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Akinrolie O, Iwuagwu AO, Kalu ME, Rayner D, Oyinlola O, Ezulike CD, Okoh AC, Makanju AO, Ugwuodo EP, Ugwuja IA, John MO, Adeleke D, Egbumike CJ, Anieto EM, Anieto IB, Alumona CJ, Onyeso OK, Ojembe B, Omeje CA, Nwachukwu EC, Ekediegwu EC, Onyeso KM, Adeboye A, Ibekaku M, Akinrolie O, Onyekere CP. Longitudinal Studies of Aging in Sub-Saharan Africa: Review, Limitations, and Recommendations in Preparation of Projected Aging Population. Innov Aging 2024; 8:igae002. [PMID: 38628825 PMCID: PMC11020233 DOI: 10.1093/geroni/igae002] [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: 05/02/2023] [Indexed: 04/19/2024] Open
Abstract
Background and Objectives The United Nations has projected a 218% increase in older people in Sub-Saharan Africa (SSA) between 2019 and 2050, underscoring the need to explore changes that would occur over this time. Longitudinal studies are ideal for studying and proffering solutions to these changes. This review aims to understand the breadth and use of longitudinal studies on aging in the SSA regions, proffering recommendations in preparation for the projected aging population. Research Design and Methods This paper is the third of a four-part series paper of a previous systematic mapping review of aging studies in SSA. We updated the search (between 2021 and 2023) and screened the titles/abstracts and full-text articles by a pair of independent reviewers. Data were extracted using a standardized data-charting form, identifying longitudinal studies in SSA. Results We identified 193 studies leveraging 24 longitudinal study data sets conducted at 28 unique sites. The World Health Organization's Study on Global AGEing and Adult Health (WHO-SAGE) (n = 59, 30.5%) and Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (n = 51, 26.4%) were the most used longitudinal data sets. Four studies used more than one longitudinal study data set. Eighteen of the longitudinal study data sets were used only in 1-4 studies. Most (n = 150, 77.7%) of the studies used a cross-sectional analytical approach. Discussion and Implications Longitudinal studies on aging are sparingly being utilized in SSA. Most analyses conducted across the longitudinal data set were cross-sectional, which hindered the understanding of aging changes that occurred over time that could better inform aging policy and interventions. We call for funding bodies, such as WHO-SAGE, to develop funding competitions that focus on conducting longitudinal analyses, such as structural equation modeling, highlighting changes occurring among the aging population in SSA.
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Affiliation(s)
- Olayinka Akinrolie
- Applied Health Sciences, Faculty of Graduate Studies, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony O Iwuagwu
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Department of Social Work, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Michael E Kalu
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Daniel Rayner
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Oluwagbemiga Oyinlola
- School of Social Work, McGill University, Montreal, Quebec, Canada
- Medical Social Services Department, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Chigozie D Ezulike
- Department of Social Work, University of Nigeria, Nsukka, Enugu State, Nigeria
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Augustine C Okoh
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Adebayo O Makanju
- Interdisciplinary Social Research Program (Aging and Health), Trent University, Peterborough, Ontario, Canada
| | - Ebere P Ugwuodo
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Immaculata A Ugwuja
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | | | - Deborah Adeleke
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Ijeoma B Anieto
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Chiedozie James Alumona
- Department of Physiotherapy, College of Basic Medical Sciences, Chrisland University, Abeokuta, Ogun State, Nigeria
- Faculty of Health Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | | | - Blessing Ojembe
- Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chidinma A Omeje
- Physiotherapy Unit, Asaba Specialist Hospital, Asaba, Delta State, Nigeria
| | - Ernest C Nwachukwu
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ezinne C Ekediegwu
- Department of Medical Rehabilitation (Physiotherapy), Faculty of Health Sciences and Technology, Nnamdi Azikwe University, Nnewi Campus, Anambra, Nigeria
| | - Kelechi M Onyeso
- Department of Estate Management, Faculty of Environmental Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Ademuyiwa Adeboye
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Michael Ibekaku
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Omobolade Akinrolie
- Department of Obstetrics and Gynecology, Health Science Centre, Winnipeg, Manitoba, Canada
| | - Chukwuebuka P Onyekere
- Department of Gerontology, Faculty of Social Sciences, University of Southampton, Southampton, UK
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria, Nsukka, Enugu State, Nigeria
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Kuper H, Ssemata AS, Smythe T, Drazdzewska J, Waiswa P, Kagurusi P, Rosato M, Mbazzi FB. Is it feasible to implement a community-based participatory group programme to address issues of access to healthcare for people with disabilities in Luuka district Uganda? A study protocol for a mixed-methods pilot study. BMJ Open 2023; 13:e074217. [PMID: 37770271 PMCID: PMC10546107 DOI: 10.1136/bmjopen-2023-074217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION On average, people with disabilities face many difficulties in accessing healthcare and experience worse health outcomes. Yet, evidence on how to overcome these barriers is lacking. Participatory approaches are gaining prominence as they can generate low-cost, appropriate and scalable solutions. This study protocol is for the pilot testing of the co-created Participatory Learning and Action for Disability (PLA-D) groups to assess feasibility. METHODS AND ANALYSIS We will pilot test PLA-D in five groups in Luuka district, Uganda during 2023. Each group will include approximately 20 members (people with disabilities, family members, carers) who will meet every 2-3 weeks over a 9-11 month period. The groups, guided by a trained facilitator, will identify issues about health and healthcare access and plan and implement locally generated solutions (eg, raising awareness of rights, advocacy and lobbying, establishing health savings and financing schemes). We will collect diverse sources of data to assess feasibility: (1) in-depth interviews and focus group discussions with group participants, non-participants and group facilitators; (2) monitoring of group activities; (3) direct observation of groups and (4) quantitative survey of group participants at baseline and endline. Data analyses will be undertaken to assess feasibility in terms of: acceptability, demand, implementation and practicality. We will develop and refine evaluation tools in preparation for a future trial. ETHICS AND DISSEMINATION Ethical approval for the study has been received by the London School of Hygiene & Tropical Medicine and the Uganda Virus Research Institute ethics committees. Informed consent will be obtained from all study participants, making adaptations for people with disabilities as necessary. We will reach different groups for our dissemination activities, including (1) people with disabilities (eg, community meetings); (2) policy and programme stakeholders in Uganda and international (eg, individual meetings, evidence briefs) and (3) academics (journal articles, conference/seminar presentations).
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Tracey Smythe
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Peter Waiswa
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Femke Bannink Mbazzi
- International Centre for Evidence in Disability, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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Ebasone PV, Peer N, Dzudie A, Kengne AP. Prevalence of selected cardiometabolic risk factors in the global ART-naïve HIV infected population: A protocol for a systematic review and meta-analysis. PLoS One 2023; 18:e0286789. [PMID: 37289750 PMCID: PMC10249803 DOI: 10.1371/journal.pone.0286789] [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] [Received: 06/22/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION People living with HIV/AIDS (PLHIV) are at increased risk of cardiometabolic diseases attributable to the effects of the virus, antiretroviral therapy (ART) and traditional risk factors. Most studies have focused on assessing the effect of ART on cardiometabolic diseases in PLHIV with fewer studies assessing the cardiometabolic risk profile prior to exposure to ART. Therefore, this protocol is for a systematic review and meta-analysis to estimate the global prevalence of selected cardiometabolic risk factors in ART-naïve PLHIV and their association with HIV specific factors. METHODS We shall conduct a systematic search of observational studies on the prevalence of obesity, hypertension, diabetes, and dyslipidaemia in ART-naïve PLHIV and their association with HIV specific characteristics. We will search PubMed-MEDLINE, CINAHL, SCOPUS, Academic Search Premier, Africa-Wide Information and Africa Journals Online databases to identify relevant studies published before June 2022. Two authors will independently screen, select studies, extract data, and conduct risk of bias assessments. Disagreements between the two authors will be resolved by consensus or consulting a third reviewer. Data consistently reported across studies will be pooled using random-effects meta-analysis. Heterogeneity will be evaluated using Cochrane's Q statistic and quantified using I2 statistics. The Preferred Reporting Items for Systematic reviews and Meta-Analysis protocols (PRISMA-P) 2015 guidelines are used for the reporting of this protocol. DISCUSSION This review will help determine the burden of selected cardiometabolic diseases in ART-naïve HIV-infected populations and the contribution of HIV infection, independent of ART, to cardiometabolic diseases in PLHIV. It will provide new information that can help orientate future research and potentially guide healthcare policy making. This is part of a thesis that will be submitted to the Faculty of Health Sciences, University of Cape Town, for the award of a PhD in Medicine with protocol ethical clearance number (UCT HREC 350/2021). REGISTRATION PROSPERO: CRD42021226001. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226001.
