, where those of lower-socio-economic status reside, 47% of households experienced moderate or severe food insecurity (Manfrinato et al., 2021). Food insecurity was measured by uncertainty about food acquisition, eating less, not being able to eat nutritious food, and skipping a meal. There was also an increase in both wasting and overweight among children, while women had a persistent high prevalence of obesity (Jayatissa et al., 2021).

Education and caregiving studies explored parent and teacher perceptions on school closure and remote learning. Most studies showed that technology was not a replacement for in-person learning. For example, analysis of household data from 13 LMICs showed that most countries’ remote learning responses were insufficient to keep all children learning and avoid dropouts; this was particularly true for marginalized and pre-primary children (Conto et al., 2021). Some parents reported positive aspects of school closures, including families spending more time with their children and having greater engagement with children’s learning (Lyu et al., 2020); others reported increased stress and conflict (Tarsuslu et al., 2021). Gender inequalities in household work, child rearing, and the ability to work remotely were also identified (Borah Hazarika & Das, 2021).

In terms of safety and security, a number of studies have reported on the challenges in measuring the incidence and prevalence of violence during the pandemic, including the absence of population level data and the stigma associated with reporting violence (Hackett et al., 2021). Analysis of UNICEF’s Multiple Indicator Cluster Surveys (MICS) data from three countries estimated an increase of 35–46% in violent discipline toward children (Fabbri et al., 2021). Analysis of administrative reports identified both an increase in violence against children (de Oliveira et al., 2021) and a decrease (Cabrera-Hernández & Padilla-Romo, 2020). The decrease was believed to be due to children’s reduced access to professionals, such as teachers. Increases in intimate partner violence were also reported (Ditekemena et al., 2020).

As adults had greater mortality rates from COVID-19 than children, orphanhood and caregiver loss due to COVID-19 was also quantified; it was estimated that more than 10 million children lost parents or caregivers and more than 7.5 million children experienced COVID-19-associated orphanhood up to May 2022 (Hillis et al., 2022).

Almost two-thirds of the ECDAN studies (62%) were from upper middle-income countries; only two studies were from a Caribbean country – the Dominican Republic. These focused on health concerns: the impact on vaccinations and the evaluation of a health-care worker training program to reduce maternal mortality. Of the 22 global studies, 10 (45%) included at least one Caribbean country, most often the Dominican Republic or Haiti. Representation from the English-speaking Caribbean typically occurred when administrative data reported internationally (mortality, anthropometry) were analyzed or when open surveys were conducted across countries.

The literature review suggests that analyses of the impact of the COVID-19 pandemic on young children should consider socio-economic, educational, and health consequences, as well as exposure to violence and parental stress. Additionally, there is limited analysis of the impact of the pandemic on children and families in the Caribbean.

Methods

Study design

This study was cross-sectional in design and utilized a sub-sample from Jamaica’s second national longitudinal birth cohort study, the JA KIDS study. The birth cohort study aimed to investigate health, developmental, and behavioral outcomes for young Jamaican children, born between 1 July and 30 September 2011. Details of enrollment in the birth cohort study are presented elsewhere (Reece et al., 2020; Samms-Vaughan et al., 2019; Trotman et al., 2021). Pre-enrollment of mothers expected to deliver in the birth cohort study period occurred in March to September 2011 (n = 4,576). Subsequently, some 9,742 study families (parents and children) were enrolled and evaluated within 24–48 h after childbirth, representing 87.6% of the 11,124 children born in the study period (personal communication, Jamaican Registrar General’s Department). The entire sample or sub-samples of the birth cohort were invited to be evaluated in person or via computer-assisted telephone interview (CATI) at subsequent times. At the next contact, when children were 9–12 months of age, some 7,609 (78.1% of the birth sample) participated via CATI. A computer-generated 35% random sample (n = 3381) was selected for follow-up when children were 18–22 months old. At the contact when children were 48–54 months, the sample (n = 1311) consisted of all children and families that had participated in three or four prior contacts.

