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Kapaon D, Riumallo-Herl C, Jennings E, Abrahams-Gessel S, Makofane K, Kabudula CW, Harling G. Social support receipt as a predictor of mortality: A cohort study in rural South Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003683. [PMID: 39250457 DOI: 10.1371/journal.pgph.0003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 08/13/2024] [Indexed: 09/11/2024]
Abstract
The mechanisms connecting various types of social support to mortality have been well-studied in high-income countries. However, less is known about how these relationships function in different socioeconomic contexts. We examined how four domains of social support-emotional, physical, financial, and informational-impact mortality within a sample of older adults living in a rural and resource-constrained setting. Using baseline survey and longitudinal mortality data from HAALSI, we assessed how social support affects mortality in a cohort of 5059 individuals aged 40 years or older in rural Mpumalanga, South Africa. Social support was captured as the self-reported frequency with which close social contacts offered emotional, physical, financial, and informational support to respondents, standardized across the sample to increase interpretability. We used Cox proportional hazard models to evaluate how each support type affected mortality controlling for potential confounders, and assessed potential effect-modification by age and sex. Each of the four support domains had small positive associations with mortality, ranging from a hazard ratio per standard deviation of support of 1.04 [95% CI: 0.95,1.13] for financial support to 1.09 [95% CI: 0.99,1.18] for informational support. Associations were often stronger for females and younger individuals. We find baseline social support to be positively associated with mortality in rural South Africa. Possible explanations include that insufficient social support is not a strong driver of mortality risk in this setting, or that social support does not reach some necessary threshold to buffer against mortality. Additionally, it is possible that the social support measure did not capture more relevant aspects of support, or that our social support measures captured prior morbidity that attracted support before the study began. We highlight approaches to evaluate some of these hypotheses in future research.
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Affiliation(s)
- David Kapaon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carlos Riumallo-Herl
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elyse Jennings
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shafika Abrahams-Gessel
- Harvard Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Keletso Makofane
- FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts, United States of America
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Guy Harling
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Global Health, University College London, London, United Kingdom
- Africa Health Research Institute, KwaZulu-Natal, Durban, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Kasa AS, Traynor V, Lee SC, Drury P. On the Relationship Between Frailty, Nutritional Status, Depression and Quality of Life Among Older People. Int J Older People Nurs 2024; 19:e12644. [PMID: 39225010 DOI: 10.1111/opn.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 07/21/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Frailty is a multidimensional geriatric syndrome associated with physical, psychological and social changes. There is a paucity of research on frailty in Sub-Saharan African (SSA) countries, especially Ethiopia. OBJECTIVES To assess the initial correlations among frailty, nutritional status, depression and QOL (quality of life) in a group of older people in Ethiopia who are later enrolled in a study examining the effects of a nurse-led community intervention on frailty and related health outcomes. METHODS Data from 68 community-dwelling individuals 60 years of age, or over, were collected. Frailty was measured using the Amharic version of the Tilburg Frailty Indicator. The statistical analysis included Spearman's rank correlation coefficient for degrees of association, Mann-Whitney U-test for variables with two categories and Kruskal-Wallis for variables with three or more categories. RESULTS The mean frailty score for participants was 7.3 (±1.9). Participants with higher frailty scores had lower nutritional status (rs = -0.46, p < 0.01). There was a statistically significant relationship (positive) between frailty scores and depression (rs = 0.39, p < 0.01). Depressed (Md = 9, n = 23) and non-depressed frail older people (Md = 7, n = 45) showed a significant difference in their overall frailty score, U = 330.50, z = -2.49, p = 0.01, r = 0.30. There was an inverse significant association between the level of frailty across different domains in the QOL: physical (rs = -0.44, p < 0.01), psychological (rs = -0.45, p < 0.01), social relations (rs = -0.29, p < 0.05) and environmental (rs = -0.47, p < 0.01). CONCLUSION The findings from this study were consistent with those from across middle-income and high-income countries. IMPLICATIONS FOR PRACTICE This research indicates that older people living in communities who are identified as frail often suffer from a poor nutritional status, depression and reduced QOL. It suggests that healthcare professionals in Sub-Saharan countries would benefit from recognising the frailty in this population, and developing interventions aimed at enhancing nutrition, mental health and overall well-being.
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Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Brear MR, Nkovana T, Manderson L. Sitting in Wait: Everyday Caregiving Practices for People with Dementia in Rural South Africa. Med Anthropol 2024; 43:469-481. [PMID: 39235885 DOI: 10.1080/01459740.2024.2395285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Practice theories offer potential to reveal, understand, and attribute value to the everyday thoughts and actions of dementia caregivers. Drawing on ethnographic data from research in rural South Africa, on everyday dementia care practices, we highlight the profound importance of mundane practices - especially "sitting in wait" - for optimizing wellbeing of people with dementia who are cared for at home. We draw attention to the structural drivers of homebased (informal) care, which is underpinned by state inaction. This situates the act of sitting in wait as both an act of care and an embodied form of structural powerlessness.
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Affiliation(s)
- Michelle R Brear
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Wits' School of Public Health and South African Medical Research Council, Agincourt, South Africa
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Themby Nkovana
- Wits' School of Public Health and South African Medical Research Council, Agincourt, South Africa
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Social Sciences, Monash University, Melbourne, Australia
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Schröder H, Mataboge P, McMahon SA, Gómez-Olivé FX, Schatz EJ, Bärnighausen T, De Neve JW. "I am adhering to HIV treatment so that I can live to support her": A qualitative study of upward intergenerational support in South Africa. J Glob Health 2024; 14:04083. [PMID: 38726557 PMCID: PMC11082624 DOI: 10.7189/jogh.14.04083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Intergenerational family care, which was upended by the HIV epidemic in sub-Saharan Africa (SSA), may return to a pre-HIV era arrangement as access to antiretroviral therapy (ART) expands and treated adults can once again provide support for older household members. Empirical research has demonstrated positive 'spillover effects' of ART uptake from treated adults to younger generations, yet much less is known about the nature and breadth of such effects to older generations. This study explores the role and lived experiences among adults who take up ART and those of an older generation with whom they live. Methods We conducted a qualitative study consisting of semi-structured interviews (n = 46) embedded in the Agincourt Health and Demographic Surveillance System (HDSS) in rural South Africa, between July and September 2022. We purposefully sampled two respondent categories: (i) young or middle-aged adults on ART (aged 18-59 years old); and (ii) older adults (aged ≥60 years old) who were affiliated with a young or middle-aged adult on ART. We used thematic content analysis to extract, code, and categorise relevant text by types of upward spillover effects from ART in younger adults to older adults. Quantitative data was extracted from the existing Agincourt HDSS database and matched to qualitative interview data based on Clinic link unique identifiers of study participants. Results Mean age was 41 years among young or middle-aged adults (n = 29) and 72 years among older adults (n = 17). Among younger adults, time on ART ranged from five months to more than 21 years. Both young or middle-aged adults on ART and older adults reported positive spillover effects for older adults across five main tiers: caregiving, financial support, physical and mental health, living arrangements and household relationships, and stigma and reputation. Spillover challenges included financial costs and caregiving responsibilities following ART initiation of young or middle-aged adults, although these additional caregiving responsibilities were generally not perceived as particularly burdensome. Conclusions ART is likely to benefit older adults in South Africa whose families are affected by HIV. This study identified a wide range of perceived spillover effects from ART in younger adults to older adults, including improvements to upward intergenerational support. These qualitative findings offer a guide to researchers, policymakers, and donors to capitalise on the broader societal effects of a large-scale health intervention to further support family structures and meet the needs of a growing older population.
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Affiliation(s)
- Henning Schröder
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Palesa Mataboge
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - F Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Enid J Schatz
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health, College of Health Sciences, University of Missouri, Columbia, Missouri, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, University of Heidelberg, Heidelberg, Germany
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Dixon CA, Roos V, Katjene M, Hoffman J. Effective Relationships Between Younger Caregivers and Older Care Recipients Across a Continuum of Formal Residential Care Settings: A Scoping Review and a Critical Analysis. Public Health Rev 2024; 45:1606562. [PMID: 38601905 PMCID: PMC11004294 DOI: 10.3389/phrs.2024.1606562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/05/2024] [Indexed: 04/12/2024] Open
Abstract
Objective: This article aims to conduct a scoping review of what constitutes effective relational interactions between caregivers (CGs) and older persons (OPs) across formal residential care settings. Methods: A scoping review of publications between January 2000 and December 2021 yielded 10,929 articles, and after removing duplicates and applying exclusion criteria, 36 articles were analysed. Results: Articles were scrutinised for interactions involving both CGs and OPs, using a thematic framework analysis to identify effective relational constructs. Four themes emerged: 1) Diverse perspectives on the same context: for OPs it is home, and for CGs, workplace. 2) CGs move for a one-up position and OPs submit to a one-down, or as friends. 3) Relational qualities have been mostly associated with CGs, confirming care as a unidirectional action 4). Relationships between CGs and OPs result either in effective or ineffective care outcomes. Conclusion: The dual meanings attached to the same context limit the authentic interactions between CGs and OPs. We propose a relational caregiving approach by considering the interactions of both CGs and OPs, changing the relational definition, and demonstrating effective relational qualities.
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Affiliation(s)
- Carol-Ann Dixon
- Optentia Research Unit, North West University, Vanderbijlpark, South Africa
| | - Vera Roos
- Optentia Research Unit, North West University, Vanderbijlpark, South Africa
| | - Matthews Katjene
- Optentia Research Unit, North West University, Vanderbijlpark, South Africa
| | - Jaco Hoffman
- Optentia Research Unit, North West University, Vanderbijlpark, South Africa
- Oxford Institute of Population Ageing, University of Oxford, Oxford, United Kingdom
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Quach LT, Ritchie CS, Reynolds Z, Paul R, Seeley J, Tong Y, Hoeppner S, Okello S, Nakasujja N, Olivieri-Mui B, Saylor D, Greene M, Asiimwe S, Tindimwebwa E, Atwiine F, Sentongo R, Siedner MJ, Tsai AC. HIV, Social Networks, and Loneliness among Older Adults in Uganda. AIDS Behav 2024; 28:695-704. [PMID: 38281251 PMCID: PMC10947585 DOI: 10.1007/s10461-023-04258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
Loneliness among older adults has been identified as a major public health problem. Yet little is known about loneliness, or the potential role of social networks in explaining loneliness, among older people with HIV (PWH) in sub-Saharan Africa, where 70% of PWH reside. To explore this issue, we analyzed data from 599 participants enrolled in the Quality of Life and Ageing with HIV in Rural Uganda study, including older adults with HIV in ambulatory care and a comparator group of people without HIV of similar age and gender. The 3-item UCLA Loneliness Scale was used to measure loneliness, and HIV status was the primary explanatory variable. The study found no statistically significant correlation between loneliness and HIV status. However, individuals with HIV had smaller households, less physical and financial support, and were less socially integrated compared to those without HIV. In multivariable logistic regressions, loneliness was more likely among individuals who lived alone (aOR:3.38, 95% CI:1.47-7.76) and less likely among those who were married (aOR:0.34, 95% CI:0.22-0.53) and had a higher level of social integration (aOR:0.86, 95% CI: 0.79-0.92). Despite having smaller social networks and less support, older adults with HIV had similar levels of loneliness as those without HIV, which may be attributed to resiliency and access to HIV-related health services among individuals with HIV. Nonetheless, further research is necessary to better understand the mechanisms involved.
