Deaths of female sex workers and sexually exploited adolescent girls during the COVID-19 pandemic in Kenya, Nigeria, and the Democratic Republic of the Congo: Results of a cross-sectional study

PLOS Glob Public Health. 2026 Aug 12;6(8):e0005781. doi: 10.1371/journal.pgph.0005781. eCollection 2026.

ABSTRACT

Deaths among sexually exploited adolescent girls (SEAG) and female sex workers (FSW) are under-researched and under-reported. Although excess mortality during the COVID-19 pandemic has been documented among vulnerable populations, specific data on SEAG and FSW remain scarce. This lack of reliable data limits the ability of sex worker organizations and public health programs to design effective interventions or respond to shifting risks. We applied the Community Knowledge Approach to collect peer-reported data on deaths of FSW. Participants included 853 FSW across eight cities in Kenya, Nigeria, and the Democratic Republic of the Congo (DRC). Data collection took place in 2022 (Kenya and Nigeria) and 2023 (DRC), covering deaths during the COVID-19 pandemic. A total of 3,810 FSW deaths were reported, including 324 SEAG (<18 years) deaths: 1,482 deaths in the DRC, 870 in Kenya, and 1,458 in Nigeria. Overall, maternal causes resulted in 28.5% of deaths, with abortion alone responsible for 19.2%. Homicide was the leading individual cause (22.6%), followed by HIV/AIDS (11.7%) and suicide (8.8%). Of 280 peripartum deaths, 175 resulted in stillbirths or neonatal deaths. The majority of the deceased (2,243; 58.9%) were mothers, leaving behind 4,310 children. Among deaths of SEAG, maternal causes and homicide were the leading causes of death. Over one-third (110; 35.0%) were pregnant at the time of death; another third (105; 33.5%) were already mothers. The youngest reported age at death was 11. In the DRC, 30.0% of deceased SEAG were daughters of FSWs. This study reveals a substantial, largely invisible death toll among SEAG and FSW during the pandemic. Many of these deaths could have been prevented through existing, cost-effective interventions. The findings underscore an urgent need for targeted public health responses and mortality surveillance for this neglected population-both to prevent further deaths and to mitigate the long-term consequences for the children left behind.

PMID:42585184 | DOI:10.1371/journal.pgph.0005781