Widowhood, Socio-Economic Status, Health and Wellbeing in Low and Middle-Income Countries

Challenges and Coping Strategies in Transitioning From Caregiving to Widowhood: A Systematic Review

Ninety-one percent of surviving spouses in the U.S. cared for their spouses before they died. This review explores the challenges of the transition from caregiving to widowhood and different coping strategies used by widowed spousal caregivers. A systematic review of literature on the transition from caregiving to widowhood was conducted using four major academic search engines. Overall, 280 articles were identified, with 22 meeting the inclusion criteria. Challenges for widowed caregivers included experiencing care burden, letting go of the caregiver role, grief, and triggers. Widowed caregivers' coping strategies included social support and services use, filling the time gap, finding spirituality, and engaging in unhealthy behaviors. Future research is needed to determine the efficacy of widowed caregivers' coping strategies. Concerted and collaborative action by health professionals, community organizations, and policymakers is needed to develop programs and other approaches to support widowed caregivers.

Socioeconomic status, perceived family support and psychological distress in older Kenyans: a cross-sectional study

OBJECTIVES

Incidences of psychological distress are on the rise among older Kenyans. While socioeconomic status and family support have been shown to impact the mental health of older individuals, they remain understudied in the older Kenyan population. This study investigated the prevalence of psychological distress among older Kenyans and examined its relationships with economic status and perceived family support.

METHOD

Data came from a cross-sectional survey of 376 older Kenyans from four rural and urban areas in 2022. The survey collected demographic, global health, social support, socioeconomic, and psychological health variables. Structural equation modeling was used to test the relationship between socioeconomic status, family support, and psychological distress.

RESULTS

Overall, 61% reported high psychological distress, with women experiencing significantly higher levels. Structural equation modeling results indicated that food insecurity, flooring material, material wealth, chronic health, self-rated physical health, sex, and education were significant predictors. The dimensions of family support were not significantly associated with psychological distress.

CONCLUSION

The findings illuminate that psychological distress is a critical health concern for the sample and needs targeted health interventions. They also underline the essential role of economic status in the psychological distress of older Kenyans. Future studies should explore these relationships using longitudinal, family-level, and representative data.

Correlates of disability among primary care patients with common mental disorders and chronic medical conditions- a cross-sectional study from rural South India

PURPOSE

We examined the correlates of disability among people with non-communicable diseases (NCDs) and comorbid common mental disorders (CMDs) from rural India.

METHODS

The sample comprised 2,486 participants enrolled in a cluster randomized trial (cRCT), Healthier OPtions through Empowerment (HOPE). Participants were 30 years or older, with a diagnosis of major depressive disorder, dysthymia, generalized anxiety disorder, and/or panic disorder on the MINI-International Neuropsychiatric Interview, with hypertension, diabetes, dsylipidemia and/ or ischemic heart disease. Disability was measured with the 12-item version of WHODAS 2.0. The severity of depression and anxiety was measured using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), respectively. Multiple linear regression analyses were used to examine associations.

RESULTS

The mean age was 59 ± 10.0 years, three quarters (1864) of the participants were female, and 64.0% were married. More than half of the participants had no formal education (57.9%). Most of the participants had two or more chronic medical conditions (73.0%). The mean disability score was 24.3. The mean depression score was 8.5, and the mean anxiety score was 6.7. Higher levels of disability were reported by participants ≥ 60 years of age, those with moderate and severe depression, and moderate anxiety. Among female participants, being unmarried was associated with greater disability. Male participants without formal education reported greater levels of disability.

CONCLUSION

Higher severity of CMDs is significantly associated with higher levels of disability. For women, being unmarried and for men having no formal education was associated with higher levels of disability.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02310932 [URL: https://clinicaltrials.gov/ct2/show/record/NCT02310932 ] registered on December 8, 2014, and Clinical Trials Registry India CTRI/2018/04/013001, registered on April 4, 2018. Retrospectively registered.