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Affiliation(s)
- Peter Vanes Ebasone
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Western Cape, South Africa
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
| | - Nasheeta Peer
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Western Cape, South Africa
- Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Anastase Dzudie
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Andre Pascal Kengne
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Western Cape, South Africa
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
- Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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Gumede D, Meyer-Weitz A, Edwards A, Seeley J. Understanding older peoples' chronic disease self-management practices and challenges in the context of grandchildren caregiving: A qualitative study in rural KwaZulu-Natal, South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000895. [PMID: 36962615 PMCID: PMC10021571 DOI: 10.1371/journal.pgph.0000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022]
Abstract
While chronic diseases are amongst the major health burdens of older South Africans, the responsibilities of caring for grandchildren, by mostly grandmothers, may further affect older people's health and well-being. There is a paucity of information about chronic disease self-management for older people in the context of grandchildren caregiving in sub-Saharan Africa. Guided by the Self-Management Framework, the purpose of this qualitative methods study was to explore the chronic disease self-management practices and challenges of grandparent caregivers in rural KwaZulu-Natal, South Africa. Eighteen repeat in-depth interviews were carried out with six grandparent caregivers aged 56 to 80 years over 12 months. Thematic analysis was conducted based on the Self-Management Framework. Pathways into self-management of chronic illnesses were identified: living with a chronic illness, focusing on illness needs, and activating resources. Self-perceptions of caregiving dictated that grandmothers, as women, have the responsibility of caring for grandchildren when they themselves needed care, lived in poverty, and with chronic illnesses that require self-management. However, despite the hardship, the gendered role of caring for grandchildren brought meaning to the grandmothers' lives and supported self-management due to the reciprocal relationship with grandchildren, although chronic illness self-management was complicated where relationships between grandmothers and grandchildren were estranged. The study findings demonstrate that grandchildren caregiving and self-management of chronic conditions are inextricably linked. Optimal self-management of chronic diseases must be seen within a larger context that simultaneously addresses chronic diseases, while paying attention to the intersection of socio-cultural factors with self-management.
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Affiliation(s)
- Dumile Gumede
- Centre for General Education, Durban University of Technology, Durban, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Anna Meyer-Weitz
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Anita Edwards
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Motsamai TB, Mhaka-Mutepfa M. Depression: Determinants That Influence the Mental Health of Older People (60 Years +) in Botswana. Gerontol Geriatr Med 2022; 8:23337214211053121. [PMID: 35237710 PMCID: PMC8883394 DOI: 10.1177/23337214211053121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/06/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
Correlates of depression in older people were explored in this study. The prevalence of depression was also calculated. Data were collected using a cross-sectional study stratified by district in urban and rural Botswana using the Patient Health Questionnaire. A snowballing technique was utilized to recruit older participants (N = 378; age = 71.8; SD = 9.1) with low to high incomes. Univariate and multivariate analyses were used to investigate the associations among demographics, individual, social, and environmental factors, and depression. The prevalence of depression and social impairment in older people was 7.8% and 20.6%. The correlates significantly associated with depression in Model 2 were education, income earned, resilience, and self-esteem (F (6, 358) = 19.5, p < .001; R2 = 23%) after adjusting for all influencing factors. Self-perceived health was associated with depression in Model 3 [F (11,340) = 12.5, p < .001; R2 = 28%]. In the final model, resilience, quality of life (QOL), and leisure were significantly associated with depression (p < .001), followed by anxiety, somatic symptoms, and social impairment (p < .05) [F (20,214) = 9.2, p < .001; R2 = 46%]. Findings provide preliminary information on the determinants of depression for further review by the research community. Stakeholders should also take cognizance of these correlates during their practice to curb depression in older people.
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A mixed-methods, population-based study of a syndemic in Soweto, South Africa. Nat Hum Behav 2021; 6:64-73. [PMID: 34949783 PMCID: PMC8799501 DOI: 10.1038/s41562-021-01242-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022]
Abstract
A syndemic has been theorized as a cluster of epidemics driven by harmful social and structural conditions wherein the interaction between the constitutive epidemics drive excess morbidity and mortality. We conducted a mixed-methods study to investigate a syndemic in Soweto, South Africa, consisting of a population-based quantitative survey (N=783) and in-depth, qualitative interviews (N=88). We used ethnographic methods to design a locally relevant measure of stress. Here we show that multimorbidity and stress interacted with each other to reduce quality of life. The paired qualitative analysis further explored how the quality of life impacts of multimorbidity were conditioned by study participants’ illness experiences. Together these findings underscore the importance of recognizing the social and structural drivers of stress and how they affect the experience of chronic illness and well-being.
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Mwangala PN, Mabrouk A, Wagner R, Newton CRJC, Abubakar AA. Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review. BMJ Open 2021; 11:e052810. [PMID: 34551953 PMCID: PMC8461287 DOI: 10.1136/bmjopen-2021-052810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/06/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE In this systematic review, we aimed to summarise the empirical evidence on common mental disorders (CMDs), cognitive impairment, frailty and health-related quality of life (HRQoL) among people living with HIV aged ≥50 years (PLWH50 +) residing in sub-Saharan Africa (SSA). Specifically, we document the prevalence and correlates of these outcomes. DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA The following online databases were systematically searched: PubMed, CINAHL, PsycINFO, Embase and Scopus up to January 2021. English-language publications on depression, anxiety, cognitive function, frailty and quality of life among PLWH50+ residing in SSA were included. DATA EXTRACTION AND SYNTHESIS We extracted information, including study characteristics and main findings. These were tabulated, and a narrative synthesis approach was adopted, given the substantial heterogeneity among included studies. RESULTS A total of 50 studies from fifteen SSA countries met the inclusion criteria. About two-thirds of these studies emanated from Ethiopia, Uganda and South Africa. Studies regarding depression predominated (n=26), followed by cognitive impairment (n=13). Overall, PLWH50+ exhibited varying prevalence of depression (6%-59%), cognitive impairments (4%-61%) and frailty (3%-15%). The correlates of CMDs, cognitive impairment, frailty and HRQoL were rarely investigated, but those reported were sociodemographic variables, many of which were inconsistent. CONCLUSIONS This review documented an increasing number of published studies on HIV and ageing from SSA. However, the current evidence on the mental and well-being outcomes in PLWH50+ is inadequate to characterise the public health dimension of these impairments in SSA, because of heterogeneous findings, few well-designed studies and substantial methodological limitations in many of the available studies. Future work should have sufficiently large samples of PLWH50+, engage appropriate comparison groups, harmonise the measurement of these outcomes using a standardised methodology to generate more robust prevalence estimates and confirm predictors. PROSPERO REGISTRATION NUMBER CRD42020145791.
