ArticleLiterature Review

Contemporary views on dementia as witchcraft in sub-Saharan Africa: A systematic literature review

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Abstract

Aim: A systematic review to explore the impact of cultural beliefs of dementia as witchcraft in sub-Saharan Africa. Background: The population of sub-Saharan Africa is aging, which increases the number of those at risk of dementia. Mental health and physical diseases that affect behaviour have often been associated with witchcraft. Accusations of witchcraft leave individuals vulnerable and at risk. Method: A systematic review, which followed the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and completed a PRISMA checklist. CINHAL, PsychINFO, Web of Knowledge, PubMed and Science Direct databases were searched for relevant studies published from their inception to 31st May 2019 by applying appropriate Medical Subject Headings. Data analysis adhered to Thomas and Harding's thematic synthesis. Results: The review identified limited literature on this topic, with only five papers meeting the inclusion and exclusion criteria. Studies explored health provision, and knowledge and beliefs of dementia in Tanzania and South Africa. Three themes emerged: 1) poor knowledge of dementia, including the belief of dementia as witchcraft; 2) challenges of supporting a family member with dementia in the community; and 3) health seeking behaviours of and for people with dementia. Conclusion: There remains a need for dementia awareness and education across sub-Saharan Africa communities, including faith and traditional healers, and healthcare professionals to support pluralistic healthcare provision. Nurses are the best-placed healthcare professionals to support these initiatives and the development and implementation of low-resource non-pharmacological interventions to support people with dementia and their families living in the community. Relevance to clinical practice: Nurses working in sub-Saharan Africa and those caring for patients from sub-Saharan Africa can only provide person-centred care and support for a person with dementia and their family if they understand their cultural beliefs, one of which may include witchcraft.

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... It is estimated that people over the age of 60 will increase from 46 million people in 2015 to 157 million people by 2050 (Aboderin & Beard, 2015), the fastest growing population being in sub-Saharan Africa. In 2015, it was estimated that 186,000 people were living with dementia in South Africa, which is predicted to increase to 275,000 by 2030, with 225,000 of those expected to be women (Brooke & Ojo, 2019). Current comprehensive studies within the Southern African context revealed that people suffering from dementia would be at risk of being accused of witchcraft due to religious and cultural superstitions, especially due to the inability to associate the term "dementia" within local languages (Brooke & Ojo, 2019;Mkhonto & Hanssen, 2018). ...
... In 2015, it was estimated that 186,000 people were living with dementia in South Africa, which is predicted to increase to 275,000 by 2030, with 225,000 of those expected to be women (Brooke & Ojo, 2019). Current comprehensive studies within the Southern African context revealed that people suffering from dementia would be at risk of being accused of witchcraft due to religious and cultural superstitions, especially due to the inability to associate the term "dementia" within local languages (Brooke & Ojo, 2019;Mkhonto & Hanssen, 2018). Hence the elderly often face discrimination, particularly those with cognitive decline and memory impairment (Borochowitz, 2011). ...
... It is becoming increasingly clear that enhanced awareness and robust support are required to improve and normalize the terminology and language used when addressing and dealing with AD diagnosis and prognosis ("World Alzheimer Report 2019: Attitudes to dementia," 2019). In addition, the prevalence of AD is higher in females than males and thus elderly women are more prone to violence (Brooke & Ojo, 2019). Moreover, an existing notion of male honour in some communities may further contribute to partner violence with females being the main victims (Krug et al., 2002). ...
Chapter
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Female sex workers constitute a diverse group working in a wide array of contexts. They face disproportionate burdens of HIV, HIV risk and limited access to healthcare services. Sub-Saharan Africa bears the brunt of HIV among sex workers, with the highest proportion of global sexual transmission of HIV in sex work (17.8%) occurring in the region.
... This review indicates that mediocre dementia knowledge among healthcare professionals is associated with limited professional training and inadequate education since dementia care has not been integrated into medical or nursing curricula in China (Hsiao et al., 2016;Li et al., 2019;Wang, Xiao, Luo, et al., 2018;Yu et al., 2013). These findings are consistent with studies reporting inadequate knowledge of dementia of healthcare professionals from developing countries such as Africa (Brooke & Ojo, 2020 (Pinkert et al., 2018). ...