Selection of study sample

The study on the impact of COVID-19 was conducted among families who participated in the 48- to 54-month JA KIDS contact, for whom recent telephone contacts were more readily available. These 1,311 families were socio-demographically similar to the original birth cohort population of 9,724 in maternal age, number of prior pregnancies, socio-economic status, and general health. However, mothers from the 48- to 54-month contact were less likely to have tertiary education (7.3%) than the original cohort population (9.6%) (p < .01) (Reece et al., 2020). The COVID-19 study inquired of all children resident in the home of the JA KIDS families.

Study period

The study enrolled primary caregivers during the 2-month period from 23 April to 26 June 2020. All schools and workplaces, apart from essential services, were closed to the public during this period.

Study sites

As the original sample was population based, this study included participants from all 14 parishes in Jamaica.

Recruitment/enrollment

Potential study participants were contacted by telephone and invited to participate in the COVID-19 study. Oral informed consent was obtained, after which interviews were conducted by a trained and experienced team of interviewers.

Data collection procedures and study instrument

A single survey instrument, designed by the authors for this study, was administered via telephone. The questionnaire was divided into six subsections: Household and Family Demographic Characteristics; Children’s Care, Supervision, and Education; Child and Family Health Prior to and Since COVID-19; Exposure to Violence; Parental Perception of Parent and Child Needs During COVID-19; Socioeconomic Status and Family Status Prior to and Since COVID-19.

Data were entered at the time of interview via CATI. The advantages and disadvantages of CATI, specifically for obtaining public health information, have been studied (Choi, 2004). Among the advantages identified are reduced survey costs, access to large samples, interviewee anonymity allowing more valid responses to sensitive questions, more efficient interviewing and data entry, possibility of inclusion of a survey management system (SMS), reduced data incompleteness and data transcription errors, and rapid analysis and production of results. Disadvantages include the time necessary to establish CATI technology and train technical staff, self-report errors, limited concentration of interviewees for long questionnaires, loss of interviewer-interviewee rapport, data entry errors, and bias in relation to population access to telephone services.

In the pandemic situation in Jamaica, CATI was particularly useful during lockdown periods when face-to-face interviews could not be conducted. The CATI system was built by highly trained personnel, and the questionnaire was designed to be completed within 30 min. The existence of a population-based sample with access to telephone numbers would have reduced the bias of population access to telephone services in the Jamaican study. Additionally, the majority of Jamaicans have access to a cellular phone; the World Bank reports a mobile penetration rate of 103% in Jamaica in 2021 (databank.worldbank.org-Mobile-penetration).

Data analysis

Following range and logic checks, analyses were conducted using SPSS v 21. Descriptive analyses were performed using frequencies.

Ethical approval

Ethical approval was received from the University of the West Indies Mona Campus Research Ethics Committee (approval # ECP 183 19/20).

Results

Participation rate

A total of 649 JA KIDS families, or 49.5% of the target study population of 1,311, participated in the COVID-19 study. The main reason for nonparticipation was inability to contact participants using available telephone numbers (35.6%); home or personal cellular telephone numbers were not in use, were restricted, or had changed. The last contact with families occurred in the period of August 2015 to July 2016. Other reasons for nonparticipation were parental refusal to participate, primarily because of the absence of compensation or the perception that families were only contacted when there was a research need (9.3%), the perception that interviewers were fraudulent (5.1%), and child and family migration (0.5%).

Description of study participants

Some 53.8% (n = 346) of study participants were male and 46.2% (n = 297) were female, consistent with the original birth cohort population. JA KIDS were between 8 years 8 months and 8 years 11 months at the time of the interview. JA KIDS birth mothers were present in 89.8% of homes and birth fathers in 38.5%. Despite being a sample of households with children, the study sample compared favorably with household demographic data obtained from Jamaica’s annual national household survey, the Jamaica Survey of Living Conditions (JSLC) 2019, with data collected from May 2019 to February 2020 (Planning Institute of Jamaica [PIOJ] and Statistical Institute of Jamaica [STATIN], 2022). For children up to 8 years, birth mothers were present in 84.7% of homes and birth fathers in 34.3%.