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Affiliation(s)
- Lien T Quach
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Centre for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA.
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- The Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, USA.
| | - Christine S Ritchie
- Centre for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Zahra Reynolds
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Paul
- Department of Psychological Sciences, University of Missouri at St. Louis, St. Louis, USA
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yao Tong
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susanne Hoeppner
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University School of Medicine, Kampala, Uganda
| | - Brianne Olivieri-Mui
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith Greene
- Department of Medicine, Indiana University School of Medicine and Indiana University Center for Aging Research, Regenstreif Institute, Inc., Indianapolis, IN, USA
| | - Stephen Asiimwe
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Kabwohe Clinical Research Center, Kabwohe, Uganda
| | | | - Flavia Atwiine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Medical Practice Evaluation Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
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Yu ST, Houle B, Schatz E, Angotti N, Kabudula CW, Gómez-Olivé FX, Clark SJ, Menken J, Mojola SA. Understanding Household Dynamics From the Ground Up: A Longitudinal Study From a Rural South African Setting. Demography 2024; 61:31-57. [PMID: 38240041 DOI: 10.1215/00703370-11146140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Investigations into household structure in low- and middle-income countries (LMICs) provide important insight into how families manage domestic life in response to resource allocation and caregiving needs during periods of rapid sociopolitical and health-related challenges. Recent evidence on household structure in many LMICs contrasts with long-standing viewpoints of worldwide convergence to a Western nuclearized household model. Here, we adopt a household-centered theoretical and methodological framework to investigate longitudinal patterns and dynamics of household structure in a rural South African setting during a period of high AIDS-related mortality and socioeconomic change. Data come from the Agincourt Health and Socio-Demographic Surveillance System (2003-2015). Using latent transition models, we derived six distinct household types by examining conditional interdependency between household heads' characteristics, members' age composition, and migration status. More than half of households were characterized by their complex and multigenerational profiles, with considerable within-typology variation in household size and dependency structure. Transition analyses showed stability of household types under female headship, while higher proportions of nuclearized household types dissolved over time. Household dissolution was closely linked to prior mortality experiences-particularly, following death of a male head. Our findings highlight the need to better conceptualize and contextualize household changes across populations and over time.
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Affiliation(s)
- Shao-Tzu Yu
- School of Demography, The Australian National University, Canberra, Australia
| | - Brian Houle
- School of Demography, The Australian National University, Canberra, Australia; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Enid Schatz
- Department of Public Health, University of Missouri-Columbia, Columbia, MO, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Nicole Angotti
- Department of Sociology, American University, Washington, DC, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Samuel J Clark
- Department of Sociology, The Ohio State University, Columbus, OH, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Jane Menken
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Sanyu A Mojola
- Department of Sociology, School of Public and International Affairs, and Office of Population Research, Princeton University, Princeton, NJ, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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8
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Kasa AS, Drury P, Chang HC(R, Lee SC, Traynor V. Measuring the effects of a nurse-led intervention on frailty status of older people living in the community in Ethiopia: A protocol for a quasi-experimental study. PLoS One 2024; 19:e0296166. [PMID: 38241265 PMCID: PMC10798498 DOI: 10.1371/journal.pone.0296166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 12/05/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The recent recognition of the multidimensional features of frailty has emphasised the need for individualised multicomponent interventions. In the context of sub-Saharan Africa, few studies have examined: a) the frailty status of the older population; b) the level of frailty and its health implications and; c) the impact of a nurse-led intervention to reduce frailty. OBJECTIVES This study aims to design, implement, and evaluate a nurse-led intervention to reduce frailty and associated health consequences among older people living in Ethiopia. METHODS The study will be conducted on 68 older persons using a pre-, post-, and follow-up single-group quasi-experimental design. Residents of Ethiopia, ≥60 years and living in the community will be invited to participate in a 24-week program designed to decrease frailty and associated health consequences. Data will be collected at three-time points: baseline, immediately after the intervention, and 12 weeks post-intervention. To determine the effect of the intervention, changes in frailty, nutritional status, activities of daily living, depression and quality of life scores will be measured. To measure the effect of a nurse-led intervention on the level of frailty among older people a generalised linear model (GLM) using repeated measures ANOVA will be used. Statistical significances will be set at p-values < 0.05. DISCUSSION The results of this study will determine the impact of a nurse-led intervention to reduce frailty amongst community-dwelling older people living in Ethiopia. The results of this study will inform the development of future interventions designed to reduce frailty in lower-income countries. TRIAL REGISTRATION The trial was registered in ClinicalTrials.gov with the identifier of NCT05754398.
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Affiliation(s)
- Ayele Semachew Kasa
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Peta Drury
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
| | - Hui-Chen (Rita) Chang
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, New South Wales, Australia
| | - Shu-Chun Lee
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong (UOW), New South Wales, Australia
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9
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Young R, Ssekasanvu J, Kagaayi J, Ssekubugu R, Kigozi G, Reynolds SJ, Wawer MJ, Nonyane BAS, Chang LW, Kennedy CE, Paina L, Anglewicz PA, Quinn TC, Serwadda D, Nalugoda F, Grabowski MK. HIV and viremia prevalence in non-migrating members of migrant households in Rakai region, Uganda: A cross-sectional population-based study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.08.23299745. [PMID: 38106065 PMCID: PMC10723567 DOI: 10.1101/2023.12.08.23299745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Introduction In sub-Saharan Africa, migrants are more likely to be HIV seropositive and viremic than non-migrants. However, little is known about HIV prevalence and viremia in non-migrants living in households with in- or out-migration events. We compared HIV outcomes in non-migrating persons in households with and without migration events using data from the Rakai Community Cohort Study (RCCS), an open population-based cohort in Uganda. Methods We analyzed RCCS survey data from one survey round collected between August 2016 and May 2018 from non-migrating participants aged 15-49. Migrant households were classified as those reporting ≥1 member moving into or out of the household since the prior survey. A validated rapid test algorithm determined HIV serostatus. HIV viremia was defined as >1,000 copies/mL. Modified Poisson regression was used to estimate associations between household migration and HIV outcomes, with results reported as adjusted prevalence ratios (adjPR) with 95% confidence intervals (95%CI). Analyses were stratified by gender, direction of migration (into/out of the household), and relationship between non-migrants and migrants (e.g., spouse). Results There were 14,599 non-migrants (7,654, 52% women) identified in 9,299 households. 4,415 (30%) lived in a household with ≥1 recent migrant; of these, 972(22%) had migrant spouses, 1,102(25%) migrant children, and 875(20%) migrant siblings. Overall, HIV prevalence and viremia did not differ between non-migrants in migrant and non-migrant households. However, in stratified analyses, non-migrant women with migrant spouses were significantly more likely to be HIV seropositive compared to non-migrant women with non-migrant spouses (adjPR:1.44, 95%CI:1.21-1.71). Conversely, non-migrant mothers living with HIV who had migrant children were less likely to be viremic (adjPR:0.34, 95%CI:0.13-0.86). Among non-migrant men living with HIV, spousal migration was associated with a non-significant increased risk of viremia (adjPR:1.37, 95%CI:0.94-1.99). Associations did not typically differ for migration into or out of the household. Conclusions Household migration was associated with HIV outcomes for certain non-migrants, suggesting that the context of household migration influences the observed association with HIV outcomes. In particular, non-migrating women with migrating spouses were more likely to have substantially higher HIV burden. Non-migrants with migrant spouses may benefit from additional support when accessing HIV services.
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Arif R, Chaudhry A, Chaudhry T. Empowered mothers and co-resident grandmothers: Two fundamental roles of women impacting child health outcomes in Punjab, Pakistan. PLoS One 2023; 18:e0285995. [PMID: 37922238 PMCID: PMC10624287 DOI: 10.1371/journal.pone.0285995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 05/06/2023] [Indexed: 11/05/2023] Open
Abstract
We show that i) empowered mothers and ii) coresident grandmothers each benefit children's nutritional health measured by height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for age groups 5 years and less. First, using cross-sectional data from the Pakistan Demographic and Health Survey (PDHS) for the year 2017-18, we estimate the impact of empowered mothers on child health outcomes using an instrumental variable approach to correct for endogeneity. Empowerment is measured by two indices: as a sum of the questions that gauge both attitudinal and behavioral dimensions of female agency and also and using multiple correspondence analysis (MCA) for these same questions. Second, we use a fuzzy regression discontinuity design (FRDD) to measure the causal impact of coresident grandmothers on the health outcomes of the children using multiple rounds of the Multiple Indicator Cluster Survey (MICS) from the years 2008, 2011, 2014 and 2018. The difference between the actual ages of the grandmother from the Potential Retirement Eligibility Criteria (PREC) has been used to correct for potential endogeneity. The results show that on average, the weight for age z-scores (WFA) for children under five increases by 0.28 SD with a one-index point increase in mother's empowerment. Similarly, on average, WFA increases by 0.098 SD when grandmothers are present in a household. Finally, we explore heterogeneity in the average effects stated above based upon the gender of the child as well as the wealth and geographic location of the household. The benefits of mothers' empowerment are largely driven by improvements in girls' nutrition as well as children living in rural areas while the presence of grandmothers primarily improves the nutrition of boys, children in rural areas, and children belonging to poor families.
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Affiliation(s)
- Rabia Arif
- Department of Economics, Lahore School of Economics, Burki (Lahore), Pakistan
| | - Azam Chaudhry
- Faculty of Economics, Lahore School of Economics, Burki (Lahore), Pakistan
| | - Theresa Chaudhry
- Department of Economics, Lahore School of Economics, Burki (Lahore), Pakistan
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11
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Angotti N, Mojola SA, Wen Y, Ferdinando A. Biomedical bargains: Negotiating "safe sex" on antiretroviral treatment in rural South Africa. Soc Sci Med 2023; 330:116036. [PMID: 37390807 DOI: 10.1016/j.socscimed.2023.116036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023]
Abstract
Wide-scale availability of antiretroviral treatment (ART) has transformed the global landscape for HIV prevention, shifting emphasis away from a strictly behavioral focus on changing sexual practices towards a biomedical approach. Successful ART management is measured by an undetectable viral load, which helps maintain overall health and prevent onward viral transmission. The latter utility of ART, however, must be understood in the context of its implementation. In South Africa, ART has become easily accessible - yet ART knowledge spreads unevenly, while counseling advice and normative expectations and experiences of gender and aging interact to inform sexual practices. As ART enters the sexual lives of middle-aged and older people living with HIV (MOPLH), a population growing rapidly, how has it informed sexual decisions and negotiations? Drawing on in-depth interviews with MOPLH on ART, corroborated with focus group discussions and national ART-related policies and guidelines, we find that for MOPLH, sexual decisions increasingly feature compliance with biomedical directives and concern for ART efficacy. Seeking consensus regarding the biological risks of sex on ART becomes an important feature of sexual negotiations, and anticipated disagreements can pre-empt sexual relationships altogether. We introduce the concept of biomedical bargains to explain what happens when disagreements arise, and the terms of sex are negotiated using competing interpretations of biomedical information. For both men and women, ostensibly gender-neutral biomedical discourses provide new discursive resources and strategies for sexual decisions and negotiations, yet biomedical bargains are still embedded in gender dynamics-women invoke the dangers of jeopardizing treatment efficacy and longevity to insist on condoms or justify abstinence, while men utilize biomedical arguments in an effort to render condomless sex safe. While the full therapeutic benefits of ART are critical for the efficacy and equity of HIV programs, they will nonetheless always affect, and be affected by, social life.