Surviving after the Death of a Spouse: A Phenomenological Study of Young and Low-Income Mothers in Turkey

The aim of this study is to examine psychosocial adjustment of low-income mothers who lost their spouses at a young age. The study was conducted using a qualitative research method with a phenomenological approach. The data was collected through focus group interviews. Thirteen women between the ages of 26 and 43 participated in the study. In this study, manifest content analysis was carried out with an inductive perspective. In this scope, five interrelated themes emerged as loss, initial reactions, difficulties, coping ways, and change. For the participants, the death of their spouse was perceived as the loss of a loved one, the loss of their children's father, a loss of security, and the loss of an abusive spouse. The initial reactions that emerged as a result were shock, helplessness, anxiety, and ambivalence. Participants faced social pressure, exclusion, parenting an orphaned child, insufficient basic life skills, and economic difficulties after their spouses' deaths. In order to cope with these difficulties, they sought social support, applied for social assistance funds, focused on their motherhood roles, used religious coping mechanisms, and set boundaries. It was determined that participants learned new skills, gained self-confidence, and developed helping behaviors toward others during the post-loss change process. Findings revealed that participants are unable to access adequate social, economic, and psychological resources in society. This circumstance caused them to withdraw from their social environment and reevaluate their existential goals. The new identity created by these women could be interpreted as a challenge to the culture that marginalizes them.

Treatment for Insomnia Symptoms is Associated with Reduced Depression Among Older Adults: A Propensity Score Matching Approach

OBJECTIVES

The study aimed to investigate the effect of utilization of treatment for insomnia symptoms on the prevalence of major depressive disorder among older adults in India.

METHODS

We used the data from the Longitudinal Ageing Study in India (LASI), 2017-18. The sample included 10,911 older individuals who reported insomnia symptoms. The propensity score matching (PSM) approach was used to compare the depressive disorder among those who received vs. not received treatment.

RESULTS

Only 5.7% of older adults reporting insomnia symptoms received treatment. On average, prevalence of depressive disorder among men and women who received treatment for insomnia symptoms was lesser by 0.79 and 0.33 points, respectively, than those who did not receive treatment. In the matched sample, treatment for insomnia symptoms was significantly associated with lesser prevalence of depression for both older men (β= -0.68, p < .001) and older women (β= -0.62, p < .001).

CONCLUSIONS

The current findings suggest that treatment for insomnia symptoms can reduce the risk of depressive disorder among older adults and the effects are higher among older men than women.

Widowhood status, morbidity, and mortality in India: evidence from a follow-up survey

A known health effect of widowhood is an increased mortality risk among surviving spouses, with gender- and age-specific observations. While morbidity conditions with socio-economic factors may exacerbate the effect of widowhood on mortality, no research has attempted to predict mortality among the widowed over the married population with the presence of morbidity in India. Thus, the present study concurrently examines marital status and health in the Indian setting, bringing substantial empirical evidence to explore the link between marital status, morbidity, and mortality. The study used prospective data from India Human Development Survey (IHDS) wave 1 (2004-2005) and wave 2 (2011-2012). In total, 82,607 individuals aged 25 years and above were considered for the analysis. To present the preliminary findings, descriptive statistics and bivariate analysis were used. Using multivariable logistic regression, the interaction effect of marital status and morbidity status was estimated to predict the likelihood of mortality. Across all socio-economic groups, widowed individuals reporting any morbidity had a higher mortality proportion than married people. Young widowers with any morbidity are more susceptible to increased mortality. Asthma among young widowers and cardiovascular diseases among elderly widowers significantly elevate the probability of mortality. However, older widowed women with diabetes had a lower probability of mortality than older married women with diabetes. The widowers' disadvantage in mortality and morbidity may be attributable to less care-receiving and the greater incidence of unhealthy lifestyle practices during the post-widowhood period, indicating the need for more research.

The Effects of Religiosity on Depression Trajectories After Widowhood

This longitudinal study analyzed data from the 2006-2016 waves of the nationally representative Health and Retirement Study (HRS). Trajectories of depression among older adults ≥ 50 years (N = 1254) were examined over time to explore patterns of depression among those entering widowhood and the potential impact of religiosity on depressive symptoms during various stages of widowhood. Ordinary least squares (OLS) regression analysis was used to examine the association between widowhood and depression and the role of religiosity as a moderator of this association. Older adults experienced a statistically significant increase in depressive symptomology after the onset of widowhood, and depressive symptomology decreased post widowhood, but did not return to pre-widowhood levels. Additionally, high religious service attendance and higher intrinsic religiosity were both associated with lower depressive symptomology. High religious service attendance moderated the relationship between widowhood and depression among widowed older adults living alone.