The majority (91.7%) of surveys were completed by the JA KIDS birth mother, with 3.1% completed by the birth father and 5.2% by another primary caregiver – primarily other female relatives, such as grandmothers, and mother’s partner. The main reasons for the JA KID living with other caregivers were migration of biological parents and parental financial challenges. In terms of union status of primary caregivers, 32.1% were married, 40.0% were in a common law relationship, 26.3% were in a visiting relationship, and 1.6% were either separated or widowed.

While all households had at least one child attending primary level schooling (the JA KID), 2.6% (n = 15) had a child in nursery school, 26.9% (n = 157) had a child in pre-school, and 41.2% (n = 246) had a child in secondary school. Only three families (0.5%) reported a child in the home enrolled in special education.

Socio-economic status prior to COVID-19

The mother of the JA KID was the major wage earner in 42.5% of families, the birth father in 29.4%, both parents in 7.4%, grandparents in 7.2%, and a spouse who was not the biological father in 6%. Some 50.8% owned their home fully, 8.2% were making mortgage payments, 22.5% were paying rent or were on leased property, 15.7% occupied a house without paying rent based on personal arrangements, and 1.2% were living on land illegally. Modern unshared water closet toilet facilities were reported by 76.0% of families and safe water supply by 81.2%. In the JSLC 2019, the proportion of households that were owned was 54.2%; 76.4% had unshared water closet access and 77.7% had safe water.

The majority of households reported that one adult (28.6%) or two adults (51.0%) contributed to the household income; 20.4% of households reported that three to six adults contributed. Family income supported a single adult in 17.3% of families, two adults in 43.2%, three adults in 24.2% of families, and 4–10 adults in 15.3% of families. Family income supported one child in 27.5% of families, two children in 36.1%, three children in 22.1%, and four to nine children in 14.3% of families. Crowding, defined as two or more persons per room, was present in 40.8% of households.

Thirty-seven percent (37.0%) of families reported receiving no additional financial support other than income from their own employment prior to the COVID-19 pandemic. The main forms of support were the Government of Jamaica’s established and evaluated conditional cash transfer program, the PATH program (35.3%) (Levy & Ohls, 2010), relatives overseas (33.1%), and relatives in Jamaica (10.0%). All other sources of financial support were reported by 1% of families or fewer, including those from national insurance, foundations, charities, and churches.

Socio-economic effects of the COVID-19 pandemic

Subsequent to the COVID-19 pandemic, 44.5% of families (n = 286) reported one employed adult in their household having his/her income reduced or lost, while 24.9% (n = 160) reported between two and five adults having reduced or lost income. There was no significant difference in the proportion of job losses. Less than a third of families (30.6%, n = 197) reported no change in income. Of the 446 families who had their income reduced or lost, some 77.8% (n = 347) were major wage earners. Only 33 families (5.2%) reported at least one adult having an increase in income.

Only 1.5% of families reported an additional adult and 1.4% reported an additional child joining the family. Fewer than 1% of families reported a child or an adult leaving the home. An adult working from home was reported by 11.5% of families.

Table 1 shows the change in families’ ability to meet economic needs before and after the COVID-19 pandemic. The proportion of respondents reporting difficulty (i.e., that it was difficult or very difficult) providing food increased by 22.5% points during the pandemic, as compared to those finding difficulty paying utilities (19.8% points), paying phone and internet bills (19.6% points), purchasing goods for children (11.4% points), and paying rent/mortgage (5.3% points).

Table 1. Caregiver ability to meet socio-economic needs pre- and post-COVID-19.