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Affiliation(s)
- Nicole Angotti
- Department of Sociology, American University, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Sanyu A Mojola
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Sociology, Princeton University, USA; School of Public and International Affairs, and Office of Population Research, Princeton University, USA
| | - Yunhan Wen
- Department of Sociology, Princeton University, USA
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Sherr L, Macedo A, Tomlinson M, Skeen S, Hensels IS, Steventon Roberts KJ. Parenting in Adversity: Effects of Older Caregivers, Biological Carers and Troubled Carers on Child Outcomes in High HIV-Affected Communities. J Cross Cult Gerontol 2023:10.1007/s10823-023-09482-6. [PMID: 37243786 DOI: 10.1007/s10823-023-09482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/29/2023]
Abstract
Caregiving by older adults is a common phenomenon, enhanced in the era of HIV infection. This longitudinal study was set up to examine the effect of caregiver age, relationship and mental wellbeing on child (4-13 years) outcomes (psychosocial and cognitive) in a sample of 808 caregiver- child dyads in South Africa and Malawi. Respondents were drawn from consecutive attenders at Community Based Organisations (CBOs) and interviewed with standardised inventories at baseline and followed up 12-15 months later. Analysis focused on three separate aspects of the caregiver; age, relationship to the child, and mental wellbeing, results are stratified with regard to these factors. Results showed that compared to younger caregivers, over 50 years were carrying a heavy load of childcare, but caregiver age for the most part was not associated with child outcomes. Being biologically related to the child (such as biological grandparenting) was also not a significant factor in child outcomes measured. However, irrespective of age and relationship, caregiver mental health was associated with differences in child outcome - those children of caregivers with a greater mental health burden were found to report experiencing more physical and psychologically violent discipline. Over time, the use of violent discipline was found to reduce. These data suggest that older caregivers and grandparents are providing comparable care to younger caregivers, for young children in the face of the HIV epidemic and that interventions should focus on mental health support for all caregivers, irrespective of age or relationship to the child.
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Affiliation(s)
- Lorraine Sherr
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK.
| | - Ana Macedo
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Imca S Hensels
- Department of Psychology, University of Manchester, Manchester, UK
| | - Kathryn J Steventon Roberts
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
- Department for Social Policy and Intervention, University of Oxford, Oxford, UK
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Schröder H, Yapa HM, Gómez-Olivé FX, Thirumurthy H, Seeley J, Bärnighausen T, De Neve JW. Intergenerational spillover effects of antiretroviral therapy in sub-Saharan Africa: a scoping review and future directions for research. BMJ Glob Health 2023; 8:bmjgh-2022-011079. [PMID: 37068847 PMCID: PMC10111905 DOI: 10.1136/bmjgh-2022-011079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/24/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) may influence individuals who do not receive the intervention but who are connected in some way to the person who does. Relatively little is known, however, about the size and scope of, what we term, spillover effects of ART. We explored intergenerational spillover effects of ART in sub-Saharan Africa (SSA) and identified several directions for future research. METHODS We conducted a scoping review between March and April 2022. We systematically searched PubMed, PsycINFO, EconLit, OTseeker, AIDSInfo, Web of Science, CINHAL, Google Scholar and African Index Medicus. We analysed the distribution of included studies over time and summarised their findings. We examined the intergenerational impact of ART provision to working-age adults living with HIV on children ('downward' spillover effects) and older adults ('upward' spillover effects). We categorised types of intergenerational spillover effects according to broad themes which emerged from our analysis of included studies. FINDINGS We identified 26 studies published between 2005 and 2022 with 16 studies assessing spillover effects from adults to children (downward), and 1 study explicitly assessing spillover effects from working-age adults to older adults (upward). The remaining studies did not fully specify the direction of spillover effects. Most spillover effects of ART to household and family members were beneficial and included improvements in wealth, labour market outcomes, health outcomes and health services utilisation, schooling, and household composition. Both children and older adults benefited from ART availability among adults. Detrimental spillover effects were only reported in three studies and included financial and opportunity costs associated with health services utilisation and food insecurity in the first year after ART. CONCLUSIONS ART may lead to substantial spillover effects across generations and sectors in SSA. Further research is needed to capitalise on positive spillover effects while mitigating potential negative spillover effects. The returns to investments in large-scale health interventions such as ART may be underestimated without considering these societal benefits.
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Affiliation(s)
- Henning Schröder
- Heidelberg Institute of Global Health, Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - H Manisha Yapa
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
- Africa Health Research Institute, Durban, South Africa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Medical Faculty, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, Durban, South Africa
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Medical Faculty, Heidelberg University, Heidelberg, Germany
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Trani JF, Zhu Y, Park S, Khuram D, Azami R, Fazal MR, Babulal GM. Multidimensional poverty is associated with dementia among adults in Afghanistan. EClinicalMedicine 2023; 58:101906. [PMID: 36969341 PMCID: PMC10030911 DOI: 10.1016/j.eclinm.2023.101906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Background Multidimensional poverty is associated with dementia, but no evidence is available for countries in conflict. Methods A cross-sectional study was conducted in two provinces of Afghanistan between February 15th 2022 and April 20th 2022 among adults age 50 and older. Multidimensional poverty included six dimensions of well-being and 16 indicators of deprivation. The Rowland Universal Dementia Assessment Scale measured dementia. Poverty between adults with and without dementia was examined, adjusting for sex. Associations between dementia and poverty were investigated using multivariate regression model. Findings Of the 478 adults included, 89 (52.7%) had mild, and 25 (14.8%) had moderate to severe dementia. More women than men had mild (52.7% vs 33.3%) and moderate-to-severe dementia (14.8% vs 5.8%). Approximately 33.9% adults with mild and 51.2% adults with moderate-to-severe dementia were found to be deprived in four or more dimensions compared to 21.8% without dementia. The difference in four dimensions of multidimensional poverty between adults with mild and moderate-to-severe dementia and adults without dementia was respectively 59.5% and 152.88%. Education, employment, health, and living conditions were the main contributors to the adjusted poverty head count ratio. Multidimensional poverty in four or five dimensions was strongly associated with dementia among older adults particularly over 70 years old (odds ratio [OR], 17.38; 95% CI, 2.22-135.63), with greater odds for older women overall (OR, 2.69; 95% CI, 1.76-4.11). Interpretation Our findings suggest that early improvement in social determinants of health through targeted structural policies may lower dementia risk later in life. Specifically, better access to free, quality education, healthcare, and basic living standard together with employment opportunities could reduce risk of dementia. Funding The present study was funded by a grant from the Alzheimer Association (AARG-NTF-21-851241).
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Affiliation(s)
- Jean-Francois Trani
- Brown School, Washington University, St. Louis, MO, USA
- National Conservatory of Arts and Crafts, Paris, France
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
| | - Yiqi Zhu
- Adelphi University, New York, USA
| | - Soobin Park
- Brown School, Washington University, St. Louis, MO, USA
| | | | - Rahim Azami
- World Health Organization, Geneva, Switzerland
| | | | - Ganesh M. Babulal
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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David IJ, Schatz E, Angotti N, Myroniuk TW, Mojola SA. "I'm Getting Life from the Treatment": Perceptions of Life and Death Among Middle-Aged and Older Medication-Adherent Persons Living with HIV in Rural South Africa. J Aging Soc Policy 2023:1-23. [PMID: 36973857 DOI: 10.1080/08959420.2023.2195348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/15/2022] [Indexed: 03/29/2023]
Abstract
The widespread availability of health information and treatment for HIV in Southern Africa does not reach all populations. Few programs and materials are developed with middle-aged and older rural individuals living with HIV as the target audience, despite this being a growing population. This vacuum inevitably exacerbates the disjuncture between clinical and experiential knowledge. This study uses in-depth interviews from 2018 with middle-aged and older rural South Africans who self-report medication adherence to ART in order to explore experiences of living with HIV and beliefs about anti-retroviral treatment (ART). Participants revealed a general sense of vulnerability as a major motivation for HIV medication adherence. A majority of the participants believed that death was imminent if they defaulted on ART at any point in time. Although the availability of ART brought hope to many, HIV was still perceived as a death sentence, particularly if ART adherence was imperfect. The study findings suggest a need to examine the psychosocial component of community programs for middle-aged and older people living with HIV. For this growing population that experienced the full course of the epidemic, more research is needed on the burden of psychological and mental health issues emerging from the need for long-term HIV medication adherence.
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Affiliation(s)
- Ifeolu J David
- Department of public health, University of Missouri, Columbia, MO, USA
| | - Enid Schatz
- Department of public health, University of Missouri, Columbia, MO, USA
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of sociology, American University, Washington DC, USA
| | - Tyler W Myroniuk
- Department of public health, University of Missouri, Columbia, MO, USA
| | - Sanyu A Mojola
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of sociology, Princeton University, Princeton, NJ, USA
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16
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Abdelatif N, Naidoo I, Dunn S, Mazinu M, Essack Z, Groenewald C, Maharaj P, Msomi N, Reddy T, Roberts B, Zuma K. Heterogeneity in COVID-19 infection among older persons in South Africa: Evidence from national surveillance data. Front Public Health 2023; 11:1009309. [PMID: 37006523 PMCID: PMC10061133 DOI: 10.3389/fpubh.2023.1009309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundThe 2021 World Health Organization study on the impact of COVID-19 on older people (≥60 years) in the African region highlighted the difficulties they faced as the virus spread across borders and dominated the way of life. These difficulties included disruptions to both essential health care services and social support, as well as disconnections from family and friends. Among those who contracted COVID-19, the risks of severe illness, complications, and mortality were highest among near-old and older persons.ObjectiveRecognizing that older persons are a diverse group including younger- and older-aged individuals, a study was conducted to track the epidemic among near-old (50–59 years) and older persons (≥60 years) in South Africa covering the 2 years since the epidemic emerged.MethodsUsing a quantitative secondary research approach, data for near-old and older persons were extracted for comparative purposes. COVID-19 surveillance outcomes (confirmed cases, hospitalizations, and deaths) and vaccination data were compiled up to March 5th, 2022. COVID-19 surveillance outcomes were plotted by epidemiological week and epidemic waves to visualize the overall growth and trajectory of the epidemic. Means for each age-group and by COVID-19 waves, together with age-specific rates, were calculated.ResultsAverage numbers of new COVID-19 confirmed cases and hospitalizations were highest among people aged 50–59- and 60–69-years. However, average age-specific infection rates showed that people aged 50–59 years and ≥80 years were most vulnerable to contracting COVID-19. Age-specific hospitalization and death rates increased, with people aged ≥ 70 years most affected. The number of people vaccinated was slightly higher among people aged 50–59 years before Wave Three and during Wave Four, but higher among people aged ≥ 60 years during Wave Three. The findings suggest that uptake of vaccinations stagnated prior to and during Wave Four for both age groups.DiscussionHealth promotion messages and COVID-19 epidemiological surveillance and monitoring are still needed, particularly for older persons living in congregate residential and care facilities. Prompt health-seeking should be encouraged, including testing and diagnosis as well as taking up vaccines and boosters, particularly for high-risk older persons.