Journey Towards a Meaningful Life: Adaptation and Resilience in the Lives of Young Hindu Widows

Spousal death is a life-altering and traumatic life event in married life, compelling the surviving partner to transition and make substantial adjustments to their new life situation. Losing a spouse can affect individuals differently based on gender, impacting their psychological, social, and economic well-being. This article describes adaptation to a new life condition as widows strive to reconcile their roles, status, and identity while binding their resilience to direct their lives. This study explored the lives of 17 young Hindu widows in rural and semi-urban areas of Haryana, India. Using personal face-to-face interviews and purposive sampling, it captured their unique life stories. After losing their spouses, participants showed impressive resilience, reshaping their lives and identities. They navigated challenges firmly, emphasising personal commitment over social support for effective adaptation. It highlights a need for better support systems for widows, offering potential pathways to enhance their post-loss well-being.

Economics of widowhood mortality in adult women in India

The economic consequence of widowhood on health is well-established, demonstrating that economic factors can significantly link with health outcomes, even the risk of mortality for widows. However, empirical evidence is restricted only to developed countries. Thus, this study assesses the role of economic factors (paid work, pension and household economic status) on the mortality of widows in broad age groups in India. We used two waves of the India Human Development Survey (IHDS), a nationally representative prospective dataset in India for 42,009 women (married and widows) aged 25 years and above at IHDS wave 1 whose survival status was observed between two waves. Further, 6,953 widows were considered for sub-sample analysis in this study. Logistic regression and propensity score matching (PSM) were applied to understand the association and causality between economic factors and mortality for widows. Poor household economic status, paid regular work, and receiving a widowed pension were significantly associated with lower mortality risk for young widows. In comparison, unpaid and paid regular work was linked with lower mortality risk for old widows. The result of causal analysis suggests that receiving a widows' pension had a slight impact on mortality reduction for young widows while engaging in paid regular work significantly reduced the mortality of old widows. This research confirms that the link between economic factors and mortality among widows is age dependent in the Indian context.

Willingness to pay for hepatitis B virus vaccine and associated factors among households in Bahir Dar City, northwest Ethiopia: using contingent valuation method

Background

The prevention of disease burden and death through vaccination is one of the most cost-effective methods. Even though the Hepatitis B Virus (HBV) has significant public health problems in Ethiopia, there is no compulsory HBV vaccination program for adults and the vaccine's market value was not yet estimated in the Ethiopia context. Therefore, this study aimed to assess the willingness to pay (WTP) for the HBV vaccine and its associated factors among households in Bahir Dar City, northwest Ethiopia.

Methods

A cross-sectional study was conducted among 620 households from March 1 to 30, 2020. A systematic random sampling technique was employed to select the required number of households. An interviewer-administered questionnaire was used to collect the necessary information. The contingent valuation method was conducted to measure WTP for the HBV vaccine. A Tobit regression model was employed to investigate significantly associated factors, and variables with a p-value of <0.05 were considered statistically significant.

Results

In this study, 62.17% of households were willing to pay for the HBV vaccine with an average cost of ETB174.24 (US$5.25). Male household heads (P = 0.014), favorable attitude (P = 0.017), and good knowledge (P < 0.001) toward the vaccine were positively associated with WTP, whereas age (P < 0.001), single marital status (P = 0.012) and divorced/widowed (P = 0.018) marital status were negatively associated with WTP.

Conclusions

Overall, most households were willing to pay for the HBV vaccine with an average demand of ETB174.24 (US$5.25). Therefore, a national-level HBV vaccine strategy should be designed considering the households' willingness to pay. In addition, working on attitudes and knowledge toward the vaccine could potentially increase the household's willingness to pay for the HBV vaccine.