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Affiliation(s)
- Patrick Nzivo Mwangala
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Adam Mabrouk
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ryan Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parkton, Gauteng, South Africa
| | - Charles R J C Newton
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina A Abubakar
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
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Edwards A, Siedner MJ, Nash S, Neuman M, Danaviah S, Smit T, Gareta D, Kowal P, Seeley J. HIV serostatus, inflammatory biomarkers and the frailty phenotype among older people in rural KwaZulu-Natal, South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:177-185. [PMID: 32892699 DOI: 10.2989/16085906.2020.1790398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective: We compared the prevalence of frailty by HIV serostatus and related biomarkers to the modified frailty phenotype among older individuals in a rural population in South Africa. Methods: Questionnaire data were from a cohort of people living with HIV (PWH) on antiretroviral therapy (ART) and HIV-uninfected people aged 50 years and older sampled from the Africa Health Research Institute Demographic Health and Surveillance area in northern KwaZulu-Natal. The prevalence of frailty was compared using five categories: (1) physical activity; (2) mobility; (3) fatigue; (4) gait speed; and (5) grip strength, and assessed for demographic, clinical, and inflammatory correlates of frailty. Results: Among 614 individuals in the study, 384 (62.5%) were women. The median age at study enrolment was 64 years [Interquartile range (IQR) (58.6-72.0)]. 292 (47.6%) were PWH. 499 (81%) were classified as either pre-frail or frail. 43 (7%) were frail and HIV positive, 185 (30%) were pre-frail and HIV positive, 57 were frail and HIV negative and 214 (35%) were pre-frail and HIV negative. Frailty was similar for HIV negative and PWH (17.7% vs 14.7%, p = 0.72). Women were more likely to be frail (18.3% vs 13.04%, p = 0.16). The prevalence of frailty increased with age for both HIV groups. In the multivariable analysis, the odds of being frail were higher in those aged 70 years and above than those aged between 50 and 59 years (p < 0.001). Females were less likely to be pre-frail than males (p < 0.001). There was no association between any of the inflammatory biomarkers and frailty and pre-frailty. Conclusion: In this population, the prevalence of frailty is similar for PWH and people without HIV, but higher for women than men. These data suggest that the odds of developing frailty is similar for PWH over the age of 50 years, who survive into older age, as for people without HIV.
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Affiliation(s)
- Anita Edwards
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Mark J Siedner
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Harvard Medical School, Boston, USA
| | - Stephen Nash
- London School of Hygiene and Tropical Medicine, London, UK
| | - Melissa Neuman
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Paul Kowal
- World Health Organization, Division of Data, Analytics and Delivery for Impact, Geneva, Switzerland
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,London School of Hygiene and Tropical Medicine, London, UK
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Mugisha Okello J, Nash S, Kowal P, Naidoo N, Chatterji S, Boerma T, Seeley J. Survival of people aged 50 years and older by HIV and HIV treatment status: findings from three waves of the SAGE-Wellbeing of Older People Study (SAGE-WOPS) in Uganda. AIDS Res Ther 2020; 17:17. [PMID: 32410634 PMCID: PMC7226937 DOI: 10.1186/s12981-020-00276-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
Background Data on the survival status of older adults on antiretroviral treatment (ART) are scarce in sub-Saharan Africa. The objective of this study was to determine the survival status of people aged 50 years and older who were HIV-negative, HIV-positive not on ART, and HIV-positive on ART. Methods We used three waves of data from the World Health Organisation Study on Global Ageing and adult health- Well Being of Older People Study cohort in Uganda, conducted in 2009, 2012–2013 and 2015–2016. The cohort included HIV-negative and HIV-positive persons aged 50 years and older recruited from multiple rural and peri-urban sites in Uganda. Data were collected using interviewer-administered questionnaire. Time-dependent ART data were collected from medical records using a data-abstraction form. This study was conducted before the universal test and treat policy came into effect. We fitted Cox survival models to estimate hazard ratios to compare the risk of death between groups, adjusted for age, sex, marital status and hypertension. Results Of 623 participants, 517 (82.9%) of respondents had follow-up data and were included in this analysis. We observed 1571 person-years of follow-up from 274 people who were HIV-negative, and 1252 from 243 who were HIV-positive. The estimated mortality adjusted hazard ratio (aHR) was 1.89 (95% CI 1.0–3.4; p = 0.04) among people living with HIV compared to HIV-negative people. The aHR for mortality among people receiving ART compared with HIV-negative people was 1.75 (95% CI 0.9–3.5). People who were HIV-positive and not receiving ART had the greatest risk of death (aHR = 2.09, 95% CI 1.0–4.4 compared with HIV negative participants). The aHR for HIV-positive people not receiving ART, compared to those who were on treatment, was 1.19 (95% CI 0.6–2.5). Conclusion Older adults living with HIV on ART had a risk of mortality that was nearly twice as high as HIV-negative adults. Further analyses of longitudinal data should be done to understand factors that affect the survival of older adults on ART.
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Tran TM, Fuller AT, Butler EK, Muhumuza C, Ssennono VF, Vissoci JR, Makumbi F, Chipman JG, Galukande M, Haglund MM, Luboga S. Surgical need among the ageing population of Uganda. Afr Health Sci 2019; 19:1778-1788. [PMID: 31149008 PMCID: PMC6531960 DOI: 10.4314/ahs.v19i1.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Uganda's ageing population (age 50 years and older) will nearly double from 2015 to 2050. HIV/AIDS, diabetes, stroke among other disease processes have been studied in the elderly population. However, the burden of disease from surgically-treatable conditions is unknown. OBJECTIVES To determine the proportion of adults above 50 years with unmet surgical need and deaths attributable to probable surgically-treatable conditions. METHODS A cluster randomized sample representing the national population of Uganda was enumerated. The previously validated Surgeons Overseas assessment of surgical need instrument, a head-to-toe verbal interview, was used to determine any surgically-treatable conditions in two randomly-selected living household members. Deaths were detailed by heads of households. Weighted metrics are calculated taking sampling design into consideration and Taylor series linearization was used for sampling error estimation. RESULTS The study enumerated 425 individuals above age 50 years. The prevalence proportion of unmet surgical need was 27.8% (95%CI, 22.1-34.3). This extrapolates to 694,722 (95%CI, 552,279-857,157) individuals living with one or more surgically treatable conditions. The North sub-region was observed to have the highest prevalence proportion. Nearly two out of five household deaths (37.9%) were attributed to probable surgically treatable causes. CONCLUSION There is disproportionately high need for surgical care among the ageing population of Uganda with approximately 700,000 consultations needed.
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Affiliation(s)
- Tu M Tran
- Duke University Division of Global Neurosurgery and Neuroscience
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neuroscience
- Duke University School of Medicine
| | - Elissa K Butler
- University of Washington Department of Surgery 1959 NE Pacific Street Box 356410 Seattle, WA 98195 USA
| | | | - Vincent F Ssennono
- Uganda Bureau of Statistics, Kampala, Uganda; Statistics House, Plot 9 Colville Street Box 7186 Kampala, Uganda
| | | | | | - Jeffrey G Chipman
- University of Minnesota Department of Surgery, Minneapolis, MN, USA; 420 Delaware Street SE Mayo Mail Code 195 Minneapolis, MN 55455 USA
| | - Moses Galukande
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neuroscience
- Duke University School of Medicine
- Duke University Department of Neurosurgery, Durham, NC, USA Durham, NC, USA 310 Trent Drive, Room 301 Durham, NC 27710 USA
| | - Samuel Luboga
- Makerere University College of Health Sciences, Department of Anatomy, Kampala, Uganda P. O. Box 7072, New Mulago Hospital Complex Kampala, Uganda
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11
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Knight L, Schatz E, Mukumbang FC. "I attend at Vanguard and I attend here as well": barriers to accessing healthcare services among older South Africans with HIV and non-communicable diseases. Int J Equity Health 2018; 17:147. [PMID: 30227859 PMCID: PMC6145370 DOI: 10.1186/s12939-018-0863-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/03/2018] [Indexed: 12/22/2022] Open
Abstract
Background HIV and non-communicable disease (NCD) are syndemic within sub-Saharan Africa especially among older persons. The two epidemics interact with one another within a context of poverty, inequality and inequitable access to healthcare resulting in an increase in those aged 50 and older living with HIV and experiencing an NCD co-morbidity. We explore the challenges of navigating healthcare for older persons living with HIV and NCD co-morbidity. Methods In-depth semi-structured interviews were conducted with a small sample of older persons living with HIV (OPLWH). The perspectives of key informants were also sought to triangulate the evidence of OPLWH. The research took place in two communities on the outskirts of Cape Town, South Africa. All interviews were conducted by a trained interviewer and transcribed and translated for analysis. Thematic content analysis guided data analysis. Results OPLWH experienced an HIV-NCD syndemic. Our respondents sought care and accessed treatment for both HIV and other chronic (and acute) conditions, though these services were provided at different health facilities or by different health providers. Through the syndemic theory, it is possible to observe that OPLWH and NCDs face a number of physical and structural barriers to accessing the healthcare system. These barriers are compounded by separate appointments and spaces for each condition. These difficulties can exacerbate the impact of their ill-health and perpetuate structural vulnerabilities. Despite policy changes towards integrated care, this is not the experience of OPLWH in these communities. Conclusions The population living with HIV is aging increasing the likelihood that those living with HIV will also be living with other chronic conditions including NCDs. Thus, it is essential that health policy address this basic need to integrate HIV and NCD care.