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Affiliation(s)
- Nada Abdelatif
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Inbarani Naidoo
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- *Correspondence: Inbarani Naidoo
| | - Shanaaz Dunn
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Mikateko Mazinu
- Biostatistics Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zaynab Essack
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Pietermaritzburg, South Africa
- Honorary Research Fellow, School of Law, and Honorary Research Associate, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa
| | - Candice Groenewald
- Centre for Community Based Research, Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- Honorary Research Associate, Rhodes University, Grahamstown, South Africa
| | - Pranitha Maharaj
- School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Nokukhanya Msomi
- Discipline of Virology, University of KwaZulu-Natal and National Health Laboratory Services, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Benjamin Roberts
- Developmental, Capable and Ethical State Division, Human Sciences Research Council, Durban, South Africa
| | - Khangelani Zuma
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
- Wits School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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Carries S, Mkhwanazi Z, Sigwadhi L, Moshabela M, Nyirenda M, Goudge J, Govindasamy D. An economic incentive package to support the wellbeing of caregivers of adolescents living with HIV during the COVID-19 pandemic in South Africa: a feasibility study protocol for a pilot randomised trial. Pilot Feasibility Stud 2023; 9:3. [PMID: 36624520 PMCID: PMC9827020 DOI: 10.1186/s40814-023-01237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The mental and financial strain linked to unpaid caregiving has been amplified during the COVID-19 pandemic. In sub-Saharan Africa, carers of adolescents living with HIV (ALHIV) are critical for maintenance of optimum HIV treatment outcomes. However, the ability of caregivers to provide quality care to ALHIV is undermined by their ability to maintain their own wellbeing due to multiple factors (viz. poverty, stigma, lack of access to social support services) which have been exacerbated by the COVID-19 pandemic. Economic incentives, such as cash incentives combined with SMS reminders, have been shown to improve wellbeing. However, there is a lack of preliminary evidence on the potential of economic incentives to promote caregiver wellbeing in this setting, particularly in the context of a pandemic. This protocol outlines the design of a parallel-group pilot randomised trial comparing the feasibility and preliminary effectiveness of an economic incentive package versus a control for improving caregiver wellbeing. METHODS Caregivers of ALHIV will be recruited from public-sector HIV clinics in the south of the eThekwini municipality, KwaZulu-Natal, South Africa. Participants will be randomly assigned to one of the following groups: (i) the intervention group (n = 50) will receive three cash payments (of ZAR 350, approximately 23 USD), coupled with a positive wellbeing message over a 3-month period; (ii) the control group (n = 50) will receive a standard message encouraging linkage to health services. Participants will be interviewed at baseline and at endline (12 weeks) to collect socio-demographic, food insecurity, health status, mental health (stigma, depressive symptoms) and wellbeing data. The primary outcome measure, caregiver wellbeing, will be measured using the CarerQoL instrument. A qualitative study will be conducted alongside the main trial to understand participant views on participation in the trial and their feedback on study activities. DISCUSSION This study will provide scientific direction for the design of a larger randomised controlled trial exploring the effects of an economic incentive for improving caregiver wellbeing. The feasibility of conducting study activities and delivering the intervention remotely in the context of a pandemic will also be provided. TRIAL REGISTRATION PACTR202203585402090. Registry name: Pan African Clinical Trials Registry (PACTR); URL: https://pactr.samrc.ac.za/ ; Registration. date: 24 March 2022 (retrospectively registered); Date first participant enrolled: 03 November 2021.
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Affiliation(s)
- Stanley Carries
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zibuyisile Mkhwanazi
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lovemore Sigwadhi
- grid.11956.3a0000 0001 2214 904XBiostatistics Unit, Stellenbosch University, Stellenbosch, South Africa
| | - Mosa Moshabela
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Makandwe Nyirenda
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa ,grid.415021.30000 0000 9155 0024Burden of Disease Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jane Goudge
- grid.11951.3d0000 0004 1937 1135Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Darshini Govindasamy
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Denardo D, Mojola SA, Schatz E, Gómez-Olivé FX. Antiretroviral therapy and aging as resources for managing and resisting HIV-related stigma in rural South Africa. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100148. [PMID: 36687383 PMCID: PMC9851406 DOI: 10.1016/j.ssmqr.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The widespread roll-out of antiretroviral therapy (ART) in Africa has contributed to a large population of adults aging with HIV. However, little is known about how HIV-related stigma interacts with aging in the ART era. This study uses in-depth interviews with middle-aged and older South Africans living with HIV to explore stigma-related experiences and response strategies. Participants describe a persistence of stigma which requires the deployment of a range of common and age-based stigma management and resistance strategies. We find that participants minimize their exposure to stigma through selective disclosure of their HIV status; neutralize HIV-related stigma through comparisons to chronic illnesses common among older adults, and deflect stigma through asserting an ART-adherent identity and othering younger non-adherent adults. Overall, our study highlights the roles of ART and aging as resources for managing and resisting HIV-related stigma.
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Affiliation(s)
- Danielle Denardo
- Social and Behavioral Sciences, Soka University of America, Aliso Viejo, CA, USA
| | - Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
| | - Enid Schatz
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
- Department of Public Health and Department of Women’s & Gender Studies, University of Missouri, Columbia, MO, USA
| | - F. Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, South Africa
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19
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Ralston M, Jennings E, Schatz E. Who is at Risk? Social Support, Relationship Dissolution, and Illness in a Rural Context. SOCIOLOGICAL INQUIRY 2022; 92:1053-1082. [PMID: 36059856 PMCID: PMC9436001 DOI: 10.1111/soin.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study focuses on a cohort of adults (40-plus) in rural South Africa to unpack associations between physical health and receipt of social support, and the extent to which these associations were moderated by marital status. We use logistic regression to estimate the odds of having received emotional, physical, or financial support separately for men (N = 2247) and women (N = 2609). Our results suggest having an Activity of Daily Living (ADL) limitation or having at least one chronic condition was not significantly associated with social support receipt for women, but having an ADL limitation was associated with reduced odds of receiving financial support among men. Although marital status was strongly and significantly associated with receipt of social support for both men and women, marital status moderated the relationship between health indicators and social support receipt only for men. Our findings suggest that when men, but not women, experience a marital dissolution and are suffering from a disability or a chronic condition, their networks respond by providing needed social support.
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Affiliation(s)
| | | | - Enid Schatz
- University of Missouri; University of the Witwatersand
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20
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Nutakki A, Chomba M, Chishimba L, Mataa MM, Zimba S, Kvalsund M, Gottesman RF, Bahouth MN, Saylor D. Predictors of in-hospital and 90-day post-discharge stroke mortality in Lusaka, Zambia. J Neurol Sci 2022; 437:120249. [PMID: 35405450 PMCID: PMC9133219 DOI: 10.1016/j.jns.2022.120249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Factors associated with stroke mortality are understudied in sub-Saharan Africa but have implications for designing interventions that improve stroke outcomes. We investigated predictors of in-hospital and 90-day post-discharge stroke mortality in Lusaka, Zambia. METHODS Data from consecutive adults admitted with stroke at University Teaching Hospital in Lusaka, Zambia between October 2018 and March 2019 were retrospectively reviewed for clinical in-hospital outcomes. Vital status at 90-days post-discharge was determined through phone calls. Factors associated with stroke mortality were included in multivariable logistic regression models utilizing multiple imputation analysis to determine independent predictors of in-hospital and 90-days post-discharge mortality. RESULTS In-hospital mortality was 24%, and 90-day post-discharge mortality was 22% among those who survived hospitalization. Hemorrhagic and unknown strokes, ICU care, seizures, and aspiration pneumonia were significantly associated with in-hospital mortality. Among these, hemorrhagic stroke (OR 2.88, 95% CI 1.27-6.53, p = 0.01) and seizures (OR 29.5, 95% CI 2.14-406, p = 0.01) remained independent predictors of in-hospital mortality in multivariable analyses. Ninety-day post-discharge mortality was significantly associated with older age, previous stroke, atrial fibrillation, and aspiration pneumonia, but only older age (OR 1.04, 95% CI 1.01-1.06, p = 0.007) and aspiration pneumonia (OR 3.93, 95% CI 1.30-11.88, p = 0.02) remained independently associated with 90-day mortality in multivariable analyses. CONCLUSION This Zambian stroke cohort had high in-hospital and 90-day post-discharge mortality that were associated with several in-hospital complications. Our data indicate the need for improvement in both acute stroke care and post-stroke systems of care to improve stroke outcomes in Zambia.