The role of child marriage and marital disruptions on hypertension in women - A nationally representative study from India

Child marriage is associated with negative health trajectories among women in low- and middle-income countries (LMICs). Marital disruptions in LMICs are also associated with adverse socioeconomic and health outcomes in women. Yet, little is known about the compounded health effects of experiencing both child marriage and marital disruptions. Using nationally representative data from India among women aged 18-49 years, we examined the effects of marital age (i.e., marriage before or after 18 years) and martial disruptions (i.e., widowed/divorced/separated) on the odds of having hypertension. Findings suggest that together, marital disruptions and child marriage increase the risk of hypertension. Specifically, women married as children and who experienced marital disruptions were 1.2 (95% CI: 1.2-1.3) times more likely to have hypertension compared to women who married as adults and currently in marriage. Additionally, among women married as children, those who experienced martial disruptions had a higher risk (AOR = 1.1, 95% CI: 1.0-1.2) of hypertension compared to their currently married peers. These results suggest public health strategies must consider contextual effects of being widowed/divorced/separated among women who were married as children. Simultaneously, prevention initiatives should be strengthened to reduce the incidence of child marriage in LMICs and associated downstream health consequences.

What's Your Pension Story? Women's Perspectives during the COVID-19 Pandemic on Their Old-Age Pension Status, Past and Present

This study examines the present and retrospective views of mothers who are nearing or are at retirement age regarding their economic status, pension planning, and perceptions of state pension policy. The paper addresses gaps in the literature on the cross-intersections of employment history, vulnerable economic retirement status, and marital and parental status, thereby adopting a life course perspective. Based on in-depth interviews of thirty-one mothers (ages 59-72) during the COVID-19 pandemic, the findings revealed five themes-economic abuse: an unequal distribution of pension funds following divorce; regrets over past choices; COVID-19 and pensions; the state's responsibility for old-age economic security; and knowledge is important, and I can help others. The study concludes that the majority of women at these ages perceive their current economic situation as a product of insufficient familiarity with pension plans, while voicing opinions about the state's irresponsibility regarding people of retirement age.

"Life after him was just hell": Young rural women's lived experiences of widowhood in Rajasthan, India

This phenomenological study was conducted in rural Rajasthan, India, to explore young widows' lived experiences. On receipt of written informed consent, we interviewed 14 young widows. The data were analyzed in an idiographic style using the interpretive phenomenological approach. The perspective of loss and sociocultural contexts grounded the analysis. Six themes emerged corresponding to the women's widowhood experiences: becoming a widow; entangled by customs; stigmatization; the impossible marriage; hope in widowhood; and economic deprivation. The results underline the predicaments of young widows, and these experiences are largely framed by the sociocultural and gender norms prevailing in rural communities. The study's findings imply the need for strengthening social and legislative measures for young widows.

Marital Disruption and Disparity in Tobacco Use in Reproductive-Aged Women: Evidence from India

Marital disruption defined as widowhood, divorce, or separation, has adverse consequences for women’s health and wellbeing. Extant evidence, however, is primarily available for older women or in developed country settings. Consequences of marital disruption for younger women in the developing countries is relatively less visited. The aim of this cross-sectional study is to assess whether maritally disrupted women of reproductive age (18–49 years) had differential risk of tobacco-use compared to their married counterparts. Using nationally representative data from India, we estimated multivariable logistic regressions to obtain the odds in favor of tobacco-use for maritally disrupted women. We found that compared to women remained in marriage, maritally disrupted women were 1.5 times (95% CI: 1.4–1.6) more likely to consume tobacco. The higher risk of tobacco-use of maritally disrupted women was evident in both younger (age 18–34) and older (age 35–49) cohorts. The results were robust across urban and rural areas, high- and low- education groups, and poor- and non-poor households. The higher odds of tobacco-use among maritally disrupted women persisted even after accounting for household fixed effects. The study findings thus, have implications for strengthening targeted tobacco control policies and health promotion among maritally disrupted women in low-and-middle income countries.

Association between poor self-reported health and unmarried status among adults: examining the hypothesis of marriage protection and marriage selection in the Indian context

Background

The link between marital status and health differences has long been a topic of debate. The substantial research on marriage and health has been conducted under two important hypotheses: marital protection and marriage selection. While the majority of evidence on the marriage-health relationship using these hypotheses comes from developed countries, there is a lack of evidence from Asia, particularly from India.