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Affiliation(s)
- Lucia Knight
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa.
| | - Enid Schatz
- Department of Health Sciences and Department of Women's & Gender Studies, University of Missouri, Columbia, Missouri, USA
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa
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12
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Brown FL, Carswell K, Augustinavicius J, Adaku A, Leku MR, White RG, Ventevogel P, Kogan CS, García-Moreno C, Bryant RA, Musci RJ, van Ommeren M, Tol WA. Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda. Glob Ment Health (Camb) 2018; 5:e27. [PMID: 30128163 PMCID: PMC6094406 DOI: 10.1017/gmh.2018.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/20/2018] [Accepted: 05/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Exposure to armed conflict and forced displacement constitute significant risks for mental health. Existing evidence-based psychological interventions have limitations for scaling-up in low-resource humanitarian settings. The WHO has developed a guided self-help intervention, Self Help Plus (SH+), which is brief, implemented by non-specialists, and designed to be delivered to people with and without specific mental disorders. This paper outlines the study protocol for an evaluation of the SH+ intervention in northern Uganda, with South Sudanese refugee women. METHODS A two-arm, single-blind cluster-randomised controlled trial will be conducted in 14 villages in Rhino Camp refugee settlement, with at least 588 women experiencing psychological distress. Villages will be randomly assigned to receive either SH+ with enhanced usual care (EUC), or EUC alone. SH+ is a five-session guided self-help intervention delivered in workshops with audio-recorded materials and accompanying pictorial guide. The primary outcome is reduction in overall psychological distress over time, with 3 months post-treatment as the primary end-point. Secondary outcomes are self-defined psychosocial concerns, depression and post-traumatic stress disorder symptoms, hazardous alcohol use, feelings of anger, interethnic relations, psychological flexibility, functional impairment and subjective wellbeing. Psychological flexibility is a hypothesised mediator, and past trauma history and intervention attendance will be explored as potential moderators. DISCUSSION This trial will provide important information on the effectiveness of a scalable, guided self-help intervention for improving psychological health and wellbeing among people affected by adversity. TRIAL REGISTRATION ISRCTN50148022; registered 13/03/2017.
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Affiliation(s)
- F. L. Brown
- War Child Holland, Amsterdam, The Netherlands
- Department of Global Health and Population, Research Program for Children and Global Adversity, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - K. Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - J. Augustinavicius
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A. Adaku
- HealthRight International, New York, NY
- Arua Regional Referral Hospital, Arua, Uganda
| | | | - R. G. White
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - P. Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - C. S. Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - C. García-Moreno
- Department of Reproductive Health & Research, World Health Organization, Geneva, Switzerland
| | - R. A. Bryant
- University of New South Wales, Sydney, Australia
| | - R. J. Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M. van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - W. A. Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- HealthRight International, New York, NY
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13
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Knight L, Mukumbang FC, Schatz E. Behavioral and cognitive interventions to improve treatment adherence and access to HIV care among older adults in sub-Saharan Africa: an updated systematic review. Syst Rev 2018; 7:114. [PMID: 30071903 PMCID: PMC6090879 DOI: 10.1186/s13643-018-0759-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/24/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Approximately 14% of Africans infected with HIV are over the age of 50, yet few intervention studies focus on improving access to care, retention in care, and adherence to antiretroviral therapy (ART) in this population. A review of the published literature until 2012, found no relevant ART management and care interventions for older people living with HIV (OPLHIV) in sub-Saharan Africa. The aim of this systematic review is to update the original systematic review of intervention studies on OPLHIV, with a focus on evidence from sub-Saharan Africa. METHODS We conducted a systematic review of the available published literature from 2012 to 2017 to explore behavioral and cognitive interventions addressing access to ART, retention in HIV care and adherence to ART in sub-Saharan Africa that include older adults (50+). We searched three databases (MEDLINE, EMBASE, and Education Resources Information Center) using relevant Medical Subject Headings (MeSH) terms as well as a manual search of the reference lists. No language restrictions were placed. We identified eight articles which were analyzed using content analysis with additional information obtained directly from the corresponding authors. RESULTS AND DISCUSSION There were no studies that exclusively focused on OPLHIV. Three studies referred only to participants being over 18 years and did not specify age categories. Therefore, it is unclear whether these studies actively considered people living with HIV over the age of 50. Although the studies sampled older adults, they lacked sufficient data to draw conclusions about the relevance of the outcomes of this group. CONCLUSIONS These findings underscore the need to increase the evidence-base of which interventions will work for older Africans on ART.
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Affiliation(s)
- Lucia Knight
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, P Bag X17, Bellville, 7535, South Africa.
| | - Enid Schatz
- Department of Health Sciences and Department of Women's and Gender Studies, University of Missouri, Columbia, USA
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14
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Hyle EP, Mayosi BM, Middelkoop K, Mosepele M, Martey EB, Walensky RP, Bekker LG, Triant VA. The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review. BMC Public Health 2017; 17:954. [PMID: 29246206 PMCID: PMC5732372 DOI: 10.1186/s12889-017-4940-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/22/2017] [Indexed: 12/27/2022] Open
Abstract
Background Sub-Saharan Africa (SSA) has confronted decades of the HIV epidemic with substantial improvements in access to life-saving antiretroviral therapy (ART). Now, with improved survival, people living with HIV (PLWH) are at increased risk for non-communicable diseases (NCDs), including atherosclerotic cardiovascular disease (CVD). We assessed the existing literature regarding the association of CVD outcomes and HIV in SSA. Methods We used the PRISMA guidelines to perform a systematic review of the published literature regarding the association of CVD and HIV in SSA with a focus on CVD surrogate and clinical outcomes in PLWH. Results From January 2000 until March 2017, 31 articles were published regarding CVD outcomes among PLWH in SSA. Data from surrogate CVD outcomes (n = 13) suggest an increased risk of CVD events among PLWH in SSA. Although acute coronary syndrome is reported infrequently in SSA among PLWH, limited data from five studies suggest extensive thrombus and hypercoagulability as contributing factors. Additional studies suggest an increased risk of stroke among PLWH (n = 13); however, most data are from immunosuppressed ART-naïve PLWH and thus are potentially confounded by the possibility of central nervous system infections. Conclusions Given ongoing gaps in our current understanding of CVD and other NCDs in PLWH in SSA, it is imperative to ascertain the burden of CVD outcomes, and to examine strategies for intervention and best practices to enhance the health of this vulnerable population. Electronic supplementary material The online version of this article (10.1186/s12889-017-4940-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA. .,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Bongani M Mayosi
- Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Keren Middelkoop
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Mosepele Mosepele
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Botswana-Harvard AIDS Partnership, Gaborone, Botswana
| | - Emily B Martey
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St., 9th Floor, Boston, MA, 02114-2696, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard University Center for AIDS Research (CFAR), Boston, MA, USA.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Virginia A Triant
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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15
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Myroniuk TW. Marital Dissolutions and the Health of Older Individuals in a Rural African Context. J Gerontol B Psychol Sci Soc Sci 2017; 72:656-664. [PMID: 27382043 PMCID: PMC5927165 DOI: 10.1093/geronb/gbw077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Research from high-income countries has often found a negative relationship between marital dissolutions and health. This paper assesses that relationship among older sub-Saharan Africans, on a now-aging continent. Such individuals are likely to be at risk of a dissolution, or have already experienced one, due to high rates of marriage. METHODS Data from over 1,200 rural Malawians, age 45+, are employed from the 2008 and 2010 waves of the Malawi Longitudinal Study of Families and Health. Cross-sectional and lagged dependent variable regressions examine the relationship between marital dissolutions and 4 measures of self-reported health: retrospective health, relative health (compared with others in one's village), and age-standardized SF-12 mental and physical health scales. RESULTS Worse relative, mental, and physical health are associated with being currently divorced/widowed compared with being married. However, worse retrospective health is linked to becoming divorced/widowed between 2008 and 2010. Those divorced/widowed prior to 2008, and who remained so through 2010, are in worse relative and physical health. DISCUSSION The findings question the relative hardship of marital dissolutions for those who have managed to survive into old age, and call for the collection of more detailed longitudinal data on older Africans on this topic.