... Generally, healthcare professionals and family carers in China possess negative attitudes towards dementia care (Du et al., 2014;Hsiao et al., 2016;Wu et al., 2016). Similar negative attitudes towards dementia care by healthcare professionals and carers were found in countries in Europe and Africa (Brooke & Ojo, 2020;Evripidou et al., 2019). Stigma associated with dementia can negatively affect the attitudes of healthcare professionals, as well as the perceptions and health-seeking behaviours of carers (Brooke & Ojo, 2020), which can delay diagnosis and treatment and thus, impede quality care for people with dementia (Herrmann et al., 2018). ...
... Similar negative attitudes towards dementia care by healthcare professionals and carers were found in countries in Europe and Africa (Brooke & Ojo, 2020;Evripidou et al., 2019). Stigma associated with dementia can negatively affect the attitudes of healthcare professionals, as well as the perceptions and health-seeking behaviours of carers (Brooke & Ojo, 2020), which can delay diagnosis and treatment and thus, impede quality care for people with dementia (Herrmann et al., 2018). Attitudes towards dementia care by healthcare professionals and family carers were more negative in rural China compared with urban China, where there were more stigma and lower health literacy . ...
Article
Aims and objectives To establish an understanding of healthcare professionals’ dementia knowledge and attitudes towards dementia care, and family carers’ perceptions of dementia care in China Background Healthcare professionals and family carers of people with dementia deliver most of the dementia care in China. However, little research on healthcare professionals’ dementia knowledge and attitudes towards dementia care, and family carers’ dementia care perceptions has been conducted in China Methods An integrative review was conducted and reported based on the PRISMA guidelines and Whittemore and Knafl's framework. Eight English databases were searched without date restriction: CINAHL Plus with Full Text, MEDLINE, PubMed, Web of Science, Cochrane Library, Embase, PsycINFO and Scopus; and three Chinese databases: China National Knowledge Infrastructure, Chongqing Weipu and Wanfang, plus a manual search of reference lists. Results Thirty‐eight primary research papers were included in the review. Three themes were identified from the synthesis: 1) knowledge and competency; 2) attitudes towards dementia care; and 3) carers’ burden and unmet needs. Healthcare professionals’ dementia knowledge ranged from low to moderate levels and attitudes towards dementia care were generally negative. With low levels of knowledge of dementia and negative attitudes including stigma, family carers were under stress with insufficient support, and they expected more support from community nurses. Conclusions There is an apparent need for a national policy on healthcare professional education and training to improve dementia care practice in China. Such a policy may improve support services for family carers. Relevance to clinical practice Nurses, and particularly community nurses, are well‐positioned to support family carers in China. However, healthcare professionals in China are not prepared for this. Therefore, education and training on dementia care should be integrated into medical and nursing undergraduate programs and provided for healthcare professionals after commencing employment, and strategies to reduce stigma are needed
... According to George-Carey et al. (2012), dementia prevalence likely doubles every 5 years after age 65, which will lead to increases in Nigeria as the population ages. In addition, like other Sub-Saharan African (SSA) countries, this increasing prevalence is not matched with increasing scientific knowledge and awareness about dementia (Brooke & Ojo, 2019;Spittel et al., 2019), but rather remains grounded in folk or everyday beliefs (Kleinman, 1978) coupled with reliance on unpaid caregivers (Schatz & Seeley, 2015). Subsequently, Nigeria also shares some similarities to other SSA countries in that dementia carries stigma for people living with dementia and their families because some believe that dementia is a punishment for transgressions earlier in life or is caused by witchcraft (Brooke & Ojo, 2019;Spittel et al., 2019;Yusuf & Baiyewu, 2012). ...
... In addition, like other Sub-Saharan African (SSA) countries, this increasing prevalence is not matched with increasing scientific knowledge and awareness about dementia (Brooke & Ojo, 2019;Spittel et al., 2019), but rather remains grounded in folk or everyday beliefs (Kleinman, 1978) coupled with reliance on unpaid caregivers (Schatz & Seeley, 2015). Subsequently, Nigeria also shares some similarities to other SSA countries in that dementia carries stigma for people living with dementia and their families because some believe that dementia is a punishment for transgressions earlier in life or is caused by witchcraft (Brooke & Ojo, 2019;Spittel et al., 2019;Yusuf & Baiyewu, 2012). To complicate matters, family members of persons with dementia risk being ostracized by others, including other family members, because of these beliefs (Adebiyi et al., 2016). ...