Socio-Economic Needs	Pre-COVID-19			Post-COVID-19
	Very Difficult	Difficult	Not Difficult	Very Difficult	Difficult	Not Difficult
Ability to afford food	3.6%	42.6%	53.8%	18.5%	50.2%	31.3%
Ability to afford clothing	2.8%	36.3%	60.8%	17.1%	27.3%	55.7%
Ability to pay rent/mortgage	3.6%	31.0%	65.5%	14.2%	35.6%	50.2%
Ability to pay utility bills	7.6%	44.0%	48.3%	23.7%	47.7%	28.6%
Ability to pay phone/internet bills	6.9%	44.8%	48.3%	21.4%	49.9%	28.7%
Ability to provide goods for children	4.4%	43.9%	51.7%	19.1%	40.6%	40.4%

Table 2 shows the ability of families to meet socio-economic needs during the pandemic by socio-economic status, as measured by two household socio-economic measures: presence of modern, unshared toilet facilities and crowding. These measures with different distributions in the population showed that families of lower socio-economic status were more likely to find it difficult or very difficult to meet socio-economic needs. Significance levels were attained for both socio-economic measures in the ability to provide food and clothing, and for one measure in the ability to pay utilities, phone or internet bills, and purchase goods for children. Significance was not attained for the ability to pay rent or mortgage.

Table 2. Caregiver ability to meet socio-economic needs by household socio-economic status.

Socio-Economic Needs	Degree of Difficulty	Modern Toilet Facilities (%)		P value	Crowding (%)		P value
		Yes	No		No	Yes
Ability to Afford Food	Very Difficult	68.1	31.9	.039	30.4	69.6	.006
	Difficult	76.5	23.5		40.3	59.7
	Not Difficult	80.6	19.4		49.2	50.8
Ability to Afford Clothing	Very Difficult	59.5	40.5	.000	31.3	68.7	.019
	Difficult	66.4	33.6		37.3	62.7
	Not Difficult	79.2	20.8		47.3	52.7
Ability to Pay Rent/Mortgage	Very Difficult	75.0	25.0	.473	38.7	61.3	.361
	Difficult	80.0	20.0		40.8	59.2
	Not Difficult	84.1	15.9		50.0	50.0
Ability to Pay Utility Bills	Very Difficult	68.8	31.3	.006	36.2	63.8	.124
	Difficult	76.2	23.8		40.5	59.5
	Not Difficult	83.9	16.1		47.8	52.2
Ability to Pay Phone/Internet Bills	Very Difficult	74.3	25.7	.627	33.3	66.7	.033
	Difficult	75.8	24.2		40.1	59.9
	Not Difficult	78.7	21.3		48.5	51.5
Ability to Provide Goods for Children	Very Difficult	70.9	29.1	.044	34.9	65.1	.057
	Difficult	75.1	24.9		37.4	62.6
	Not Difficult	81.9	18.1		46.6	53.4

Educational support

The sources of educational/learning material accessed by children while schools were closed is indicated by school level in Table 3. Children attending nursery school or receiving special education were excluded from further educational analysis due to small numbers.

Table 3. Sources of educational/learning material in the home by school level.

School Level	Sources of Educational/Learning Material
	Books in Home		Schoolbooks		Television/Radio		Ministry of Education Web-Based Programs		Other Web-Based Programs		Other
	No.	%	No.	%	No.	%	No.	%	No.	%	No.	%
Pre-School (n = 157)	90	57.3	119	75.8	42	26.8	9	5.7	11	7.0	49	31.2
Primary (n = 648)	261	40.2	593	91.5	160	24.7	102	15.7	39	6.0	267	41.2
Secondary (n = 246)	56	22.8	199	80.9	54	22.0	47	19.1	16	6.5	77	31.3

Schoolbooks were the main source of educational/learning material at all levels, but proportionately more primary school children utilized schoolbooks (91.5%) than secondary (80.9%) and pre-school (75.8%) children. This was followed by utilization of existing books in the home for all levels. Pre-school children, at 57.3%, were proportionately more likely to utilize books already in the home than primary (40.2%) and secondary (22.8%) level children. Television and radio programs were accessed equally by approximately a quarter of children at all school levels. The “other” category, documented by 41.2% of respondents for primary school children, included school work sent via electronic means by teachers for 51.9% of those 77 respondents who recorded an answer. Other means of education included using Google or YouTube.

