Older people's health in sub-Saharan Africa

Aboderin, Isabella; Beard, John

doi:10.1016/s0140-6736(14)61602-0

Cited by 168 publications

(129 citation statements)

References 8 publications

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“…[1] Although the population structure in sub-Saharan Africa (SSA) remains young in relative terms, this region already has double the number of older adults than northern Europe, and this figure is expected to grow faster than anywhere else in the world, increasing from 46 million in 2015 to 157 million by 2050. [2] Worldwide there is a growing burden of non-communicable diseases (NCDs) including cardiovascular diseases, chronic lung diseases, diabetes and cancer[3] along with a projected rapid shift from communicable diseases to NCDs as the dominant causes of morbidity and mortality in LMICs. [4] As NCDs predominate in middle and later life, older adults are likely to carry the greatest burden of NCDs.…”

Section: Introductionmentioning

confidence: 99%

Age Related Patterns of Disease and Mortality in Hospitalised Adults in Malawi

et al. 2017

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BackgroundThe epidemic of non-communicable diseases (NCDs) in low and middle income countries (LMICs) is widely recognised as the next major challenge to global health. However, in many LMICs, infectious diseases are still prevalent resulting in a “double burden” of disease. With increased life expectancy and longevity with HIV, older adults may particularly be at risk of this double burden. Here we describe the relative contributions of infections and NCDs to hospital admissions and mortality, according to age, in Malawi’s largest hospital.MethodsPrimary diagnosis on discharge/death, mortality rates, and HIV status were recorded prospectively on consecutive adult medical in-patients over 2 years using an electronic medical records system. Diagnoses were classified as infections or NCDs and analysed according to age and gender.Findings10,191 records were analysed. Overall, infectious diseases, particularly those associated with HIV, were the leading cause of admission. However, in adults ≥55 years, NCDs were the commonest diagnoses. In adults <55 years 71% of deaths were due to infections whereas in adults ≥55 years 56% of deaths were due to NCDs.InterpretationInfectious diseases are still the leading cause of adult admission to a central hospital in Malawi but in adults aged ≥55 years NCDs are the most frequent diagnoses. HIV was an underlying factor in the majority of adults with infections and was also present in 53% of those with NCDs. These findings highlight the need for further health sector shifts to address the double burden of infectious and NCDs, particularly in the ageing population.

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Section: Introductionmentioning

confidence: 99%

Age Related Patterns of Disease and Mortality in Hospitalised Adults in Malawi

et al. 2017

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“…To date there has been limited research on age in ART programmes in resource-constrained settings (10-13) and mortality has been estimated from standard patient record systems which are known to miss a high proportion of deaths (14, 15). Using linkages with the South African vital registration system, the International epidemiologic Databases to Evaluate AIDS-Southern Africa (IeDEA-SA) collaboration is able to correct mortality estimates for loss to follow-up (LTF), providing a unique opportunity to explore the long-term outcomes of a large number of older individuals starting ART in South Africa since 2004.…”

Section: Introductionmentioning

confidence: 99%

Age in antiretroviral therapy programmes in South Africa: a retrospective, multicentre, observational cohort study

et al. 2015

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Background As access to antiretroviral therapy (ART) expands, increasing numbers of older patients will start treatment and require specialised long-term care. However the impact of age in ART programs in resource-constrained settings is poorly understood. South Africa has the second largest population of older (≥50 years) people in sub-Saharan Africa. The HIV epidemic is also ageing rapidly and the country has one of the highest HIV population prevalences worldwide. This study explored the effect of age on mortality on ART in South Africa and whether this effect was mediated by baseline immunologic status. Methods IeDEA-SA is a regional collaboration which combines routine observational data from large ART programmes across Southern Africa. This study was a retrospective cohort analysis of adults starting ART from 2004-2013 in six large South African cohorts: two primary care clinics, three hospitals and a large rural cohort. The primary outcome was mortality; secondary outcomes were loss to follow-up (LTF), immunologic and virologic responses. Patients' vital status was ascertained through linkage to the National Population Register. Inverse probability weighting was used to correct mortality for LTF. Mortality was estimated using Cox's proportional hazards and competing risks regression. The interaction between baseline CD4+ cell count and age was tested. Immunologic responses were graphed by age and duration on ART. Findings 83 566 patients were followed for 174 640 patient-years. Patients were predominantly female, especially in the younger age groups: 81% (18 819/23 258) of patients 16-29 years and 66% (12 812/19 372) of those aged 30-34. Mortality increased with age in a dose response, mediated by baseline immunologic status. Patients with CD4 counts <50 cells/μL were a particularly high risk group, comprising 14% of all older patients starting ART. The percentage of older patients enrolling increased with successive calendar years from 6% (290/4 999) in 2004 to 10% (35/9 657) in 2012/13, comprising 9% of total enrolment (7 295/83 566). By analysis closure, 14% of all patients still alive and in care were ≥50 years old. Interpretation Health services need re-orientation towards diagnosing and starting ART in older individuals. Policies are needed for long-term care of older people with HIV. Funding Supported by NIH (NIAID), USAID & South African Centre for Epidemiological Modelling & Analysis.

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“…In addition, infectious disease morbidity and mortality in many low-income and middle-income countries increasingly affect older people because of the aging population and changes in the epidemiology of some diseases such as HIV/AIDS or tuberculosis (10,11). Globally, the leading contributors to disease burden in older people are cardiovascular diseases (30.3% of the total burden in people aged 60 years and older), malignant neoplasms (15.1%), chronic respiratory diseases (9.5%), musculoskeletal diseases (7.5%), and mental and neurological disorders (6.6%) (Figure 1) (7,12).…”

Section: Burden Of Disease As a Results Of Aging Of The Populationmentioning

confidence: 99%