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While COVID-19\u2013related morbidity and mortality were lower than expected in Sub-Saharan Africa, this region reports the highest global levels of violence experienced by these groups. In order to investigate this shadow pandemic, we undertook a cross-sectional survey in three countries at the height of the pandemic in order to explore both the impacts of COVID-19, as well as attitudes towards violence against women and older adults. The results illustrate high levels of reported attitudes justifying violence against women (23% in Uganda, 59% in Ghana, and 80% in Kenya) as well as attitudes of acceptability of violence against older adults (39% in Ghana, 69% in Uganda, and 94% in Kenya). Attitudes supporting violence were associated with resource insecurity, low levels of reported well-being, and high levels of reported emotional distress. Addressing violence against vulnerable populations through policy and practice interventions now could serve to preclude similar future shadow pandemics in the face of anticipated global disruptions, such as those related to climate, conflict, and\/or health emergencies.<\/jats:p>","DOI":"10.1093\/heapro\/daag111","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T10:36:22Z","timestamp":1788518182000},"source":"Crossref","is-referenced-by-count":0,"title":["Shadow pandemics: violence and vulnerability as part of the COVID-19 experience in Sub-Saharan Africa"],"prefix":"10.1093","volume":"41","author":[{"given":"Abraham M","family":"Nunbogu","sequence":"first","affiliation":[{"name":"United Nations University Institute for Water, Environment and Health , Richmond Hill, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan J","family":"Elliott","sequence":"additional","affiliation":[{"name":"United Nations University Institute for Water, Environment and Health , Richmond Hill, Ontario ,","place":["Canada"]},{"name":"Department of Geography and Environmental Management, Faculty of Environment, University of Waterloo , Waterloo, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Karanja","sequence":"additional","affiliation":[{"name":"Community Health Support Programme , PO Box 872-40100, Kisumu ,","place":["Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaiah","family":"Omondi","sequence":"additional","affiliation":[{"name":"Department of Geography and Environmental Management, Faculty of Environment, University of Waterloo , Waterloo, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2642-7200","authenticated-orcid":false,"given":"Satveer","family":"Dhillon","sequence":"additional","affiliation":[{"name":"Department of Geography 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