The majority of primary (86.2%) and secondary (80.8%) level children received educational/learning materials from schools for 3 or more days per 5-day school week (Table 4). However, only a half of pre-school children (53.2%) received materials for that period.

Table 4. Frequency of receiving educational/learning material from schools by school level.

School Level	Frequency of Receiving Educational/Learning Material From Schools
	Every Day		Most Days (3–5 days/week)		Occasional Days (1–2 days/week)		Never
	No.	%	No.	%	No.	%	No.	%
Pre-School (n = 143)	63	44.1	13	9.1	26	18.2	41	28.7
Primary (n = 634)	458	72.2	89	14.0	39	6.2	48	7.6
Secondary (n = 235)	142	60.4	48	20.4	24	10.2	21	8.9

The most frequent method for receiving educational material from schools was WhatsApp, utilized by parents or children themselves for 65.8% (102/155) of pre-school children, 84.2% (543/645) of primary students, and 75.4% (177/238) of secondary level students. This was followed by Zoom/Skype for 22.2% (143/645) of primary level children and 31.5% (75/238) of secondary level children. Zoom/Skype was used by only nine pre-school children.

Respondents indicated that internet access was available by smart phone in 90.6% of homes, by tablet in 44.7%, by laptop computer in 28.0%, by desktop computer in 4.0%, and by other means, most often smart television, in 5.8%. As many as 68.2% of children were reported to have a tablet, phone, or computer available for personal use. For 2.4% of children (15/633), tablets were obtained through the Government of Jamaica Tablets in School program, which predated the pandemic and began as a pilot project in 2014.

There was no significant difference in access to a smartphone due to socio-economic status as measured by toilet facilities. However, children of lower socio-economic status were significantly less likely to have access to a tablet (p = .001), laptop computer (p = .002), or a desktop computer (p = .018).

Child and family physical health pre- and post-COVID-19

The majority of caregivers (89.9%) reported themselves to be in good, very good, or excellent health, 7.3% reported themselves to be in fair health, and 2.9% reported poor physical health prior to COVID-19. Subsequent to COVID-19, 83.8% of caregivers reported themselves to be in good to excellent physical health, 11.6% reported fair health, and 4.6% reported poor health.

Just under a half of households (46.5%, n = 302) reported the presence of adults with chronic illnesses. The most common illnesses were hypertension (27.4%), asthma (13.4%), diabetes (10.2%), cardiovascular disease (5.5%), and sickle cell disease (1.5%). Kidney disease, cancer, seizures, HIV/AIDS, and disabilities were reported by 1% or less. Fewer households (27.3%, n = 147) reported children with chronic illnesses; asthma was reported in 19.9% of households, hypertension in 1.8%, seizures in 1.5%, diabetes in 1.1%, and sickle cell disease in 0.9%. Cardiovascular disease and kidney disease were reported in 0.2% and HIV/AIDS and cancer were not reported in any household in the sample. Some 9% of children (n = 58) and 17.6% (n = 114) of adults were reported to have missed regular clinic visits for medical care.

Children’s care and supervision

Prior to the COVID-19 pandemic, the main persons providing care and supervision for children in the home were birth mothers (56.5%), grandparents (18.2%), birth fathers (6.8%), adult/adolescent siblings (3.6%), and other relatives and non-relatives (14.9%). Since the pandemic, the main persons providing care and supervision for children were mothers (69.3%), grandparents (10.6%), birth fathers (5.4%), adult/adolescent siblings (5.0%), and other relatives and non-relatives (9.7%).