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Affiliation(s)
- Aparna Nutakki
- Rush Medical College of Rush University, Chicago, IL, USA
| | - Mashina Chomba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Lorraine Chishimba
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Stanley Zimba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Michelle Kvalsund
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia; Department of Neurology, University of Rochester Medical Center, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, MD, USA
| | - Mona N Bahouth
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Deanna Saylor
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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21
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Rutagumirwa SK, Bailey A. “It's all about being a woman”: Intersections of multiple (dis)advantages experienced by older women in Tanzania. J Aging Stud 2022; 61:101021. [DOI: 10.1016/j.jaging.2022.101021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/14/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
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22
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Trani JF, Moodley J, Maw MTT, Babulal GM. Association of Multidimensional Poverty With Dementia in Adults Aged 50 Years or Older in South Africa. JAMA Netw Open 2022; 5:e224160. [PMID: 35333360 PMCID: PMC8956981 DOI: 10.1001/jamanetworkopen.2022.4160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Limited research exists investigating the association between multidimensional poverty and dementia in low-and middle-income countries (LMICs). OBJECTIVE To investigate the association between multidimensional poverty and dementia among adults aged 50 years or older living in South Africa. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted in Soweto, Johannesburg, South Africa, between November 11, 2019, and February 28, 2020. Participants included 227 adults aged 50 years or older. Data analysis was concluded from August 1 to 30, 2021. EXPOSURES Multidimensional poverty included 7 dimensions that are central to well-being (education, health, economic activity, living standards, social participation, fair treatment, and psychological well-being) and 11 indicators of deprivation within those dimensions (limited access to education; severe limitation of activity; difficulty functioning; unemployment; deprivation of access to running water, electricity, and a flush toilet; lack of involvement in community groups; discrimination; depression; and decreased self-esteem). MAIN OUTCOMES AND MEASURES The 8-item Interview to Differentiate Aging and Dementia (Assessing Dementia 8 [AD8]) and the Rowland Universal Dementia Assessment Scale (RUDAS) were used to assess dementia. Level and depth of poverty were compared between adults with no dementia and those with a score above the threshold for either the AD8 or the RUDAS, or for both the AD8 and the RUDAS, adjusting for gender, age group, and marital status. Correlation analyses assessed the overlap of dimensions of deprivation. Associations between dementia and multidimensional poverty were investigated using a multivariable logistic regression model. RESULTS A total of 227 adults (146 women [64.3%]; mean [SD] age, 63.7 [0.5] years) were included in the study; 101 (44.5%) had dementia identified by the AD8, 14 (6.2%) had dementia identified by the RUDAS, and 50 (22.0%) had dementia identified by both the AD8 and the RUDAS. More men than women did not have dementia (26 of 81 [32.1%] vs 36 of 146 [24.7%]), and 33 of 165 adults with dementia (20.0%) compared with 6 of 62 adults (9.7%) without dementia were found to be deprived in 4 dimensions or more. The difference between adults with and adults without dementia in the Multidimensional Poverty Index for deprivation in 4 dimensions was 145.8% for dementia identified by both the AD8 and the RUDAS and 118.2% for dementia identified by either the AD8 or the RUDAS. Education, health, and employment were the main contributors to the adjusted poverty head count ratio. Multidimensional poverty was strongly associated with dementia as measured by the AD8 and the RUDAS (adjusted odds ratio [OR], 2.31; 95% CI, 1.08-4.95), with higher odds for older women (OR, 2.03; 95% CI, 1.00-4.12) or those living in large households (for each additional household member: OR, 1.27; 95% CI, 1.05-1.53). CONCLUSIONS AND RELEVANCE This study suggests that the prevalence and depth of poverty were higher among adults with dementia. A lack of education, poor health, and unemployment were major dimensions of poverty that were associated with a higher prevalence of dementia. Long-term interventions beginning early in life may affect social determinants of health through targeted structural policies (eg, access to quality education and health care) and prevent dementia later in life.
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Affiliation(s)
- Jean-Francois Trani
- Brown School, Washington University, St Louis, Missouri
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Center for Social Development in Africa, University of Johannesburg, Johannesburg, South Africa
| | - Jacqueline Moodley
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - May Thu Thu Maw
- Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ganesh M. Babulal
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC
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23
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Mojola SA, Angotti N, Schatz E, Houle B. "A NOWADAYS DISEASE": HIV/AIDS AND SOCIAL CHANGE IN A RURAL SOUTH AFRICAN COMMUNITY. AJS; AMERICAN JOURNAL OF SOCIOLOGY 2021; 127:950-1000. [PMID: 35967824 PMCID: PMC9365075 DOI: 10.1086/718234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Why do some people adapt successfully to change while others do not? We examine this question in the context of a severe HIV/AIDS epidemic in South Africa, where adapting (or not) to social change has borne life and death consequences. Applying an age-period-cohort lens to the analysis of qualitative life history interviews among middle-aged and older adults, we consider the role of the life course and gendered sexuality in informing Africans' strategies of action, or inaction, and in differentially driving and stalling change in each cohort in response to the HIV/AIDS epidemic. Our study illuminates the unique challenges of adapting to social change that result from dynamic interactions among aging, prevailing social structures, and a cohort's socio-historical orientation to a new period.
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Affiliation(s)
- Sanyu A Mojola
- Princeton University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Angotti
- American University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Enid Schatz
- University of Missouri Columbia and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brian Houle
- The Australian National University and MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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24
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Brinkmann B, Davies JI, Witham MD, Harling G, Bärnighausen T, Bountogo M, Siedner MJ, Ouermi L, Junghanns J, Coulibaly B, Sié A, Payne CF, Kohler IV. Impairment in Activities of Daily Living and Unmet Need for Care Among Older Adults: A Population-Based Study From Burkina Faso. J Gerontol B Psychol Sci Soc Sci 2021; 76:1880-1892. [PMID: 33715008 PMCID: PMC8557831 DOI: 10.1093/geronb/gbab041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives The importance of impairment in performing activities of daily living (ADL) is likely to increase in sub-Saharan Africa because few care options for affected people exist. This study investigated the prevalence of ADL impairment, the extent to which care need was met, and described characteristics of people with ADL impairment and unmet need in Burkina Faso. Methods This study used data from the Centre de Recherche en Santé de Nouna Heidelberg Aging Study, a population-based study among 3,026 adults aged older than 40 years conducted in rural Burkina Faso. Information on 6 basic ADL items was sought, with a follow-up question asking whether care need was not met, partially met, or met. Bivariable correlations and multivariable logistic regression were used to determine sociodemographic and health characteristics associated with ADL impairment and unmet need. Results ADL impairment of any kind was reported by 1,202 (39.7%) respondents and was associated with older age (adjusted odds ratio: 1.05 [95% CI: 1.04–1.06]), being a woman (1.33 [1.06–1.60]), and reporting depressive symptoms (1.90 [1.65–2.18]). Among those with ADL impairment, 67.8% had at least one unmet need. Severe ADL impairment was found in 202 (6.7%) respondents, who reported a lower prevalence of unmet need (43.1%). Severe ADL impairment was associated with depressive symptoms (2.55 [2.11–3.07]) to a stronger degree than any ADL impairment. Discussion Prevalence of ADL impairment and unmet need was high in this setting. Variation in impairment across the population highlighted key groups for future interventions. Unmet need for care was highest in middle-aged adults, indicating a gap in care provision.
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Affiliation(s)
- Ben Brinkmann
- Heidelberg Institute of Global Health, Heidelberg University, Germany
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Miles D Witham
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,AGE Research Group, NIHR Newcastle Biomedical Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle upon Tyne Hospitals NHS Trust, UK
| | - Guy Harling
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA.,Institute for Global Health, University College London, UK
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Germany.,Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
| | | | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - Jana Junghanns
- Heidelberg Institute of Global Health, Heidelberg University, Germany
| | | | - Ali Sié
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | - Collin F Payne
- School of Demography, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Iliana V Kohler
- Population Studies Center and Department of Sociology, University of Pennsylvania, Philadelphia, USA
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25
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Negin J, Seeley J. Incidence data do not count everyone. Lancet HIV 2021; 8:e603. [PMID: 34592140 DOI: 10.1016/s2352-3018(21)00243-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Joel Negin
- The University of Sydney School of Public Health, Sydney, NSW 2006, Australia.
| | - Janet Seeley
- London School of Hygiene & Tropical Medicine, London, UK; The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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26
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“It is all About Giving Priority to Older Adults’ Needs:” Challenges of Formal Caregivers in Two Old Age Homes in Ethiopia. AGEING INTERNATIONAL 2021. [DOI: 10.1007/s12126-021-09436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Schatz E, David I, Angotti N, Gómez-Olivé FX, Mojola SA. From "Secret" to "Sensitive Issue": Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment. J Aging Health 2021; 34:14-24. [PMID: 34027688 DOI: 10.1177/08982643211020202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE As HIV shifts from "death sentence" to "chronic condition," disclosure of HIV status to intimate partners and family is a significant component of both prevention and treatment adherence. While disclosure is closely considered in many studies, few examine middle-aged and older persons' (age 40+) perspectives or practices. We trace older rural South Africans' views on HIV disclosure to their partners and family members in a high prevalence community over a period of extensive antiretroviral treatment (ART) rollout. METHODS Community focus group discussions (FGD) conducted in 2013 and 2018 show shifts in older persons' thinking about HIV disclosure. FINDINGS Our FGD participants saw fewer negative consequences of disclosure in 2018 than in 2013, and highlighted positive outcomes including building trust (partners) as well as greater support for medication collection and adherence (family). DISCUSSION Particularly as the epidemic ages in South Africa and globally, tracing changes in older persons' views on disclosure is an important step in developing messaging that could enhance treatment as prevention and ART adherence.
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Affiliation(s)
- Enid Schatz
- University of Missouri14716, Columbia, MO, USA.,37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Nicole Angotti
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,8363American University, Washington, DC, USA
| | - F Xavier Gómez-Olivé
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanyu A Mojola
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,6740Princeton University, Princeton, NJ, USA
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Johnson C, Kumwenda M, Meghji J, Choko AT, Phiri M, Hatzold K, Baggaley R, Taegtmeyer M, Terris-Prestholt F, Desmond N, Corbett EL. 'Too old to test?': A life course approach to HIV-related risk and self-testing among midlife-older adults in Malawi. BMC Public Health 2021; 21:650. [PMID: 33812381 PMCID: PMC8019342 DOI: 10.1186/s12889-021-10573-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the aging HIV epidemic, increasing age can be associated with hesitancy to test. Addressing this gap is a critical policy concern and highlights the urgent need to identify the underlying factors, to improve knowledge of HIV-related risks as well as uptake of HIV testing and prevention services, in midlife-older adults. METHODS We conducted five focus group discussions and 12 in-depth interviews between April 2013 and November 2016 among rural and urban Malawian midlife-older (≥30 years) men and women. Using a life-course theoretical framework we explored how age is enacted socially and its implications on HIV testing and sexual risk behaviours. We also explore the potential for HIV self-testing (HIVST) to be part of a broader strategy for engaging midlife-older adults in HIV testing, prevention and care. Thematic analysis was used to identify recurrent themes and variations. RESULTS Midlife-older adults (30-74 years of age) associated their age with respectability and identified HIV as "a disease of youth" that would not affect them, with age protecting them against infidelity and sexual risk-taking. HIV testing was felt to be stigmatizing, challenging age norms, threatening social status, and implying "lack of wisdom". These norms drove self-testing preferences at home or other locations deemed age and gender appropriate. Awareness of the potential for long-standing undiagnosed HIV to be carried forward from past relationships was minimal, as was understanding of treatment-as-prevention. These norms led to HIV testing being perceived as a threat to status by older adults, contributing to low levels of recent HIV testing compared to younger adults. CONCLUSIONS Characteristics associated with age-gender norms and social position encourage self-testing but drive poor HIV-risk perception and unacceptability of conventional HIV testing in midlife-older adults. There is an urgent need to provide targeted messages and services more appropriate to midlife-older adults in sub-Saharan Africa. HIVST which has often been highlighted as a tool for reaching young people, may be a valuable tool for engaging midlife-older age groups who may not otherwise test.