Objectives

The current study examines theoretical frameworks of marriage i.e., marital protection and marriage selection in the Indian setting concurrently, bringing substantial empirical evidence to explore the link between marriage and health, considering this subject in the context of self-reported health (SRH). Secondly, this study will aid in investigating age and gender differences in marriage and health.

Methods

Using the Study on Global AGEing and Adult Health (SAGE), a cohort study of individuals aged 50 years and older with a small section of individuals aged 18 to 49 for comparative reasons, the present study population was 25 years and above individuals with complete marital information. Logistic regressions were employed to explore the connection between marital status and self-reported health. In the marriage protection hypothesis, the follow-up poor SRH was the dependent variable, whereas the initial unmarried status was the independent variable. For the marriage selection effects, initial poor SRH as the independent variable and follow-up unmarried status as the dependent variable had considered.

Results

Examining the marital protection hypothesis, the initial unmarried status (OR: 2.14; CI at 95%: 1.17, 3.92) was associated with the followed-up SRH transition from good to poor between 2007 and 2015 for young men, while initial unmarried status was linked with a lower likelihood of stable good SRH and a higher likelihood of stable poor SRH status across all age categories among women. Focusing on the marriage selection hypothesis, among young men, a significant association exists between the initial poor SRH and departure in marital status from married to unmarried. Young women with initial poor SRH (OR: 0.68; CI at 95%: 0.40, 1.00) had lower odds of stable married. In comparison, women with initially poor SRH, irrespective of age, were more likely to have higher odds of being stably unmarried.

Conclusion

Marriage indeed protects health. There are also shreds of evidence on health-selected marital status in India. Taken together, the aspect of marital protection or marriage selection is gender and age-specific in India. The findings contribute to a more comprehensive understanding of the relationship between marriage and health, which may have significant implications for health-related public policies aimed at unmarried women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14170-0.

Widowhood and cognition among older women in India: New insights on widowhood duration and mediators

Background

Widowhood, a marital status that disproportionately affects older women, has been associated with poorer health compared to married individuals. However, relatively little is known about the association between widowhood in later-life and cognitive health in low- and middle-income countries.

Methods

To address this research gap, we used data from the Longitudinal Aging Study in India (2017-19) to investigate the widowhood disparity in cognitive health among mid-aged and older women in India, including how this relationship varies by the duration of widowhood. We further examined the extent to which economic, social, and health conditions mediate this association.

Results

Cognition scores for widowed women were on average lower by almost 0.1 standard deviations compared to married women. Overall, this disparity increased with widowhood duration, with non-linearities in this association. The disparity in cognition scores increased with widowhood duration up to twenty years but did not increase further among those with longer widowhood duration. Worse physical and mental health were found to mediate almost thirty percent of the total association between widowhood and cognition. These mediators were most useful in explaining the association between lower cognition and widowhood among women who experienced widowhood for ten years or longer.

Conclusion

The study highlights the significant disadvantage in cognitive functioning among older widowed women in India. The study also provides evidence on potential mediators, suggesting differential effects of mediators at different stages of widowhood.

Young Single Widow, Dynamics of In-Laws Interference and Coping Mechanisms: Simplicity-Parsimony Approach

The incidence of short marital duration due to the demise of a husband that often exposes young widows to in-laws' exploitation of the asset of the deceased spouses, without regard for negative health consequences and potential vulnerability to poverty has not been exhaustively investigated, especially in sub-Saharan Africa where 16% of adult women are widows. The study examined the coping mechanisms among the young widow (aged ≤ 40) who have experienced short conjugal relationships (≤5 years) and burdensome from in-laws. The research design followed a qualitative approach with the aid of semi-structured in-depth interviews among 13 young widows selected through snowballing and informant-led approaches in the purposively selected communities. Data collected were analysed using descriptive statistics and a thematic approach. The findings, among others, shows the median age of young widow as 29 years. All participants, except one, have faced exploitation from their in-laws over their husbands' assets. All the participants desired to re-marry in order to: have a father figure for their children, have their own children or have more children. There is an absence of government support, but a few have received support from religious organisations. The author proposed attitudinal-change campaigns targeting the in-laws through accessible media and legislature that could challenge the exploitation of widows and unhealthy widowhood rites.