Responses to child behavior

Respondents were asked about mechanisms they used more often during the COVID-19 pandemic period, compared to the period before the onset of the pandemic, to respond to their children’s behavior. Eight options, including positive behavior support (e.g., hugging and reasoning), non-corporal punishment (e.g., time-out, withdrawal of privileges), emotional abuse (e.g., shouting at children and threatening children), and physical abuse (e.g., spanking), were offered. The majority of respondents reported using positive behavior support more; 85.9% reasoned more with their children and 73.8% hugged their children more. Almost two-thirds of parents (65.6%) used withdrawal of privileges more, but 60.6% shouted at children more and 52.2% threatened punishment more than prior to the COVID-19 pandemic. Less than half of parents reported using time out (45.3%), spanking (23.9%) and asking someone else to manage the children’s behaviour (19.1%) more frequently during the pandemic. Some 53 (8.5%) respondents offered other options, the majority of which (n = 27) were engaging the child more in chores, play, and family activities. There were no differences in parental responses due to household socio-economic status as measured by toilet facilities.

Experiences of violence

Few respondents reported experiences of violence during the early months of the COVID-19 pandemic; the most frequently reported was emotional violence, such as threatening or belittling (6.8%, n = 44). Of this group, 2.6% were threatened by a current or previous partner, 2.4% by a relative or other non-related adult, 1.2% by a stranger, and 0.6% by colleagues and neighbors. Types of threat included restriction of movement at 1.4%, restriction of access to financial resources at 0.9%, physical violence without an implement (e.g., slapping and punching) at 0.3%, and physical violence with an implement (e.g., stabbing and chopping) at 0.3%; rape and sexual harassment were reported less frequently.

Only 3.1% (n = 20) of all respondents, and less than a half of those reporting violent incidents, thought that children in the home had witnessed these events. Only 0.9% (n = 6) made a report to the police.

Perception of support required for children

Respondents were provided with seven response options that had the potential to improve the situation for children during COVID-19; an eighth response category, “Other,” was open ended. As shown in Table 5, more than 60% of respondents identified greater access to children’s teachers and to the internet and Wi-Fi, and a greater variety of educational programs by the Ministry of Education, as important supports for children. Fewer respondents (35.7%) identified leisure and toy activities as important child support activities.

Table 5. Perceptions of support required for children.

Perceptions of Support Required for Children	%
More access to children’s teachers by internet/phone	63.9%
More access to internet/Wi-Fi for education	61.6%
Greater variety of educational programs provided by Ministry of Education	61.2%
More access to education on COVID-19 for children	52.9%
More access to creative programs	49.3%
More access to educational programs other than that provided by the Ministry of Education	46.7%
More leisure and play activities and toys in the home	35.7%
Other	5.9%

Perception of support required for adults

Respondents were provided with nine response options that had the potential to improve the situation for adults during the COVID-19 pandemic; a tenth response category, “Other,” was open ended. The most common form of parental support identified was programs to facilitate teaching children at home (73.2%); this was followed by financial support (67.0%) and programs on child behavior management (60.7%) (Table 6).

Table 6. Perceptions of support required for adults.

Perceptions of Support Required for Adults	%
More access to parent support programs on how to teach children at home	73.2%
Direct financial support, because of lost income	67.0%
More access to parent support programs on how to manage children’s anxiety and other behaviors	60.7%
More access to programs/counselors to support my mental health and relieve stress	49.5%
More access to leisure activities to improve my physical health	42.5%
More access to information about COVID-19; I need to know everything	42.2%
My workplace being set up to facilitate work from home	19.7%
Less information about COVID 19; too much information is scary and worrying	15.6%
Other	2.2%

Study limitations

The study had some methodological limitations. The participation rate was low, primarily because of outdated contact information. Data were collected for only a two-month period just after the onset of the pandemic and therefore represents the immediate impact of the COVID-19 pandemic only. The small sample size did not allow for analysis of the educational impact of COVID-19 on children attending nursery school or children receiving special education. Data were collected by self-report only; self-report bias may have led to socially acceptable responses, particularly for sensitive questions such as personal experiences of violence.