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Affiliation(s)
- Tyler W Myroniuk
- Department of Sociology and Anthropology, George Mason University, Fairfax, Virginia
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16
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Akinyemi JO, Ogunbosi BO, Fayemiwo AS, Adesina OA, Obaro M, Kuti MA, Awolude OA, Olaleye DO, Adewole IF. Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria. Afr Health Sci 2017; 17:315-321. [PMID: 29062325 DOI: 10.4314/ahs.v17i2.4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. OBJECTIVES To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. METHODS Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. RESULTS Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). CONCLUSION There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.
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Affiliation(s)
- Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Babatunde O Ogunbosi
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adetona S Fayemiwo
- Department of Medical Microbiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olubukola A Adesina
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michael Obaro
- Department of Pharmacology and Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Modupe A Kuti
- Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olutosin A Awolude
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - David O Olaleye
- Department of Virology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Isaac F Adewole
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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17
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Abstract
Sub-Saharan Africa (SSA) has traditionally had a low life expectancy due to the onslaught of the HIV epidemic, high levels of chronic diseases, injuries, conflict and undernutrition. Therefore, research into public health concerns of older persons has largely been overlooked. With a growing population, the roll-out of antiretroviral treatment, and the effects of globalisation, SSA is experiencing an increase in the number of people over 50 years of age as well as an increase in the prevalence of non-communicable diseases (NCD). The aim of this review is to highlight available research on the health status of older persons in SSA, and to identify the current gaps that warrant further investigation. A literature search was conducted across multiple databases to identify studies in SSA on older persons (aged 50 years and older) related to health indicators including nutritional status, NCD and HIV burden. While it was concluded that older persons are at an increased risk of poor health, it was also determined that significant gaps exist in this particular area of research; namely nutrient deficiency prevalence. Resources should be directed towards identifying the health concerns of older persons and developing appropriate interventions.
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18
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Abimanyi-Ochom J, Mannan H, Groce NE, McVeigh J. HIV/AIDS knowledge, attitudes and behaviour of persons with and without disabilities from the Uganda Demographic and Health Survey 2011: Differential access to HIV/AIDS information and services. PLoS One 2017; 12:e0174877. [PMID: 28406929 PMCID: PMC5390986 DOI: 10.1371/journal.pone.0174877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/16/2017] [Indexed: 11/18/2022] Open
Abstract
Uganda is among the first to use the Washington Group Short Set of Questions on Disability to identify persons with disabilities in its Demographic and Health Survey. In this paper, we review the HIV Knowledge, Attitudes and Behaviour component of the 2011 Ugandan Demographic and Health Survey, analysing a series of questions comparing those with and without disabilities in relation to HIV/AIDS knowledge, attitudes and practices. We found comparable levels of knowledge on HIV/AIDS for those with and those without disabilities in relation to HIV transmission during delivery (93.89%, 93.26%) and through breastfeeding (89.91%, 90.63%), which may reflect increased attention to reaching the community of persons with disabilities. However, several gaps in the knowledge base of persons with disabilities stood out, including misconceptions of risk of HIV infection through mosquito bites and caring for a relative with HIV in own household (34.39%, 29.86%; p<0.001; 91.53%, 89.00%; p = 0.001, respectively). The issue is not just access to appropriate information but also equitable access to HIV/AIDS services and support. Here we found that persons with multiple disabilities were less likely than individuals without disabilities to return to receive results from their most recent HIV test (0.60[0.41-0.87], p<0.05). HIV testing means little if people do not return for follow-up to know their HIV status and, if necessary, to be connected to available services and supports. Additional findings of note were that persons with disabilities reported having a first sexual encounter at a slightly younger age than peers without disabilities; and persons with disabilities also reported having a sexually transmitted disease (STD) within the last 12 months at significantly higher rates than peers without disabilities (1.38[1.18-1.63], p<0.01), despite reporting comparable knowledge of the need for safer sex practices. This analysis is among the first to use HIV/AIDS-related questions from Demographic Health Surveys to provide information about persons with disabilities in Uganda in comparison to those without disabilities. These findings present a more complex and nuanced understanding of persons with disabilities and HIV/AIDS. If persons with disabilities are becoming sexually active earlier, are more likely to have an STD within the preceding 12 month period and are less likely to receive HIV test results, it is important to understand why. Recommendations are also made for the inclusion of disability measures in Uganda's AIDS Indicator Survey to provide cyclical and systematic data on disability and HIV/AIDS, including HIV prevalence amongst persons with disabilities.
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Affiliation(s)
- Julie Abimanyi-Ochom
- School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Hasheem Mannan
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Nora Ellen Groce
- Leonard Cheshire Disability and Inclusive Development Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Joanne McVeigh
- Centre for Global Health and School of Psychology, Trinity College Dublin, Dublin, Ireland
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19
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Mendenhall E, Kohrt BA, Norris SA, Ndetei D, Prabhakaran D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 2017; 389:951-963. [PMID: 28271846 PMCID: PMC5491333 DOI: 10.1016/s0140-6736(17)30402-6] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/01/2016] [Accepted: 11/30/2016] [Indexed: 12/11/2022]
Abstract
The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.
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Affiliation(s)
- Emily Mendenhall
- School of Foreign Service, Georgetown University, Washington, DC, USA.
| | - Brandon A Kohrt
- Department of Psychiatry, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya; Africa Mental Health Foundation, Nairobi, Kenya
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India; London School of Hygiene & Tropical Medicine, London, UK
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20
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Mugisha JO, Schatz EJ, Negin J, Mwaniki P, Kowal P, Seeley J. Timing of Most Recent Health Care Visit by Older People Living With and Without HIV. Int J Aging Hum Dev 2016; 85:18-32. [PMID: 27913758 DOI: 10.1177/0091415016680071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this article is to document factors associated with the recency of health-care service utilization by people aged 50 years and over living with and without HIV in Uganda. A survey was conducted with 510 Ugandans aged 50 and older, living with and without HIV. The survey included information on sociodemographic characteristics, health state, self-reported chronic conditions, and timing of most recent visit to a health-care facility (time since last visit [TSLV]). We use ordinal logistic regression to identify independent factors associated TSLV. Independent factors associated with TSLV (>6 months) include age, OR = 2.40 [95% CI 1.08-5.37] for those aged 80 years and above, urban respondents, OR = 0.6 [95%CI 0.38-0.94], HIV-positive respondents, OR = 0.33 [95%CI 0.18-0.59], and better health. To understand the meaning of these finding, further investigation should examine (a) how best to define and measure older persons' health-care service needs and (b) older persons' decision-making processes around the timing of their access to health-care facilities.
