Ageing and Health in Sub-Saharan Africa

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Ageing and Health in Sub-Saharan Africa

• Robert Cumming
• University of Sydney
• Australia

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(No Transcript)
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In sub-Saharan Africa there are

• 25 million people living with HIV
• 37 million older people (aged 60)

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Percentage of older persons (60) Sub-Saharan
Africa and other world regions, 1950-2050
34
27
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23
17
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Source United Nations, World Population
Prospects. The 2006 Revision
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Absolute number (millions) of older persons
(60)Sub-Saharan Africa and other world regions
2005-2050
Source United Nations, World Population
Prospects. The 2006 Revision
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Ward Round Infectious Diseases

• Tetanus
• Cryptococcal meningitis x 3
• HIV/AIDS wasting
• Toxoplasmosis x 2
• Measles
• Malaria
• Diabetes
• Kaposis sarcoma
• TB

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Ward Round Cardiology

• Atrial thrombosis
• Pericardial effusion (TB)
• Mitral incompetence
• Bacterial endocarditis x 2
• Heart failure (hypertension)
• Bronchopneumonia
• Stroke

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Uganda and AustraliaBasic Facts
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Population Age DistributionUganda and Australia
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Life Expectancy at Various AgesUganda and
Australia
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Major Causes of DeathSub-Saharan Africa

Malaria
Diarrhoea
Measles
IHD
MVA
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Leading Causes of Death at Age 60Sub-Saharan
Africa

• Males
• 1. Heart disease
• 2. Stroke
• 3. Pneumonia
• 4. COPD
• 5. Prostate cancer
• 6. TB
• 7. HIV/AIDS

• Females
• 1. Stroke
• 2. Heart disease
• 3. Pneumonia
• 4. Kidney disease
• 5. Diabetes
• 6. COPD
• 7. Hypertensive heart dis.

Cervical cancer is no 10 and breast cancer is no
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Source Rao et al in Disease and Mortality in
Sub-Saharan Africa, World Bank 2006
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Prevalence of High Blood Pressure(gt140/90)
Source Steyn et al in Disease and Mortality in
Sub-Saharan Africa, World Bank 2006
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Prevalence of Obesity
Source Steyn et al in Disease and Mortality in
Sub-Saharan Africa, World Bank 2006
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Prevalence of DiabetesCameroon and Australia
Sources Mbanya et al. Diabetalogia
199740824-829 and Dunstan et al. Diabetes Care
200225829-834
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Prevalence of DisabilityPopulation and Housing
Census Uganda 2002
Difficulty in moving, seeing, hearing, speaking
or learning that has lasted 6 months or more
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TAFU Survey of Older People in Uganda (2006)

• 382 subjects
• 182 interviewed individually
• 200 interviewed in groups
• Selected from 7 districts from all 4 regions of
  Uganda and Kampala
• Age range 65-80 (mean 68 years)
• 55 female
• Semi-structured interview

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PovertyTAFU Survey
Would you describe your income as.
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NutritionTAFU Survey
Do you have enough to eat?
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Main Problems Facing Older PeopleTAFU Survey
Only asked in group interviews (n200)
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Health ProblemsTAFU Survey
Do you have any sickness now?
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Prevalence of DementiaNigeria and USA
African-Americans living in the community
Source Hendrie et al. Am J Psych
19951521485-1492
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Prevalence of DepressionNigeria (2003)
Survey of 2,452 people aged 65 in
Yoruba-speaking areas Overall prevalence of
depresssion 7.1
Source Gureje et al. Lancet 2007370957-964
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Common Health Problems Among Older People

• Causes of death
• Heart disease
• Stroke
• Causes of disability
• Arthritis
• Dementia
• Falls and fractures
• Incontinence
• Poor vision

• Risk factors
• High blood pressure
• Diabetes
• Physical inactivity
• Other
• Depression
• Polypharmacy
• Elder abuse

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HIV and Older Peoplein Sub-Saharan Africa
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Impact of HIV on Older People

• Infection with HIV
• Caregiving for children and grandchildren
• Grief due to death of children
• Financial impact
• Stigma

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HIV Prevalence in Uganda
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Children Living with Grandparents
Source Bicego et al. Soc Sci Med
2003561235-1247
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Services for Older People

• No aged pension
• No aged care services
• Policy on ageing
• International NGOs
• Older Persons NGOs

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Medical Practitioners
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Whats Next?

• Study of musculoskeletal disease in sub-Saharan
  Africa (Wellcome)
• Training in non-communicable disease prevention
  and control (British Council)
• Study of health of grandparents caring for
  orphans living with HIV (AARF)
• Establish a geriatric medicine out-patients
  clinic at Mulago Hospital