Discussion

The participants in this study were socio-demographically representative of the Jamaican population, based on household measures. The data showed that 7 of every 10 families were affected by reduced or lost income during the early months of the pandemic, with five or six of these families likely significantly affected by virtue of the income affected being that of the major wage earner. Another study conducted in Jamaica by UNICEF at the same time had similar results; 80% of households with children had reduced income, and 24% reported being laid off (UNICEF Jamaica, 2021). New employment during the early pandemic period was a rare occurrence, impacting only five of every 100 families. The reduced income manifested itself primarily in more than 20% points greater food insecurity, compared to the pre-pandemic level among study families of just below 50%. The 2019 JSLC reported food insecurity nationally to be 42% (PIOJ & STATIN, 2022). Worsening food insecurity was not due to changes in family size, as few families increased in size during the pandemic. A study in eight Caribbean countries confirmed that food security was a major concern with the onset of COVID-19; 16% of households reported sub-optimal diet, 40% experienced hunger, and 42% reported being moderately or severely affected (Perry et al., 2021). A UN Women report found that, regionally, significant numbers of parents responded to food insecurity by eating less or going hungry to ensure their children’s dietary needs were met (Padmore, 2021).

Difficulty paying utility and communication bills (defined as a combination of difficult and very difficult) rose by just under 20% points. Apart from the effects of lost or reduced income, food, utility, and communication costs would have increased as more family members were at home for longer daytime periods. The ability to purchase goods for children also fell. Households were not equally affected by COVID-19. Significantly higher proportions of families of lower socioeconomic status reported difficulty in meeting the socio-economic needs investigated, with the exception of rent and mortgage payments. Housing costs were likely least affected, as half of families owned their homes and another 17% lived rent free, the majority through legal means. Home ownership and rent-free status would therefore have offered significant economic relief, compared to other commodities during the pandemic. Culturally, rent or mortgage free status often occurs as a result of family-owned homes, through which generational wealth is transmitted, and extended family members supported.

Governments worldwide, including the Government of Jamaica, implemented alternative means of education shortly after schools were closed. As indicated by this study, primary and secondary school children were better supported by the public school system, with over 80% receiving educational material from the school system at least 3 days per week. In comparison, only just over a half of pre-school children (53.2%) received educational support from schools for at least 3 days per week and more than a quarter received no educational support at all. Yet pre-school attendance is greater than 90% in Jamaica. Indeed, a greater proportion of pre-school children (57.3%) were supported by books in the home environment than by schools in the early months of the pandemic.

Similarly, Ministry of Education web-based programs were used by 16% of primary and 19% of secondary level children, but only by 6% of pre-school children. Children of lower socio-economic status were less likely to access remote learning by a tablet or laptop; their main access was through smartphones.

Although existing schoolbooks were the main source of educational material in the home, pre-school children also used these less frequently than primary and secondary level children did. Overall, the educational needs of pre-school children were less well met than were those of primary and secondary level children. This is concerning, as the pre-school period is known to be the most rapid period of brain growth and a building block for further educational progress. Global estimates point to long-term effects of learning loss on pre-school children, including millions falling “off track” in early development in the short term, learning deficits in adolescence in the medium term, and billions of earnings lost in adulthood (McCoy et al., 2021); these effects are most prominent in low- and lower middle-income countries.

The pandemic, with high rates of adult mortality and morbidity from the COVID-19 infection, saw health systems across the world shift focus from preventive to acute care. Other health consequences affected children. Jamaica is known to have a high proportion of non-communicable diseases (NCDs), with hypertension, diabetes, and asthma being the most common (Mitchell-Fearon et al., 2014). As high mortality and morbidity rates are associated with NCDs and prevention, early identification and regular health visits are promoted by the Jamaican Ministry of Health. This study demonstrated two impacts of the pandemic on preexisting chronic illnesses of adults and children. First, it negatively affected caregiver's physical health based on a 6% point higher personal perception of only fair or poor physical health; perception of health is known to be a good indicator of physical health (Idler & Angel, 1990). Second, it reduced access to regular health care, as health facilities were either closed or diverted from preventive and primary care to support critically ill patients, primarily with diagnoses of COVID-19 and its complications. The impact of loss of family members on children by increasing orphanhood as a result of COVID-19 mortality and morbidity has been determined (Hillis et al., 2022), but the impact of worsening health status for non-COVID-19 chronic illnesses on children’s caregivers has not been adequately determined. Similar to adults, access to regular health care for childhood chronic conditions, primarily asthma in the Jamaican context, was reduced, with almost one in 10 children missing appointments. Access to preventive health care, such as immunization, was not inquired about in this study, but reduced immunization rates for children across the world as a result of the pandemic have been highlighted by researchers.