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Affiliation(s)
- Joseph O Mugisha
- 1 MRC/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda.,2 Department of Health Sciences, University of Missouri, Columbia, USA
| | - Enid J Schatz
- 2 Department of Health Sciences, University of Missouri, Columbia, USA
| | - Joel Negin
- 3 School of Public Health, University of Sydney, Sydney, Australia
| | - Paul Mwaniki
- 1 MRC/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Paul Kowal
- 4 World Health Organization Study on global AGEing and adult health, Geneva, Switzerland.,5 Research Centre for Generational Health and Ageing, University of Newcastle, NSW, Australia
| | - Janet Seeley
- 1 MRC/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda.,6 London School of Hygiene and Tropical Medicine, London, UK
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21
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Negin J, Gregson S, Eaton JW, Schur N, Takaruza A, Mason P, Nyamukapa C. Rising Levels of HIV Infection in Older Adults in Eastern Zimbabwe. PLoS One 2016; 11:e0162967. [PMID: 27828979 PMCID: PMC5102380 DOI: 10.1371/journal.pone.0162967] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/31/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With the scale-up of antiretroviral treatment across Africa, many people are living longer with HIV. Understanding the ageing of the HIV cohort and sexual behaviour among older adults are important for appropriately responding to the changing demographics of people living with HIV. METHODS We used data from a large population-based open cohort in eastern Zimbabwe to examine HIV prevalence trends and incidence among those aged 45 years and older. Five survey rounds have been completed between 1998 and 2011. Incidence was analysed using midpoint between last negative and first positive HIV test. RESULTS Across the survey rounds, 13,071 individuals were followed for 57,676 person years. While HIV prevalence among people aged 15-44 has fallen across the five rounds, HIV prevalence among those aged 45-54 has increased since the 2006-08 survey round. In the 2009-11 round, HIV prevalence among men aged 45-54 was 23.4% compared to 11.0% among those aged 15-44. HIV positive people aged 45-54 now represent more than 20% of all those living with HIV in Manicaland. Among those aged 45 years and older, there were 85 seroconversions in 11,999 person years for an HIV incidence of 0.708 per 100 person years. Analysis of cohort data and assessment of behavioural risk factors for HIV infection among older people shows significantly lower levels of condom use among older adults and a number of seroconversions past the age of 50. CONCLUSIONS The cohort of people living with HIV is ageing in Zimbabwe and the behaviour of older adults puts them at risk of HIV infection. Older adults must be included in both HIV prevention and treatment programs.
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Affiliation(s)
- Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
- * E-mail:
| | - Simon Gregson
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Jeffrey W. Eaton
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Nadine Schur
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Peter Mason
- Biomedical Research and Training Institute, Harare, Zimbabwe
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Constance Nyamukapa
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, United Kingdom
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Adjei AA, Agyemang S, Krampa FD, Abdul-Rahman M, Ofei F, Lartey M, Adiku TK, Gyasi RK, Tettey Y. Unrecognized human immunodeficiency virus infection and risk factors among elderly medical patients at the Korle Bu teaching hospital, Accra, Ghana. Trop Dis Travel Med Vaccines 2016; 2:18. [PMID: 28883962 PMCID: PMC5530923 DOI: 10.1186/s40794-016-0034-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The human immunodeficiency virus (HIV) infection usually infects persons in the reproductive age group (15-49 years), but elderly people are also susceptible. Many people in sub-Saharan Africa including Ghana believe that elderly people are not at risk for HIV. Despite numerous reports of the high prevalence of HIV infection among the elderly worldwide, there are no from Ghana. This work determined the sero-prevalence of HIV infection and risk factors for its transmission among 1,100 hospitalized elderly people at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana. METHODS Subjects voluntarily completed a risk-factor questionnaire and provided a blood specimen for HIV testing. RESULTS Of the study participants, 440 were male (mean age: 64 ± 10.55 years), and 660 were female (mean age: 63 ± 9.51 years). The overall HIV-1 sero-prevalence among the subjects was 4.18 % (n = 46). On multivariate analysis, there was no statistical significance between the socio-demographics or risk factors and the HIV status of the participants. CONCLUSION The results suggest high prevalence of HIV-1 among hospitalized elderly people at KBTH, recommending the need to include the elderly in HIV/AIDS testing, prevention, and control programmes. TRIAL REGISTRATION Trial registration number: MS-Et/M.9 - p4.10/2012-2013. Registered: 10th April, 2013.
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Affiliation(s)
- Andrew A. Adjei
- Office of Research, Innovation and Development, University of Ghana, Legon, Accra, Ghana
- Department of Pathology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Seth Agyemang
- Immunology Department, Central Laboratories, Korle Bu Teaching Hospital, Accra, Ghana
| | - Francis D. Krampa
- Department of Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Mubarak Abdul-Rahman
- Department of Pathology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Francis Ofei
- Department of Medicine and Therapeutics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Margaret Lartey
- Department of Medicine and Therapeutics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Theophilus K. Adiku
- Department of Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Richard K. Gyasi
- Department of Pathology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Yao Tettey
- Department of Pathology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
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Cau BM, Falcão J, Arnaldo C. Determinants of poor self-rated health among adults in urban Mozambique. BMC Public Health 2016; 16:856. [PMID: 27553080 PMCID: PMC4995828 DOI: 10.1186/s12889-016-3552-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/18/2016] [Indexed: 11/17/2022] Open
Abstract
Background Self-rated health is a measure expressing the general condition of health of individuals. Self-rated health studies are common in developed countries and in some developing regions. Despite increasing proportion of adult and older population in sub-Saharan Africa and poor population health indicators, there is a dearth of studies on self-rated health in the region. This study examines factors associated with poor self-rated health among adult individuals in Maputo metropolitan area in Mozambique. Methods Data for this study come from a survey of 1768 individuals aged 18 years or more carried out in Maputo metropolitan area, Mozambique, in 2015. Employing multiple logistic regression, the study used a subsample of 677 female and male respondents aged 40 years or more to estimate the determinants of poor self-rated health. Results About 54 % of respondents aged 40 years or more believed that their health status was poor. Female respondents [Odds Ratios (OR) = 3.43, p <0.01], single (OR = 4.71, p < 0.05), widow (OR = 1.81, p < 0.05), separated or divorced (OR = 2.08, p < 0.05) and those believing that hypertension or heart problem was a major community health problem (OR = 1.56, p < 0.05) displayed higher odds of reporting poor health than their peers, net of other factors. Furthermore, individuals aged 40–49 years (OR = 0.45, p < 0.01), or 50–59 years (OR = 0.59, p < 0.05), those whose work involves intensive physical activity (OR = 0.60, p < 0.05) and those from households treating drinking water (OR = 0.49, p < 0.01) showed lower odds of reporting poor health, adjusting for other factors. Conclusion Overall, the results point to the importance of age, gender, marital status, socioeconomic circumstances, individuals’ health behaviors and perceived community health problems as key determinants of poor self-rated health among adults in Maputo metropolitan area. Given the growing number of adult and older people in sub-Saharan Africa, the rising importance of non-communicable diseases and the scarcity of studies on determinants of poor self-rated health among adults in the region, our findings may have implications for a better understanding of the drivers of poor health among adults in urban sub-Saharan Africa
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Affiliation(s)
- Boaventura M Cau
- Departamento de Geografia, Universidade Eduardo Mondlane (UEM), C.P. 257, Maputo, Mozambique. .,Centro de Pesquisa em População e Saúde (CEPSA), Maputo, Mozambique.