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Affiliation(s)
- Cheryl Johnson
- Global of HIV, Hepatitis and STIs Programmes, World Health Organization, 20 Ave Appia, 1211, Geneva, Switzerland. .,Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.
| | - Moses Kumwenda
- Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi.,Helse Nord TB Initiative, College of Medicine, Blantyre, Malawi
| | - Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Augustine T Choko
- Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.,Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi
| | | | - Karin Hatzold
- Population Services International, Johannesburg, South Africa
| | - Rachel Baggaley
- Global of HIV, Hepatitis and STIs Programmes, World Health Organization, 20 Ave Appia, 1211, Geneva, Switzerland
| | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Fern Terris-Prestholt
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elizabeth L Corbett
- Department of Clinical Research and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK.,Malawi Liverpool Wellcome Trust, HIV/TB Group, Blantyre, Malawi
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Adejoh SO, Boele F, Akeju D, Dandadzi A, Nabirye E, Namisango E, Namukwaya E, Ebenso B, Nkhoma K, Allsop MJ. The role, impact, and support of informal caregivers in the delivery of palliative care for patients with advanced cancer: A multi-country qualitative study. Palliat Med 2021; 35:552-562. [PMID: 33353484 PMCID: PMC7975852 DOI: 10.1177/0269216320974925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cancer is increasing in its prevalence in sub-Saharan Africa. Informal caregivers are key to supporting engagement and interaction with palliative care services, but limited literature on their role impedes development of supportive interventions. AIM We aimed to understand the role, impact, and support of informal caregivers of patients with advanced cancer when interacting with palliative care services in Nigeria, Uganda, and Zimbabwe. DESIGN Secondary analysis of qualitative interview transcripts. The dataset was assessed for fit and relevance and framework approach was used. SETTING/PARTICIPANTS Interview transcripts of informal caregivers included participants aged over 18 years of age recruited from palliative care services across participating countries. RESULTS A total of 48 transcripts were analyzed. Mean age was 37 (range 19-75) with equal numbers of men and women. Five themes emerged from the data: (1) caregivers are coordinators of emotional, practical, and health service matters; (2) caregiving comes at a personal social and financial cost; (3) practical and emotional support received and required; (4) experience of interacting and liaising with palliative care services; and (5) barriers and recommendations relating to the involvement of palliative care. CONCLUSIONS The role of informal caregivers is multi-faceted, with participants reporting taking care of the majority of medical, physical, financial, and emotional needs of the care recipient, often in the face of sacrifices relating to employment, finances, and their own health and social life. Efforts to develop comprehensive cancer control plans in sub-Saharan Africa must take account of the increasing evidence of informal caregiver needs.
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Affiliation(s)
| | - Florien Boele
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,Patient-Centred Outcomes Group, Leeds Institute of Medical Research at St James's, St James's University Hospital, Leeds, UK
| | - David Akeju
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Adlight Dandadzi
- Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Elizabeth Nabirye
- Department of Internal Medicine, Makerere University, Kampala, Uganda
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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30
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Schmidt-Sane M, Nielsen J, Chikombero M, Lubowa D, Lwanga M, Gamusi J, Kabanda R, Kaawa-Mafigiri D. Gendered care at the margins: Ebola, gender, and caregiving practices in Uganda's border districts. Glob Public Health 2021; 17:899-911. [PMID: 33517846 DOI: 10.1080/17441692.2021.1879895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In July 2019, Ebola in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern and neighbouring countries were put on high alert. This paper examines the intersections of gender, caregiving, and livelihood practices in Uganda's border districts that emerged as key factors to consider in preparedness and response. This paper is based on an anthropological study of the Ebola context among Bantu cultures. We report on data from focus group discussions and key informant interviews with various sectors of the community. The study identified intersecting themes reported here: (1) women as primary caregivers in this context; and (2) women as providers, often in occupations that increase vulnerability to Ebola. Findings demonstrate the role that women play inside and outside the home as caregivers of the sick and during burials, and intersections with livelihood-seeking strategies. Because women's caregiving is largely unpaid, women face a double burden of work as they seek other livelihood strategies that sometimes increase vulnerability to Ebola. Epidemic response should address these intersections and the context-specific vulnerabilities of caregivers; it should also be localised and community-centred and able to attend to the cultural as well as the economic needs of a community.
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Affiliation(s)
- Megan Schmidt-Sane
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA.,Center for Social Science Research on AIDS, Makerere University School of Social Sciences, Kampala, Uganda
| | - Jannie Nielsen
- Center for Social Science Research on AIDS, Makerere University School of Social Sciences, Kampala, Uganda
| | | | | | | | | | | | - David Kaawa-Mafigiri
- Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA.,Center for Social Science Research on AIDS, Makerere University School of Social Sciences, Kampala, Uganda
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Brinkmann B, Payne CF, Kohler I, Harling G, Davies J, Witham M, Siedner MJ, Sie A, Bountogo M, Ouermi L, Coulibaly B, Bärnighausen T. Depressive symptoms and cardiovascular disease: a population-based study of older adults in rural Burkina Faso. BMJ Open 2020; 10:e038199. [PMID: 33371016 PMCID: PMC7757460 DOI: 10.1136/bmjopen-2020-038199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To contribute to the current understanding of depressive disorders in sub-Saharan African (SSA) countries by examining the association of depressive symptoms with cardiovascular and cardiometabolic conditions in a population-based study of middle-aged and older adults in rural Burkina Faso. SETTING This study was conducted in the Nouna Health and Demographic Surveillance System in north-western Burkina Faso, in a mixed rural and small-town environment. The data were obtained between May and July 2018. PARTICIPANTS Consenting adults over 40 years of age (n=3026). PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were assessed using the Patient Health Questionnaire depression module (PHQ-9). Chronic cardiometabolic conditions were assessed via a lipid panel and glycated haemoglobin measures from serum, alongside anthropometry and blood pressure measurements and a self-reported questionnaire. Multivariable linear regression was used to test the relationship between depressive symptoms and cardiovascular/cardiometabolic conditions after controlling for sociodemographic factors. RESULTS Depressive symptoms were not associated with the metabolic syndrome (standardised beta coefficient=0.00 (95% CI -0.04 to 0.03)), hypertension (beta=0.01 (95% CI -0.02 to 0.05)), diabetes mellitus (beta=0.00 (95% CI -0.04 to 0.04)) and past diagnosis of elevated blood pressure or blood sugar. Prior stroke diagnosis (beta=0.04 (95% CI 0.01 to 0.07)) or heart disease (beta=0.08 (95% CI 0.05 to 0.11)) was positively associated with the standardised PHQ-9 score as were self-reported stroke symptoms. CONCLUSION Objectively measured cardiometabolic conditions had no significant association with depressive symptoms in an older, poor, rural SSA population, in contrast to observations in high income countries. However, consequences of cardiovascular disease such as stroke and heart attack were associated with depressive symptoms in older adults in Burkina Faso.
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Affiliation(s)
- Ben Brinkmann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Collin F Payne
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Iliana Kohler
- Population Studies Center (PSC) and Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Miles Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mark J Siedner
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Mamadou Bountogo
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Lucienne Ouermi
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Boubacar Coulibaly
- Centre de Recherche en Sante de Nouna, Nouna, Boucle du Mouhoun, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
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Sensoy Bahar O, Byansi W, Kivumbi A, Namatovu P, Kiyingi J, Ssewamala FM, McKay MM, Nyoni T. From "4Rs and 2Ss" to "Amaka Amasanyufu" (Happy Families): Adapting a U.S.-based Evidence-Based Intervention to the Uganda Context. FAMILY PROCESS 2020; 59:1928-1945. [PMID: 32027763 PMCID: PMC7416434 DOI: 10.1111/famp.12525] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In Uganda, one in five children presents mental health challenges, including disruptive behavior disorders (DBDs). DBDs can persist through adulthood and result in negative outcomes. Effective interventions for DBDs have been developed and tested in high-poverty communities in developed countries. Yet, most African countries, such as Uganda, lack such interventions. This paper describes the adaptation process of an evidence-based intervention of U.S. origin to optimize fit to context with intervention fidelity, as part of a randomized trial conducted with youth that exhibit behavioral challenges and their caregivers in 30 schools in Uganda. The process involved: initial meetings with headteachers and teachers to introduce the study and the main concepts of the intervention; initial manual review focusing on 4Rs and 2Ss content by the Uganda team; engagement of community stakeholders for additional feedback on content and cultural relevance; final revision of the manual; and collection of children's drawings for the illustration of the manual. This paper describes both similarities and differences between the original and adapted intervention content and methods of delivery. The findings also highlight the importance of involving community stakeholders in the adaptation process.
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Affiliation(s)
| | - William Byansi
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Apollo Kivumbi
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | - Joshua Kiyingi
- International Center for Child Health and Development, Uganda Field Office, Masaka, Uganda
| | | | - Mary M McKay
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Thabani Nyoni
- Brown School, Washington University in St. Louis, St. Louis, MO
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Alaazi DA, Menon D, Stafinski T. Health, quality of life, and wellbeing of older slum dwellers in sub-Saharan Africa: A scoping review. Glob Public Health 2020; 16:1870-1888. [PMID: 33119430 DOI: 10.1080/17441692.2020.1840610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A growing population of older adults resides in sub-Saharan Africa's urban slums. Although environmental conditions in slums are adversarial, there is limited knowledge on the wellbeing of older adults residing in these settings. This review sought to understand the scope, extent, and nature of current research on the health and wellbeing of older slum dwellers in sub-Saharan Africa. We searched 8 bibliographic databases for studies examining the health and wellbeing of older slum dwellers in the region. We also completed a grey literature search. The literature search together yielded 3,388 records, of which we selected 25 for review following a rigorous screening process. The included studies covered a variety of health issues of concern to older slum dwellers: (1) disease and injury prevalence; (2) self-assessed health and quality of life status; (3) physical/mental health impairment and disability; (4) healthcare access and utilisation; and (5) sociodemographic disparities in health and wellbeing. The gaps in this literature include a regional bias in research efforts, near absence of non-slum control samples, and limited research on the health impacts of the built environment of slums. Suggestions for future research are presented.
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Affiliation(s)
- Dominic A Alaazi
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Devidas Menon
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Tania Stafinski
- School of Public Health, University of Alberta, Edmonton, Canada
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Self-reported activities of daily living, health and quality of life among older adults in South Africa and Uganda: a cross sectional study. BMC Geriatr 2020; 20:402. [PMID: 33054734 PMCID: PMC7557065 DOI: 10.1186/s12877-020-01809-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Difficulties in performing the activities of daily living (ADL) are common among middle-aged and older adults. Inability to perform the basic tasks as well as increased healthcare expenditure and dependence on care can have debilitating effects on health and quality of life. The objective of this study was to examine the relationship between self-reported difficulty in activities of daily living (ADL), health and quality of life among community-dwelling, older population in South Africa and Uganda. METHODS We analyzed cross-sectional data on 1495 men and women from South Africa (n = 514) and Uganda (n = 981) which were extracted from the SAGE Well-Being of Older People Study (WOPS 2011-13). Outcome variables were self-reported health and quality of life (QoL). Difficulty in ADL was assessed by self-reported answers on 12 different questions covering various physical and cognitive aspects. The association between self-reported health and quality of life with ADL difficulties was calculated by using multivariable logistic regression models. RESULTS Overall percentage of good health and good quality of life was 40.4% and 20%, respectively. The percentage of respondents who had 1-3, 3-6, > 6 ADL difficulties were 42.4%7, 30.97% and 14.85%, respectively. In South Africa, having > 6 ADL difficulties was associated with lower odds of good health among men [Odds ratio = 0.331, 95%CI = 0.245,0.448] and quality of life among men [Odds ratio = 0.609, 95%CI = 0.424,0.874] and women [Odds ratio = 0.129, 95%CI = 0.0697,0.240]. In Uganda, having > 6 ADL difficulties was associated lower odds of good health [Odds ratio = 0.364, 95%CI = 0.159,0.835] and quality of life [Odds ratio = 0.584, 95%CI = 0.357,0.954]. CONCLUSION This study concludes that difficulty in ADL has a significant negative association with health and quality of life among community-dwelling older population (> 50 years) in South Africa and Uganda. The sex differences support previous findings on differential health outcomes among men and women, and underline the importance of designing sex-specific health intervention programs.