Differentiated routes to vulnerability: Marital status, children, gender and poverty

This study compares poverty risks between two types of transition involving family status, which the life course perspective considers risky events: divorce and widowhood. The case study is Israeli society, characterized by high fertility rates and a high risk of poverty. The study examines the relationship between marriage dissolution and the risk of poverty, distinguishing between divorce and widowhood, and how they are affected by the intersection of gender and number of children in the household. Based on unique administrative panel data, we studied all women and men in Israel, aged 18-60 in 2003, who married in 2003 and were widowed or divorced by 2015, as well as a random sample of 20 % of all women and men in Israel who married in 2003 and remained married until 2015. Fixed effects models calculated the probability of women and men becoming poor. Results revealed a gendered effect of entering into poverty that largely depends on how the marriage ended and the number of children in the household. Divorce increases poverty risks for women and decreases them for men. However, for both genders, the combination of divorce and more children at home increases poverty. In contrast, widowhood tends to increase poverty for men, but only for women does the poverty risk increase as the number of children rises. Findings are discussed in the context of high fertility rates, Israeli welfare policy and the economic vulnerability associated with parents' childcare responsibilities.

Gender differences in self-reported sleep problems among older adults in six middle-income countries: a cross-sectional study

This study examines gender differences in sleep problems among older adults in India, China, Ghana, Mexico, Russia, and South Africa. We used data on 33,929 individuals (50+ years) from the WHO-SAGE. Results showed significant gender differences in the prevalence of sleep problems with the largest difference in Russia followed by India. Regression results showed higher odds of sleep problems among women in India, China, Russia, and South Africa. Age, low back pain, depression, and poor self-rated health were significantly associated with sleep problems. This research confirms significant gender differences in sleep problems among the older population in middle-income countries.

Family social capital and life satisfaction among older adults living alone in urban China: the moderating role of functional health

Objectives: The present study examined the moderating effects of functional health on the association between family social capital and life satisfaction among older adults who live alone in urban China.Method: Data for this study were derived from a study "Survey on older adults aged 70 and above who live alone in urban China," which was carried out in five Chinese cities between November 2013 and May 2015. 2801 respondents passed the screening test of cognitive capacities and successfully completed the survey. Family social capital was operationalized as family interaction, number of children, and family relationship. Random-effects logistic regression was conducted to test the proposed hypotheses.Results: The moderating effects of functional health on the association between family interaction and life satisfaction were identified. While family interaction was positively associated with life satisfaction among older adults without disabilities who live alone, family interaction was negatively associated with life satisfaction among those with disabilities. Furthermore, the association between number of children and life satisfaction was nonsignificant among older adults without disabilities, when family relationship was controlled. However, number of children was positively associated with life satisfaction among those with disabilities. Finally, the results showed family relationship were important protective factors of life satisfaction among older adults living alone, regardless of their functional health levels.Conclusion: Theoretical aspects on how family social capital, living alone, and functional health are interwoven and influence mental health in later life were deliberated. Policy and intervention implications were discussed.

The labor force participation of Indian women before and after widowhood

BACKGROUND

Due to its young age structure and taboos on widow remarriage, India has a large and relatively young female widow population. Many of India’s widows are in prime working ages. India has one of the lowest female labor force participation rates in the world.

OBJECTIVE

This paper calculates the effect of widowhood on the labor force participation of Indian widows. The analysis documents how labor force participation changes associated with widowhood vary by age, caste/religion, relation to head of household, rural/urban status, and region.

METHODS

Using the India Human Development Survey (IHDS), the analysis tracks 3,217 women who experience the loss of their spouse between the two survey waves. Individual fixed effects regressions are used to measure the association between the transition to widowhood and changes in the number of days worked in the past year.

RESULTS

Widowhood was associated with a decrease in days worked for older women; but for women widowed before age 52, widowhood was associated with a large increase in the number of days they worked. Widows who joined the labor force were more likely to gain employment in permanent and salaried work than married women. Widows who resided with their in-laws or who became the household head after their husband’s death saw increases in their work participation whereas those who lived in households headed by their adult children experienced negative widowhood effects on their work participation.

CONTRIBUTION

These findings highlight the important link between marital status and female employment in India.