| | - Joana Falcão
- Centro de Pesquisa em População e Saúde (CEPSA), Maputo, Mozambique
| | - Carlos Arnaldo
- Departamento de Geografia, Universidade Eduardo Mondlane (UEM), C.P. 257, Maputo, Mozambique.,Centro de Pesquisa em População e Saúde (CEPSA), Maputo, Mozambique
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Negin J, Geddes L, Brennan-Ing M, Kuteesa M, Karpiak S, Seeley J. Sexual Behavior of Older Adults Living with HIV in Uganda. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:441-449. [PMID: 26324184 DOI: 10.1007/s10508-015-0582-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 06/02/2015] [Accepted: 06/09/2015] [Indexed: 06/04/2023]
Abstract
Sexual behavior among older adults with HIV in Sub-Saharan Africa has been understudied despite the burgeoning of this population. We examined sexual behavior among older adults living with HIV in Uganda. Participants were eligible for the study if they were 50 years of age or older and living with HIV. Quantitative data were collected through face-to-face interviews, including demographic characteristics, health, sexual behavior and function, and mental health. Of respondents, 42 were men and 59 women. More than one-quarter of these HIV-positive older adults were sexually active. A greater proportion of older HIV-positive men reported being sexually active compared to women (54 vs. 15%). Among those who are sexually active, a majority never use condoms. Sixty-one percent of men regarded sex as at least somewhat important (42%), while few women shared this opinion (20%). Multivariate logistic regression analyses revealed that odds of sexual activity in the past year were significantly increased by the availability of a partner (married/cohabitating), better physical functioning, and male gender. As more adults live longer with HIV, it is critical to understand their sexual behavior and related psychosocial variables in order to improve prevention efforts.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia.
| | - Louise Geddes
- Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Mark Brennan-Ing
- ACRIA, New York, NY, USA
- New York University College of Nursing, New York, NY, USA
| | | | - Stephen Karpiak
- ACRIA, New York, NY, USA
- New York University College of Nursing, New York, NY, USA
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
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Wandera SO, Golaz V, Kwagala B, Ntozi J. Factors associated with self-reported ill health among older Ugandans: a cross sectional study. Arch Gerontol Geriatr 2015; 61:231-9. [PMID: 26043957 PMCID: PMC4534344 DOI: 10.1016/j.archger.2015.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/18/2015] [Accepted: 05/19/2015] [Indexed: 10/26/2022]
Abstract
INTRODUCTION There is limited research on the prevalence and factors associated with self-reported ill health among older people in Uganda. OBJECTIVE Therefore, the aim of this paper was to estimate the prevalence of self-reported ill health and to identify associated risk factors among older people (age 50+) in Uganda. MATERIALS AND METHODS We conducted secondary analysis of a cross sectional survey data from a weighted sample of 2382 older persons from the 2010 Uganda National Household survey. We used frequency distributions for descriptive statistics, chi-square tests (significance set at 95%) to identify initial associations and multivariable logistic regressions reporting odds ratios to examine observed associations with self-reported ill health. RESULTS Over half (62%) of the older people reported ill health in the 30 days preceding the survey. Self-reported ill health was positively associated with being a woman, being among the oldest old, living in the eastern region, being a household head, being Catholic, self-reported non-communicable diseases (NCDs) and being disabled. CONCLUSION Gender differentials exist in self-reported ill health among older persons in Uganda.
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Affiliation(s)
- Stephen Ojiambo Wandera
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda; Consortium for Advanced Research Training in Africa (CARTA Cohort 2) Fellow, Program Based at the African Population and Health Research Centre (APHRC), Nairobi, Kenya.
| | - Valerie Golaz
- Institut National D'etudes Demographiques (INED), 133 Boulevard Davout, Paris, France
| | - Betty Kwagala
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - James Ntozi
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
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Wandera SO, Ntozi J, Kwagala B. Prevalence and correlates of disability among older Ugandans: evidence from the Uganda National Household Survey. Glob Health Action 2014; 7:25686. [PMID: 25413721 PMCID: PMC4238972 DOI: 10.3402/gha.v7.25686] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/27/2014] [Accepted: 10/27/2014] [Indexed: 12/20/2022] Open
Abstract
Background Nationally representative evidence on the burden and determinants of disability among older people in sub-Saharan Africa in general, and Uganda in particular, is limited. Objective The aim of this study was to estimate the prevalence and investigate the correlates of disability among older people in Uganda. Design We conducted secondary analysis of data from a sample of 2,382 older persons from the Uganda National Household Survey. Disability was operationalized as either: 1) having a lot of difficulty on any one question; 2) being unable to perform on any one question; or, 3) having some difficulty with two of the six domains. We used frequency distributions for description, chi-square tests for initial associations, and multivariable logistic regressions to assess the associations. Results A third of the older population was disabled. Among all older persons, disability was associated with advancement in age (OR=4.91, 95% CI: 3.38–7.13), rural residence (0.56, 0.37–0.85), living alone (1.56, 1.07–2.27), separated or divorced (1.96, 1.31–2.94) or widowed (1.86, 1.32–2.61) marital status, households’ dependence on remittances (1.48, 1.10–1.98), ill health (2.48, 1.95–3.15), and non-communicable diseases (NCDs) (1.81, 0.80–2.33). Gender was not associated with disability among older persons. Conclusions Disability was associated with advancement in age, rural residence, living alone, divorced/separated/widowed marital status, dependence on remittances, ill health, and NCDs. Interventions to improve health and functioning of older people need to focus on addressing social inequalities and on the early preventive interventions and management of NCDs in old age in Uganda.
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Affiliation(s)
- Stephen O Wandera
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda;
| | - James Ntozi
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
| | - Betty Kwagala
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
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Kaleebu P, Kamali A, Seeley J, Elliott AM, Katongole-Mbidde E. The Medical Research Council (UK)/Uganda Virus Research Institute Uganda Research Unit on AIDS--'25 years of research through partnerships'. Trop Med Int Health 2014; 20:E1-10. [PMID: 25354929 PMCID: PMC4529486 DOI: 10.1111/tmi.12415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
For the past 25 years, the Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS has conducted research on HIV-1, coinfections and, more recently, on non-communicable diseases. Working with various partners, the research findings of the Unit have contributed to the understanding and control of the HIV epidemic both in Uganda and globally, and informed the future development of biomedical HIV interventions, health policy and practice. In this report, as we celebrate our silver jubilee, we describe some of these achievements and the Unit's multidisciplinary approach to research. We also discuss the future direction of the Unit; an exemplar of a partnership that has been largely funded from the north but led in the south.
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Affiliation(s)
- P Kaleebu
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Entebbe, Uganda; Uganda Virus Research Institute, Entebbe, Uganda; London School of Hygiene and Tropical Medicine, London, UK
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Zandmomen Z, Sardashti S, Firouzeh MM, Aminabad FJ, Ghanbariragheb H, SeyedAlinaghi S, Mohraz M. Addressing predictors of HIV related risk behaviors: demographic and psychosocial profile of Iranian patients. J Infect Public Health 2014; 7:472-80. [PMID: 25182509 DOI: 10.1016/j.jiph.2014.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND For effective implementation of HIV-related behavioral interventions, better understanding the demographic characteristics of infected patients in relation with high-risk behavior profiles, physical and mental health are essential. METHODS In a cross-sectional descriptive study, 400 HIV infected patients from December 2011 through January 2013 were evaluated regarding their demographic features, and four selected subscales (high-risk behaviors, self-efficacy, well-being, and social participation). A validated questionnaire of 62 items was used for assessment. RESULTS Almost 33% of all participants were women, 28% were younger than 30 years old, and 43% were never married; 50% had no permanent jobs. Women, widowed participants, patients <30 years, and those with higher educational levels had higher mean HIV risk behavior scores. In simple and multiple linear regression models, women >50 years and <30 years had the highest scores (β=2.714, p<0.0001; β=2.00, p<0.001). Furthermore, male and illiterate patients had higher social participation scores while female and divorced participants had higher well-being and self-efficacy scores. CONCLUSION We propose that demographic features play a critical role in increasing engagement in HIV-related high-risk behaviors; these characteristics also affect patients' social participation, well-being and self-efficacy. High-risk behaviors and social participation scores among women of different age groups and the youth highlight the need for future age and gender-specific educational and behavioral interventions among them.