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Jennings EA, Ralston M, Schatz E. Support in times of need: How depressive symptoms can impact receipt of social support among aging adults in rural South Africa. SSM Popul Health 2020; 12:100666. [PMID: 33072842 PMCID: PMC7549146 DOI: 10.1016/j.ssmph.2020.100666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/08/2020] [Accepted: 09/07/2020] [Indexed: 01/28/2023] Open
Abstract
The relationship between mental health and receipt of social support is not well understood in low- and middle-income countries. In this paper, we focus on a cohort of older adults (40-plus) in rural South Africa to unpack associations between mental health and receipt of social support, and the extent to which marital status modifies these associations. We use baseline data from a population-based study, Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), conducted between 2014 and 2015. Our results suggest that men and women who report depressive symptoms are less likely to receive social support: women are less likely to receive emotional and financial support, and men are less likely to receive physical and financial support. Both men and women who are married or partnered are more likely to receive social support than their non-married counterparts. The association between depressive symptomology and receipt of social support differs for women who are separated/divorced and for men who are widowed. Specifically, the association between having depressive symptoms and receiving physical or financial support is more positive for separated/divorced women than their married/cohabiting counterparts; for men, the association between having depressive symptoms and receiving physical support is more positive for widowed men than their married/cohabiting counterparts. Our findings speak to the complicated associations between social support, marriage and mental health in later life and the different experiences that men and women may have. We estimate links between mental health and receipt of social support among a cohort of aging adults in rural South Africa. Having depressive symptoms is negatively associated with odds of receiving some types of social support for men and women. Married men and women have greater odds of receiving all types of social support relative to non-married counterparts. Depressive symptoms are more positively associated with receipt of physical support for widowed vs. married men. Depressive symptoms more positively linked with receipt of physical or financial support for divorced vs. married women.
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Affiliation(s)
- Elyse A Jennings
- Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Enid Schatz
- Department of Public Health and Women's & Gender Studies, University of Missouri, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersand, Johannesburg, South Africa
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Perceived Caregiver Stress, Coping, and Quality of Life of Older Ugandan Grandparent-Caregivers. J Cross Cult Gerontol 2020; 35:311-328. [PMID: 32566982 DOI: 10.1007/s10823-020-09403-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
With the continued loss of lives due to HIV/AIDS in sub-Saharan Africa, grandparents bear the stress of caring for children affected by the epidemic, often with very limited resources. Yet, despite the acknowledgement that these older adults serve as the backbone and safety net of the African family in this HIV/AIDS era, very limited research has focused on investigating the specific health outcomes of caregivers in this region and how these changes in health status impact the overall quality of life of caregivers. This study highlights the stress perceived by Ugandan grandparent-caregivers, its impact on their overall quality of life, and the coping strategies they use to manage their stress. Thirty-two grandparent-caregivers (age 50 years and older) were recruited from urban and rural areas in Uganda and individually interviewed in 2016. Using constructivist grounded theory as the qualitative methodology, the narratives generated from the semi-structured, one-on-one interviews were audio-recorded, transcribed, and analyzed using both open and axial coding as well as reflexive and analytic memoing. Descriptions of caregiver stress (physical, emotional, financial, and social) were reported. Additionally, study findings uniquely explore the impact of the perceived stress on the grandparents' overall quality of life. Study findings provide a foundation upon which clinicians, researchers, and policy-makers can design and implement effective interventions to improve the health and quality of life of grandparent-caregivers in sub-Saharan Africa.
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Harling G, Morris KA, Manderson L, Perkins JM, Berkman LF. Age and Gender Differences in Social Network Composition and Social Support Among Older Rural South Africans: Findings From the HAALSI Study. J Gerontol B Psychol Sci Soc Sci 2020; 75:148-159. [PMID: 29590472 PMCID: PMC6909436 DOI: 10.1093/geronb/gby013] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/05/2018] [Indexed: 01/05/2023] Open
Abstract
Objectives Drawing on the “Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa” (HAALSI) baseline survey, we present data on older adults’ social networks and receipt of social support in rural South Africa. We examine how age and gender differences in social network characteristics matched with patterns predicted by theories of choice- and constraint-based network contraction in older adults. Method We used regression analysis on data for 5,059 South African adults aged 40 and older. Results Older respondents reported fewer important social contacts and less frequent communication than their middle-aged peers, largely due to fewer nonkin connections. Network size difference between older and younger respondents was greater for women than for men. These gender and age differences were explicable by much higher levels of widowhood among older women compared to younger women and older men. There was no evidence for employment-related network contraction or selective retention of emotionally supportive ties. Discussion Marriage-related structural constraints impacted on older women’s social networks in rural South Africa, but did not explain choice-based network contraction. These findings suggest that many older women in rural Africa, a growing population, may have an unmet need for social support.
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Affiliation(s)
- Guy Harling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Institute for Global Health, University College London, UK
| | | | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Institute at Brown for Environment and Society, Brown University, Providence, Rhode Island
| | - Jessica M Perkins
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts.,Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
| | - Lisa F Berkman
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee.,MRC/Wits Rural Public Health and Heath Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts
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Abstract
As the world undergoes rapid ageing, informal support from friends and relatives is becoming especially important among older adults in middle and low income countries, where formalized social protections may be limited. We use new data from a cohort of adults ages 40 and older in rural South Africa to explore how receipt of emotional support differs by gender and marital status. Our findings suggest that women are more likely to get emotional support than men and have more sources of support. Moreover, women are more likely to get emotional support from relatives, whereas men are more likely to get support from friends. In regard to marital status, married people are more likely to get emotional support and have more sources of support than people who are not married. However, separated/divorced and widowed people are more likely to get emotional support from relatives and have more sources of non-spousal support than married people. These findings point toward gaps in informal systems of support, and the particular importance of considering men and unmarried (especially never married) people when designing policies to offer social protections to older populations.
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Caregiving burden and mental health problems among family caregivers of people with dementia in rural Uganda. Glob Ment Health (Camb) 2020; 7:e13. [PMID: 32742671 PMCID: PMC7379317 DOI: 10.1017/gmh.2020.7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 04/07/2020] [Accepted: 04/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Alzheimer's disease and related dementias are associated with increasing health burden in low- and middle-income countries. Less well-recognized is the potential health burden experienced by other affected individuals, such as family caregivers. In this study, we sought to profile the burden of care and its association with symptoms of depression and anxiety among informal caregivers of people living with dementia in rural southwestern Uganda. METHOD We conducted a cross-sectional study of 232 family caregivers of people with dementia. The key measured variables of interest were caregiving burden (Zarit Burden Index) and symptoms of depression and anxiety (Depression Anxiety Stress Scales). We fitted multivariable regression models specifying depression and anxiety symptoms as the primary outcomes of interest and caregiving burden as the primary explanatory variable of interest. RESULTS Family caregivers of people with dementia experience significant caregiving burden, with each item on the Zarit Burden Index endorsed by more than 70% of study participants. Nearly half [108 (47%)] of caregivers had Zarit Burden Interview scores >60, suggestive of severe caregiving burden. In multivariable regression models, we estimated a statistically significant positive association between caregiving burden and symptoms of both depression [b = 0.42; 95% confidence interval (CI) 0.34-0.49] and anxiety (b = 0.37; 95% CI 0.30-0.45). CONCLUSION Family caregivers of people with dementia in rural Uganda experience a high caregiving burden, which is associated with symptoms of depression and anxiety. Interventions aimed at reducing caregiving burden may have important collateral mental health benefits.
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Ralston M. Book Review: Aging in the Global South: Challenges and Opportunities. Int J Aging Hum Dev 2020. [DOI: 10.1177/0091415019896209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
In Rwanda, disruptions to family and social life as a result of the 1994 genocide, and the economic transformations in its aftermath, have complicated the fabric of elder care across the country. In this article, I focus on how elderly Rwandans are reconfiguring their care networks - many of which were destroyed during the genocide - by acting as caregivers and care receivers for each other on a daily basis. Although emotionally and physically taxing, elderly Rwandans emphasize that the "small things" embedded in the giving and receiving of care are intricately connected to how personal and collective dignity is cultivated.
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Small J, Aldwin C, Kowal P, Chatterji S. Aging and HIV-Related Caregiving in Sub-Saharan Africa: A Social Ecological Approach. THE GERONTOLOGIST 2019; 59:e223-e240. [PMID: 29045750 PMCID: PMC6524476 DOI: 10.1093/geront/gnx159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We reviewed the literature on older adults (OAs) who are caring for persons living with HIV/AIDS in sub-Saharan Africa (SSA), with the goal of adapting models of caregiver stress and coping to include culturally relevant and contextually appropriate factors specific to SSA, drawing on both life course and cultural capital theories. RESEARCH DESIGN AND METHODS A systematic literature search found 81 articles published between 1975 and 2016 which were reviewed using a narrative approach. Primary sources of articles included electronic databases and relevant WHO websites. RESULTS The main challenge of caregiving in SSA reflects significant financial constraints, specifically the lack of necessities such as food security, clean water, and access to health care. Caregiving is further complicated in SSA by serial bouts of caring for multiple individuals, including adult children and grandchildren, in the context of high levels of stigma associated with HIV. Factors promoting caregiver resilience included spirituality, bidirectional (reciprocal) caregiving, and collective coping strategies. DISCUSSION AND IMPLICATIONS The creation of a theoretical model of caregiving which focuses more broadly on the sociocultural context of caregiving could lead to new ways of developing interventions in low-resources communities.