Narratives of childless widows: exploring the lived experiences and well-being of childless widows in rural Nigeria

Background: Widows are socioeconomically disadvantaged, especially in low resource regions. Childless widows are a group whose plight may be worse given sociocultural circumstances. In the current study, we examined the lived experiences of childless widows living in remote Nigeria, highlighting this group as being in critical need for social interventions.Method: Childless widows (n = 11) in rural settings in South East Nigeria were interviewed. Narrative analysis was used in navigating the lived experiences of the widows.Results: Extreme distress, ostracism, stigma, and traumatic experiences were common in the narratives of the widows. However, childlessness was at the core of their distress. Treated as outcasts, the widows resigned to God, though some were scarcely allowed to play supportive roles among relatives. As social welfare packages are almost non-existent in this region, religious groups often played supportive roles.Conclusion: Legislation protecting widows are good but may not be sufficient if it does not translate to improved wellbeing/welfare for widows. Childless widows, especially those in rural areas, are especially vulnerable as they face peculiar deprivation and psychological distress arising from cultural/social realities. Recognising the limited resources in low income countries, mobilisation of local structures and resources to educate and monitor local communities are important.

Health insurance coverage, type of payment for health insurance, and reasons for not being insured under the National Health Insurance Scheme in Ghana

BACKGROUND

Ghana's National Health Insurance Scheme has improved access to care, although equity and sustainability issues remain. This study examined health insurance coverage, type of payment for health insurance and reasons for being uninsured under the National Health Insurance Scheme in Ghana.

METHODS

The 2014 Ghana Demographic Health Survey datasets with information for 9396 women and 3855 men were analyzed. The study employed cross-sectional national representative data. The frequency distribution of socio-demographics and health insurance coverage differentials among men and women is first presented. Further statistical analysis applies a two-stage probit Hackman selection model to determine socio-demographic factors associated with type of payment for insurance and reasons for not insured among men and women under the National Health insurance Scheme in Ghana. The selection equation in the Hackman selection model also shows the association between insurance status and socio-demographic factors.

RESULTS

About 66.0% of women and 52.6% of men were covered by health insurance. Wealth status determined insurance status, with poorest, poorer and middle-income groups being less likely to pay themselves for insurance. Women never in union and widowed women were less likely to be covered relative to married women although this group was more likely to pay NHIS premiums themselves. Wealth status (poorest, poorer and middle-income) was associated with non-affordability as a reason for being not insured. Geographic disparities were also found. Rural men and nulliparous women were also more likely to mention no need of insurance as a reason of being uninsured.

CONCLUSION

Tailored policies to reduce delays in membership enrolment, improve positive perceptions and awareness of National Health Insurance Scheme in reducing catastrophic spending and addressing financial barriers for enrolment among some groups can be positive precursors to improve trust and enrolments and address broad equity concerns regarding the National Health Insurance Scheme.

Factors that influence the health of older widows and widowers-A systematic review of quantitative research

AIM

To examine factors that influence the health of older widows and widowers. The review question was: What is the evidence of the relationship between widowhood and health in older adults?

DESIGN

Systematic review.

DATA SOURCES

Academic Search Elite, CINAHL, Medline (Ovid) and PubMed were searched for articles published between January 2013-December 2017.

REVIEW METHODS

A systematic review of quantitative research with a qualitative thematic analysis.

RESULTS

The selection process resulted in 12 studies. One of the themes that emerged was: emotional challenges related to experiences of bereavement, depression and anxiety, which was based on the sub-theme social support as the main strategy for coping with emotional pain and suffering. The second theme was: struggling with poor physical health. The findings indicate that healthcare professionals need knowledge and skills to deal with the health consequences of widowhood in old age. Building community teams can prevent emotional and physical health problems, as well as reduce mortality.

Sociodemographic variations in health-related quality of life (HRQOL) among elderly individuals in an urban locality in India

Background:

Elderly population is growing rapidly in India. To direct public health actions to improve quality of life among elderly, it is important to understand the sociodemographic factors associated with quality of life. The aim of study was to assess health-related quality of life (HRQOL) among urban elderly in a setting of Assam, India, and to examine how HRQOL varied across different sociodemographic groups among the elderly populations.

