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During the 1990s, the Kenyan agricultural sector became increasingly liberalised. For many years, both government- and non-government organisations have advised farmers on fertiliser doses, and therefore, an increase in fertiliser adoption resulting in higher yields has been expected. We analyse the evolution of fertiliser use and its impact on maize productivity and household incomes in Kenya, using four household surveys conducted between 1992 and 2013. Each survey represented all six maize-producing zones of Kenya. The results show that the percentage of fertiliser users among maize farmers has increased slightly over the years (from 62% in 1992 to 65% in 2013), and the quantity of fertiliser applied per ha has increased (from 82 kg/ha in 1992 to 100 kg/ha in 2013) but remains far below recommended levels. Therefore, maize yields have remained stagnant, or even decreased slightly (from 1360 kg/ha in 1992 to 1116 kg/ha in 2013). We also observe that the following factors affect fertiliser use and maize yields: education of the household head; area under maize cultivation; agroecological zone; uneven access to extension services; and food insecurity. We also find that fertiliser use has a positive impact on both maize yields and household income. We conclude that the liberalisation of fertiliser markets in Kenya did not have the desired effect of increasing fertiliser use and consequently maize yields, except in the high potential maize-growing areas. Possible explanations include both market factors, e.g. high prices, and non-market factors, e.g. access to information. We make two policy recommendations based on these findings – firstly, the targeted outreach of extension services should be considered, to increase fertiliser use and yields in less-productive regions, and secondly, policies should be considered that incorporate provisions for weather shocks.

ObjectiveTo provide evidence on the effect of the COVID-19 pandemic on the mental health of young people who grew up in poverty in low/middle-income countries (LMICs).DesignA phone survey administered between August and October 2020 to participants of a population-based longitudinal cohort study established in 2002 comprising two cohorts born in 1994–1995 and 2001–2002 in Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam. We use logistic regressions to examine associations between mental health and pandemic-related stressors, structural factors (gender, age), and lifelong protective/risk factors (parent and peer relationship, wealth, long-term health problems, past emotional problems, subjective well-being) measured at younger ages.SettingA geographically diverse, poverty-focused sample, also reaching those without mobile phones or internet access.Participants10 496 individuals were approached; 9730 participated. Overall, 8988 individuals were included in this study; 4610 (51%) men and 4378 (49%) women. Non-inclusion was due to non-location or missing data.Main outcome measuresSymptoms consistent with at least mild anxiety or depression were measured by Generalized Anxiety Disorder-7 (≥5) or Patient Health Questionnaire-8 (≥5).ResultsRates of symptoms of at least mild anxiety (depression) were highest in Peru at 41% (32%) (95% CI 38.63% to 43.12%; (29.49–33.74)), and lowest in Vietnam at 9% (9%) (95% CI 8.16% to 10.58%; (8.33–10.77)), mirroring COVID-19 mortality rates. Women were most affected in all countries except Ethiopia. Pandemic-related stressors such as health risks/expenses, economic adversity, food insecurity, and educational or employment disruption were risk factors for anxiety and depression, though showed varying levels of importance across countries. Prior parent/peer relationships were protective factors, while long-term health or emotional problems were risk factors.ConclusionPandemic-related health, economic and social stress present significant risks to the mental health of young people in LMICs where mental health support is limited, but urgently needed to prevent long-term consequences.

ObjectiveTo provide evidence on the effect of the COVID-19 pandemic on the mental health of adolescents and young adults who grew up in poverty in Low and Middle Income Countries (LMICs).DesignA phone survey implemented August-October 2020 to participants of a population-based cohort study since 2002 comprising two cohorts born in 1994-5 and 2001-2 in Ethiopia, India (Andhra Pradesh and Telangana), Peru and Vietnam. We examined associations between mental health and pandemic-related stressors, as well as structural factors (gender, location, wealth); and lifelong protective/risk factors (parent and peer relationship, past household wealth, long-term health problems, past emotional problems and subjective well-being) measured at younger ages.SettingA diverse, poverty focused sample, reaching those without mobile phones or internet access.Participants10,496 individuals were approached, 9,730 participated. Overall, 8,988 individuals were included in this study, 4,610 (51%) male and 4,378 (49%) female. Non-inclusion was due to non-location or missing data.Main outcome measuresAt least mild anxiety and depression were measured by Generalized Anxiety Disorder-7 (GAD-7, ≥5) and Patient Health Questionnaire-8 (PHQ-8, ≥5).ResultsRates of symptoms of at least mild anxiety (depression) were highest in Peru at 41% (32%) [95% CI, 38.63-43.12; (29.49-33.74)], and lowest in Vietnam at 9% (9%) [95% CI, 8.16-10.58; (8.33-10.77)], mirroring COVID-19 mortality rates. Females were most affected in all countries but Ethiopia. In all countries, pandemic-related stressors were associated with increased rates of anxiety and depression, though with varying levels of importance across countries. Prior parent and peer relationships were protective factors for mental health while having a long-term health problem or prior emotional problems were risk factors.ConclusionThe COVID-19 pandemic presents significant risks to the mental health of young people. Mental health support is limited in LMICs and young people have to date been lower priority for COVID-19 interventions.Strengths and limitations of this studyThe study uses data from adolescents and young adults who grew up in poverty in four LMICs which were diversely affected by the COVID-19 pandemic, therefore investigating a globally vulnerable, but understudied group both in terms of age and wealth.This study reaches a broad sample of young people who grew up in poverty, including those without internet or mobile phone access.A key strength is combining a broad range of pandemic-related stressors from survey data on experiences of COVID-19 with previously measured information on longer-term risk and protective factors, therefore contributing to a more complete picture of COVID-19 effects.A limitation of the study is that it does not have a directly comparable pre-COVID baseline for depression/anxiety, however, proxy variables are used as a baseline and the explanatory variables capture dynamics that happened during the pandemic.A further limitation is possible underreporting due to stigma associated with mental health, despite piloting and validation, as well as possible bias in self-reported experiences of pandemic-related stressors due to feelings of anxiety or depression.