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Affiliation(s)
- Zohreh Zandmomen
- Tehran University of Medical Sciences, Imam Khomeini Hospital, PO Box: 1766934746, Tehran, Iran.
| | - Sara Sardashti
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Imam Hospital, Keshavarz Blvd, PO Box: 1419733141, Tehran, Iran.
| | - Mona Mohammadi Firouzeh
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Imam Hospital, Keshavarz Blvd, PO Box: 1419733141, Tehran, Iran.
| | - Fatemeh Jahanjoo Aminabad
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran.
| | - Hamed Ghanbariragheb
- Tehran University of Medical Sciences, Imam Khomeini Hospital, PO Box: 1766934746, Tehran, Iran.
| | - SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Imam Hospital, Keshavarz Blvd, PO Box: 1419733141, Tehran, Iran.
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Imam Hospital, Keshavarz Blvd, PO Box: 1419733141, Tehran, Iran.
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Xie T, Wang G, Yan H, Yang L, Yu W, Fan J, Ruan B, Wu N. Large-scale HIV testing in the older population in China: findings from a cross-sectional study. Int J STD AIDS 2013; 25:650-5. [PMID: 24352127 DOI: 10.1177/0956462413516097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/18/2013] [Indexed: 12/17/2022]
Abstract
Aiming to explore universal HIV testing, and to understand the exact HIV prevalence in the older general population, we conducted a community-based cross-sectional epidemiological investigation in two counties of Zhejiang province, China. Using census strategy and convenience sampling method, those participants who were older than 50 years and met eligibility criteria were enrolled, and HIV prevalence was presented as a crude infection rate. A total of 215,441 (64.82%) were enrolled into this study, HIV testing was added into their health exam plan and 18 were confirmed as HIV positive, giving a crude rate of 0.84/10,000. HIV prevalence was higher among men than among women in all age groups (p < 0.05). Unlike previous research, 14 cases (78%) still had a relatively high CD4 + count; 17 cases (94%) had been infected by sexual transmission. Active large-scale HIV screening by integrating into routine health care can be an effective strategy to find people living with HIV at relative early stage of disease.
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Affiliation(s)
- Tiansheng Xie
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, China Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Guohua Wang
- Center for Disease Prevention and Control, Tongxiang, Jiaxing, China
| | - Haibo Yan
- Center for Disease Prevention and Control, Shaoxing, China
| | - Liqun Yang
- Center for Disease Prevention and Control, Tongxiang, Jiaxing, China
| | - Wei Yu
- Center for Disease Prevention and Control, Shaoxing, China
| | - Jun Fan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Ruan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, China
| | - Nanping Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, China Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Xie T, Wu N. Epidemiological and mortality analysis of older adults with HIV in eastern China. Clin Interv Aging 2013; 8:1519-25. [PMID: 24277983 PMCID: PMC3838474 DOI: 10.2147/cia.s53657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective The aims of this study were to systematically review epidemiological characteristics in older people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (PLWHA) in low endemic areas of the People’s Republic of China, analyze the causes of death and mortality, and provide a basis for targeted prevention in these populations. Methods Nine counties representative of the distribution and epidemiological factors of the HIV epidemic in Zhejiang Province were selected, and data from 1,115 HIV-positive individuals, including 196 older people (≥50 years), who were confirmed as PLWHA from January 1, 2000 to December 31, 2012, were retrospectively analyzed. Results The proportion of older PLWHA increased from 0% in 2000 to 22.45% in 2012. Sexual transmission was the main route, accounting for 82.65% of infections in this group. Compared with the younger group (range from 14 to 49 years old), the older group had significantly lower CD4+ cell counts (291.64 versus 363.63; P<0.001) when first diagnosed, and more of this group presented in the AIDS state with opportunistic infections (51.02% versus 34.06%; P<0.001). In the older group, 25 (12.76%) patients died directly of AIDS and 171 (87.24%) were censored, and in the younger group 50 (5.44%) patients died directly of AIDS and 869 (94.56%) were censored. Estimated survival time since HIV diagnosis in the older group was 11.54±0.49 years (95% confidence interval [CI] 10.59–12.50), while in the younger group it was 13.85±0.46 years (95% CI 12.94–14.76), the log rank (Mantel–Cox) test gave a chi-square value of 3.83, and there was significant difference between the groups (P<0.05). Conclusion The number of older PLWHA increased steadily over the study period in low HIV endemic provinces of a developing country. Later discovery and preexisting disease perhaps contributed to a shorter estimated survival time for older PLWHA and higher mortality.
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Affiliation(s)
- Tiansheng Xie
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China ; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, People's Republic of China
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Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa. J Affect Disord 2013; 151:31-8. [PMID: 23726780 PMCID: PMC3781323 DOI: 10.1016/j.jad.2013.05.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/03/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions. OBJECTIVES Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people. METHODS In 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE). RESULTS Overall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0-36.2%) than HIV-infected (14.8%, 95% CI 9.9-19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7-30.6%) than in HIV-affected (15.1%, 95% CI 10.3-19.8%) participants. Being female (aOR 3.04, 95% CI 1.73-5.36), receiving a government grant (aOR 0.34, 95% CI 0.15-0.75), urban residency (aOR 1.86, 95% CI 1.16-2.96) and adult care-giving (aOR 2.37, 95% CI 1.37-4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2-3 times more likely to report poor health perceptions. LIMITATIONS Study limitations include the cross-sectional design, limited sample size and possible selection biases. CONCLUSIONS Prevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.
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Nyirenda M, Newell ML, Mugisha J, Mutevedzi PC, Seeley J, Scholten F, Kowal P. Health, wellbeing, and disability among older people infected or affected by HIV in Uganda and South Africa. Glob Health Action 2013; 6:19201. [PMID: 23364075 PMCID: PMC3554811 DOI: 10.3402/gha.v6i0.19201] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/04/2012] [Accepted: 12/27/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe and compare the health status, emotional wellbeing, and functional status of older people in Uganda and South Africa who are HIV infected or affected by HIV in their families. METHODS Data came from the general population cohort and Entebbe cohort of the Medical Research Council/Uganda Virus Research Institute, and from the Africa Centre Demographic Information System through cross-sectional surveys in 2009/10 using instruments adapted from the World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE). Analysis was based on 932 people aged 50 years or older (510 Uganda, 422 South Africa). RESULTS Participants in South Africa were slightly younger (median age - 60 years in South Africa, 63 in Uganda), and more were currently married, had no formal education, were not working, and were residing in a rural area. Adjusting for socio-demographic factors, older people in South Africa were significantly less likely to have good functional ability [adjusted odds ratio (aOR) 0.72, 95% CI 0.53-0.98] than those in Uganda, but were more likely to be in good subjective wellbeing (aOR 2.15, 95% CI 1.60-2.90). South Africans were more likely to be obese (aOR 5.26, 95% CI 3.46-8.00) or to be diagnosed with hypertension (aOR 2.77, 95% CI 2.06-3.73). DISCUSSION AND CONCLUSIONS While older people's health problems are similar in the two countries, marked socio-demographic differences influence the extent to which older people are affected by poorer health. It is therefore imperative when designing policies to improve the health and wellbeing of older people in sub-Saharan Africa that the region is not treated as a homogenous entity.
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Affiliation(s)
- Makandwe Nyirenda
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.
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