Materials and Methods:

A cross-sectional study was carried among elderly aged ≥60 involving 300 participants. Eight domains of HRQOL of participants were measured using RAND SF-36. Analysis of variance test was used to examine sociodemographic differences in HRQOL.

Results:

The BP domain had highest (71.78 ± 22.25) and GH had lowest mean HRQOL score (48 ± 16.93). Males had significantly higher HRQOL score than females only in BP domain. Age gradients were observed with respect to HRQOl scores in five domains, with youngest age group having the best and oldest age group having the poorest HRQOL. Financially dependent subjects had lower HRQOL in five domains than those who were financially independent. Significant associations between education and HRQOL were found only in physical components of HRQOL, with lowest educated group being the most disadvantaged in terms of HRQOL. Marital status was found to be significantly associated with lower HRQOL scores.

Conclusion:

The study highlights sociodemographic inequalities in HRQOL among urban elderly in an Indian setting. The results may help reducing sociodemographic health inequalities among elderly in this region initiating public health actions paying more attention toward more vulnerable sections of populations.

Suicidality and associated risk factors in outpatients attending a general medical facility in rural Kenya

BACKGROUND

Low-and-Middle-Income-Countries (LMICs) account for 75% of global suicides. While primary care populations in high-income countries (HIC) typically have higher prevalence of suicidal behavior relative to general populations, few studies have explored suicidal behavior among general medical outpatients in LMICs. This study addresses the research gap by characterizing potential risk factors for suicidal ideation in a large general medical outpatient setting in rural Kenya.

METHODS

A cross-sectional study of adult general medical outpatients attending a rural sub-county hospital in Kaloleni, Kenya. Primary outcomes included major depressive disorder (MDD), posttraumatic stress disorder (PTSD) and suicidal behavior measured by the Mini International Neuropsychiatric Interview (MINI 5.0). We use binary logistic regression to model suicidality, mental disorders, intimate partner violence, and lifetime abuse.

RESULTS

394 outpatients completed the assessment. The prevalence of SI over the past month was 20%. 18% of those with suicidal ideation over the past month also attempted suicide in the past month. Participants who met criteria for MDD (suicidality item removed) were 19 times [CI: 4.56, 79.05] more likely to report suicidal ideation compared to those without MDD (adjusted odds ratio 12.15 [CI: 2.66, 55.49]).

LIMITATIONS

This was a cross sectional study design with convenience sampling and hence vulnerable to selection and recall bias.

CONCLUSION

The prevalence of SI and its strong association with actual suicide attempt in this population, make an urgent public health case for intervention. These data identify MDD as a highly significant correlate of SI.

Characterisation of the rural indigent population in Burkina Faso: a screening tool for setting priority healthcare services in sub-Saharan Africa

BACKGROUND

In Africa, health research on indigent people has focused on how to target them for services, but little research has been conducted to identify the social groups that compose indigence. Our aim was to identify what makes someone indigent beyond being recognised by the community as needing a card for free healthcare.

METHODS

We used data from a survey conducted to evaluate a state-led intervention for performance-based financing of health services in two districts of Burkina Faso. In 2015, we analysed data of 1783 non-indigents and 829 people defined as indigents by their community in 21 villages following community-based targeting processes. Using a classification tree, we built a model to select socioeconomic and health characteristics that were likely to distinguish between non-indigents and indigents. We described the screening performance of the tree using data from specific nodes.

RESULTS

Widow(er)s under 45 years of age, unmarried people aged 45 years and over, and married women aged 60 years and over were more likely to be identified as indigents by their community. Simple rules based on age, marital status and gender detected indigents with sensitivity of 75.6% and specificity of 55% among those 45 years and over; among those under 45, sensitivity was 85.5% and specificity 92.2%. For both tests combined, sensitivity was 78% and specificity 81%.

CONCLUSION

In moving towards universal health coverage, Burkina Faso should extend free access to priority healthcare services to widow(er)s under 45, unmarried people aged 45 years and over, and married women aged 60 years and over, and services should be adapted to their health needs.

ETHICS CONSIDERATIONS

The collection, storage and release of data for research purposes were authorised by a government ethics committee in Burkina Faso (Decision No. 2013-7-066). Respondent consent was obtained verbally.