Not only was there worsening physical health among caregivers, who were primarily mothers, there also was a 13% point increase in caregiving responsibilities by mothers. This likely meant increased parental stress. Apart from mothers, older children and adolescents were the only other family group that had somewhat increased child care responsibilities, rising from 3.6% to 5% points.

Children in the socially isolating situation of lockdowns often have more challenging behaviors. Despite increased responsibilities for mothers, a majority of mothers reported increased use of positive behavior intervention, such as reasoning and hugging to support their children during the pandemic. However, almost two-thirds of parents reported shouting at children more, just over a half threatening punishment more, and just under a quarter spanking more than prior to the pandemic. For context, this is on a national prevalence of violent discipline including physical punishment and psychological aggression of 85% (Pan American Health Organisation [PAHO], 2022). This survey did not identify a high prevalence of intimate partner violence; the reported rates are lower than that of 29% for emotional abuse, 25% for physical abuse, and 8% for sexual abuse identified in a national survey (Watson-Williams, 2018). However, as there was no mechanism to ensure the privacy of respondents in the home, these lower percentages may reflect a reporting bias; perpetrators and victims could potentially have been in close proximity.

Parental perception of the support needed for their children during the COVID-19 pandemic was primarily educational; the three most frequently reported of eight possible responses, indicated by more than half of respondents, were focused on children’s education. In contrast, support for children’s play and leisure activities were identified by approximately a third of respondents. Similarly, the most frequently reported need by adult respondents was more access to parent support programs on how to teach children at home. This was reported by 73% of parents, exceeding the proportion reporting the need for direct financial support (67%) due to lost or reduced income. More access to parent support programs on how to manage children’s anxiety and other behaviors was also reported by 60% of respondents. Support for mental and physical health of parents and for information were all reported by less than a half of respondents.

Conclusion

Within the first 3 months of the COVID-19 pandemic, Jamaican children were made more socio-economically vulnerable as a result of the loss of family income; food insecurity was the most common economic outcome. There was inequality in the impact of COVID-19, with a greater proportion of families of lower socio-economic status reporting vulnerability. There was restricted access to education at all levels, but pre-school children had the least access to public education. Children of lower socio-economic status had fewer options to access online education. Although child mortality and morbidity from COVID-19 were low worldwide, children with preexisting chronic illnesses had reduced access to health care as a result of re-allocation of health resources in response to COVID-19. Parents reported using positive behavioral interventions to manage children’s behavior but also reported increasing their use of emotional and physical forms of punishment. Adult caregivers, primarily mothers, reported worsened physical health and increased caregiving responsibilities. However, parents consistently prioritized support for children’s education over financial support and their own physical and mental health needs.

Other studies with longer data collection periods have shown that the initial impact on children’s economic, health, and social status persisted some 6–9 months into the pandemic. Research on the long-term impact of COVID-19 on children’s socio-economic, educational, health, and social status should be conducted.

The findings of this study may be useful in similar situations of crisis.

Disclosure statement

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

Additional information

Funding

The 2011 Jamaican Birth Cohort Study and follow-up studies were supported by the Inter-American Development Bank under Grant number ATN/JF-12312-JA. The COVID-19 study was funded by the World Bank under Grant number PO7188731. The authors acknowledge the participation and co-operation of Jamaican parents and caregivers, without whom this study could not be conducted.