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Affiliation(s)
- Jeon Small
- School of Social and Behavioral Sciences, Oregon State University
| | - Carolyn Aldwin
- Center for Healthy Aging Research, Oregon State University
| | - Paul Kowal
- SAGE, World Health Organization, Geneva, Switzerland
- Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
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Dovie DA. The Status of Older Adult Care in Contemporary Ghana: A Profile of Some Emerging Issues. FRONTIERS IN SOCIOLOGY 2019; 4:25. [PMID: 33869350 PMCID: PMC8022694 DOI: 10.3389/fsoc.2019.00025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/18/2019] [Indexed: 06/10/2023]
Abstract
The paper examines how the healthcare and social care pillars of social policy for aging societies shape inequalities in health and well-being at old age, utilizing qualitative and quantitative datasets. The results intimate the lack of geriatric infrastructure, hence the inadequacy of geriatric care provision for older adults. Systemic problems or gaps existent in Ghana led to private individuals taking advantage of the situation, turning it into an opportunity for service providers. Thus, the evolution of recreational/residential homes in Ghana is situated along three distinct patterns or forms namely the occasional, the adult day care center and residential archetypes. Collectively, these constitute formal and informal care facilities. These are often privately owned and at a cost. The nature of quality of care may be affected by the types of homes available, especially in the globalized cultural setting. A growing number of older adults resort to care homes as an alternative measure. These are discussed from two viewpoints. First, geriatric data generation, the absence of which impedes healthcare provision. Second, cash-for-care policies may exacerbate existing inequalities in care with negative consequences for health and well-being. In short, policies for aging populations are being implemented across Ghana with too little known about their consequences for inequalities in health and well-being in later life. The paper sought to address this knowledge gap by exploring a significant infrastructure by undertaking a systematic examination of how recent policy developments for aging exacerbate or reduce inequalities in health and well-being among older adults. The paper concludes that social policy for aging societies' specific key pillars (healthcare and social care research) offers opportunities for analyzing and understanding internal dynamics including the effects of policy implementation for inequalities in health and well-being at older ages, therefore enabling the identification of strategies to improve older adults' circumstances, without which older adult population will far outpace elder care provision.
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Nakamanya S, Mayanja BN, Muhumuza R, Bukenya D, Seeley J. Are treatment supporters relevant in long-term Antiretroviral Therapy (ART) adherence? Experiences from a long-term ART cohort in Uganda. Glob Public Health 2019; 14:469-480. [PMID: 30146972 PMCID: PMC6334778 DOI: 10.1080/17441692.2018.1514418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 08/07/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aimed to understand the relevance of treatment supporters in adherence among people living with HIV taking Anti-retroviral therapy (ART) for more than five years in Uganda. METHODS In-depth interviews were conducted with 50 participants (28 women and 22 men) of the Complications of Long-Term ART (CoLTART) cohort with experience of at least five years on ART in Uganda. Participants were stratified by line of ART regimen and viral loads of less or above 1000 copies/ml. Data were analyzed thematically. RESULTS Many participants felt that a treatment supporter was most useful at the beginning of therapy before individuals get used to the drugs or when they are still weak. However, this did not reflect treatment outcomes, as many individuals without treatment supporters had failed on first line ART regimens and were switched to second line ART. Those who were still on first line had viral loads of ≥1000 copies/ml. There was a preference for female treatment supporters, many of who were persistent in their supportive role. CONCLUSION Treatment supporters remain important in adherence to long-term ART. HIV-care providers need to encourage the involvement of a treatment supporter for individuals taking ART long-term.
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Affiliation(s)
| | | | | | | | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
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Comparison of Antiretroviral Therapy Adherence Among HIV-Infected Older Adults with Younger Adults in Africa: Systematic Review and Meta-analysis. AIDS Behav 2019; 23:445-458. [PMID: 29971732 PMCID: PMC6373524 DOI: 10.1007/s10461-018-2196-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
As access to antiretroviral treatment in low- and middle-income countries improves, the number of older adults (aged ≥ 50 years) living with HIV is increasing. This study compares the adherence to antiretroviral treatment among older adults to that of younger adults living in Africa. We searched PubMed, Medline, Cochrane CENTRAL, CINAHL, Google Scholar and EMBASE for keywords (HIV, ART, compliance, adherence, age, Africa) on publications from 1st Jan 2000 to 1st March 2016. Eligible studies were pooled for meta-analysis using a random-effects model, with the odds ratio as the primary outcome. Twenty studies were included, among them were five randomised trials and five cohort studies. Overall, we pooled data for 148,819 individuals in two groups (older and younger adults) and found no significant difference in adherence between them [odds ratio (OR) 1.01; 95% CI 0.94–1.09]. Subgroup analyses of studies using medication possession ratio and clinician counts to measure adherence revealed higher proportions of older adults were adherent to medication regimens compared with younger adults (OR 1.06; 95% CI 1.02–1.11). Antiretroviral treatment adherence levels among older and younger adults in Africa are comparable. Further research is required to identify specific barriers to adherence in the aging HIV affected population in Africa which will help in development of interventions to improve their clinical outcomes and quality of life.
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Harling G, Payne CF, Davies JI, Gomez-Olive FX, Kahn K, Manderson L, Mateen FJ, Tollman SM, Witham MD. Impairment in Activities of Daily Living, Care Receipt, and Unmet Needs in a Middle-Aged and Older Rural South African Population: Findings From the HAALSI Study. J Aging Health 2019; 32:296-307. [PMID: 30600746 PMCID: PMC6675676 DOI: 10.1177/0898264318821220] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: The objective of this study is to analyze the degree to which care needs are met in an aging rural African population. Method: Using data from the Health and Aging in Africa: Longitudinal Study of an INDEPTH Community (HAALSI) baseline survey, which interviewed 5,059 adults aged older than 40 years in rural South Africa, we assessed the levels of limitations in activities of daily living (ADLs) and in unmet care for these ADLs, and evaluated their association with sociodemographic and health characteristics. Results: ADL impairment was reported by 12.2% of respondents, with the proportion increasing with age. Among those with ADL impairment, 23.9% reported an unmet need and 51.4% more a partially met need. Relatives provided help most often; formal care provision was rare. Unmet needs were more frequent among younger people and women, and were associated with physical and cognitive deficits, but not income or household size. Discussion: Unmet care needs in rural South Africa are often found among individuals less expected to require care.
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Affiliation(s)
- Guy Harling
- University College London, UK
- Harvard University, Cambridge, MA, USA
| | - Collin F. Payne
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Justine I. Davies
- King’s College London, UK
- University of the Witwatersrand, Johannesburg, South Africa
| | - F. Xavier Gomez-Olive
- Harvard University, Cambridge, MA, USA
- University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
| | - Kathleen Kahn
- University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå University, Sweden
| | - Lenore Manderson
- University of the Witwatersrand, Johannesburg, South Africa
- Brown University, Providence, RI, USA
| | - Farrah J. Mateen
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Stephen M. Tollman
- University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Accra, Ghana
- Umeå University, Sweden
| | - Miles D. Witham
- University of the Witwatersrand, Johannesburg, South Africa
- Newcastle University, Newcastle upon Tyne, UK
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Tanyi PL, Pelser A, Okeibunor J. HIV/AIDS and older adults in Cameroon: Emerging issues and implications for caregiving and policy-making. SAHARA J 2018; 15:7-19. [PMID: 29409392 PMCID: PMC5804678 DOI: 10.1080/17290376.2018.1433059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The burden of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) on the elderly population in three divisions within the Northwest Region of Cameroon was examined. Data for this paper were extracted from a larger study which had been conducted concerning the burden of HIV infection and AIDS on the older adults in the Northwest Region of Cameroon. Using in-depth interviews (IDIs) and focus group discussions (FGDs), data were collected from 36 participants who were purposively selected from the three divisions which had been chosen randomly. 6 FGD sessions were held with 30 women aged 60 years and above and who were affected by HIV infection and AIDS, while IDIs sessions were held with 6 male community leaders. The results revealed that HIV infection and AIDS has added another dimension to the role of older persons. HIV infection and AIDS affects older people in diverse ways, as they have to look after themselves, their sick children and are often also left to look after their grandchildren orphaned by HIV infection and AIDS. These emerging issues in their lives make them vulnerable to health, social, economic and psychological challenges, and place a burden on them as caregivers instead of being cared for in their old age. Apart from increased direct expenditures, taking care of victims of HIV infection and AIDS requires older people to stay away from social, religious and community activities. The results showed that the loss of a child to HIV infection and AIDS affects the economic/financial well-being, participation in social/religious interactions as well as the community activities of older people participants. The implications of these findings for caregiving and social policy are discussed.
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Affiliation(s)
- Perpetua Lum Tanyi
- a PhD, is a postdoctoral research fellow at the Department of Sociology , University of the Free State , Bloemfontein , South Africa
| | - André Pelser
- b MA (Sociology) and PhD (Sociology), is a Professor at the Department of Sociology , University of the Free State , Bloemfontein , South Africa
| | - Joseph Okeibunor
- c Msc (Sociology) and PhD (Medical Sociology), is a Professor at the Department of Sociology , University of Nigeria Nsukka , Enugu , Nigeria
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Perceived quality of life and living arrangements among older rural South Africans: do all households fare the same? AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThis study explores how living arrangements influence perceived quality of life in an elderly population in rural South Africa. We use data from the longitudinal World Health Organization Study of Global Ageing and Adult Health Survey (WHO-SAGE) and from the Agincourt Health and Socio-Demographic Surveillance System (HDSS). On average, older men and women who reside in single-generation and complex-linked multigenerational households report worse quality of life than those in two-generation and linear-linked multigenerational households. However, after controlling for prior wellbeing status, we find living arrangements to have a significant impact on women's perceived quality of life only, and that it is moderated by age. We conclude that not all multigenerational arrangements are protective of older adults’ wellbeing and highlight the gendered impact of living arrangements on quality of life. These results suggest the necessity to understand how living arrangements influence the social roles of older adults and change with age.
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Schatz E, Ralston M, Madhavan S, Collinson MA, Gómez-Olivé FX. Living Arrangements, Disability and Gender of Older Adults Among Rural South Africa. J Gerontol B Psychol Sci Soc Sci 2018; 73:1112-1122. [PMID: 28651372 PMCID: PMC6093476 DOI: 10.1093/geronb/gbx081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 06/20/2017] [Indexed: 11/13/2022] Open
Abstract
Objective A limited understanding exists of the relationship between disability and older persons' living arrangements in low and middle-income countries (LMICs). We examine the associations between living arrangements, disability, and gender for individuals older than 50 years in rural South Africa. Method Using the Study on global AGEing and adult health (SAGE) survey and Agincourt Health and socio-Demographic Surveillance System (HDSS) data, we explore older persons' self-reported disability by living arrangements and gender, paying particular attention to various multigenerational arrangements. Results Controlling for past disability status, a significant relationship between living arrangements and current disability remains, but is moderated by gender. Older persons in households where they may be more "productive" report higher levels of disability; there are fewer differences in women's than men's reported disability levels across living arrangement categories. Discussion This study underscores the need to examine living arrangements and disability through a gendered lens, with particular attention to heterogeneity among multigenerational living arrangements. Some living arrangements may take a greater toll on older persons than others. Important policy implications for South Africa and other LMICs emerge among vibrant debates about the role of social welfare programs in improving the health of older individuals.
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Affiliation(s)
- Enid Schatz
- Department of Health Sciences, University of Missouri
- Department of Women’s & Gender Studies, University of Missouri
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sangeetha Madhavan
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of African American Studies, University of Maryland
| | - Mark A Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- INDEPTH Network, Ghana
- Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Intergenerational care for and by children: Examining reciprocity through focus group interviews with older adults in rural Uganda. DEMOGRAPHIC RESEARCH 2018. [DOI: 10.4054/demres.2018.38.63] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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