The lingering impacts of COVID-19 on older women in Kenya and Uganda: A quantitative analysis of health, wellbeing, and WASH insecurity.

Background: The world appears to be experiencing more than its fair share of shocks: climatic disasters, pandemics, wars and political events that have far-reaching consequences for vulnerable populations globally. One such example was the COVID-19 pandemic, which resulted in both direct and indirect impacts on older women, especially those residing in Sub-Saharan Africa, due to the already fragile economic and health care systems in place, as well as the lack of infrastructure for public services. While substantial literature now exists documenting the impact of COVID-19 on vulnerable populations, less attention has been paid to building back better. Design and Methods: Using the feminist political ecology of health framework, this research investigated the impacts of the COVID-19 pandemic on health and wellbeing among older women residing in Kenya (n=231) and Uganda (n=211) and how they are 'building back better'. Using survey data, we used a generalized linear model with a complementary loglog link function to identify factors associated with wellbeing, emotional distress and self-reported health status. Results: Only 17.7% of older women in Kenya and 14.7% in Uganda experienced an improvement in wellbeing post-COVID compared to during the pandemic. Further, there remains a sustained impact on emotional distress levels. Several factors, such as WASH insecurity and no health insurance, negatively impacted wellbeing, emotional distress and self-reported health status. Conclusion: Overall, this research documents how older women in Uganda and Kenya have been and continue to be impacted by the COVID-19 pandemic, despite declining case counts. Several policy recommendations have been outlined.