... In addition, in Nigeria, although caring for a person living with dementia who may be exhibiting associated symptoms (e.g., inappropriate language, aggression) can be difficult, caregivers rarely seek external or professional help. This is likely due to problems with health care access and the unacceptance of formal long-term care mentioned earlier (Ogunniyi et al., 2005;Okoye, 2012;Welcome, 2011), as well as the stigma associated with dementia (Adebiyi et al., 2016;Brooke & Ojo, 2019;Nwakasi et al., 2019;Spittel et al., 2019). As a result, care for people living with dementia in Nigeria is assumed to be substantially worse compared with developed countries (Ogunniyi et al., 2005). ...
Article
Some Nigerians, in their effort to make sense of dementia symptoms, use descriptions that may stigmatize people with dementia and their families. This qualitative descriptive study focused on the everyday understanding of dementia and the impact of stigma on the caregiving experiences of informal female Nigerian dementia caregivers. Semi-structured interviews were conducted with a purposive sample of 12 adult informal female caregivers in Nigeria and analyzed for themes. Afterward, results were presented to focus groups of 21 adult Nigerians residing in the United States for more contextual insight on the findings. The three major themes were misconceptions about dementia symptoms, caregiving protects against stigmatization, and stigma affects caregiving support. Overall, we argue that knowledge deficit, poor awareness, and traditional spiritual beliefs combine to drive dementia-related stigmatization in Nigeria. Strategies such as culturally appropriate dementia awareness campaigns and formal long-term care policies are urgently needed to help strengthen informal dementia caregiving in Nigeria.
... It is important to understand that intellectual performance in older people remains unchanged (Bernoth & Winkler, 2018;Eberstole et al., 2008;Touchy & Jett, 2016). Ageing changes in neurological functioning are also often interpreted through a cultural lens, for example older women with dementia are considered witches in some Ghanaian communities and are usually sent to witches camps, banished from their communities or tortured to death (ActionAid, 2012;Brooke & Ojo, 2020;Tawiah, 2011;Whitaker, 2012). Parallel to this is the belief in many communities in Ghana that pain is normal in older people (Aziato et al., 2016). ...
... The main psychological factors responsible for mental health problems in older people have been found to be anxiety and depression usually resulting from physical, psychological, financial, sexual abuses or mistreatments (Bryant et al., 2013;Dong & Simon, 2013;Jeste et al., 2005;Kok & Reynolds, 2017;WHO, 2017a). There is a growing trend of psychological abuse of older people in many African countries including Ghana due to the beliefs of witchcraft in older people (ActionAid, 2012;Brooke & Ojo, 2020;Gorman, 2000;Madueme, 2020;Onyinah, 2020;Onyinah & Scott, 2020;Sanou, 2020;Tawiah, 2011;Whitaker, 2012). In some regions of Ghana many older women with mental health issues are regarded as witches and abused, marginalised or even killed (ActionAid, 2012;Adinkrah, 2020;Crampton, 2013;Onyinah, 2020). ...
... This is not consistent with reports which show anxiety and depression in older people are usually a result of physical, psychological, financial, sexual abuses or mistreatments (Kok & Reynolds, 2017;WHO, 2017aWHO, , 2017b. There is a growing trend of psychosocial abuse of older people in many African countries including Ghana due to the beliefs of witchcraft in older people especially older women (Brooke & Ojo, 2020). In some regions of Ghana, many older women with mental health issues are regarded as witches and abused, marginalised or even killed (Onyinah, 2020;Onyinah & Scott, 2020). ...
Article
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Introduction Knowledge on ageing has an impact on the quality of care provided to older people. Although older Ghanaians provide various forms of support to family and communities, many of them experience poor nursing care in the Ghanaian health system. There is, however, dearth of evidence regarding knowledge of ageing among Ghanaian nurses. Objective This study therefore used a descriptive survey approach to investigate knowledge of graduating undergraduate nurses on physiological, and psychosocial changes in ageing. Methods Seventy graduating undergraduate nurses were surveyed to identify their knowledge on physiological and psychosocial changes leading to care needs of older people in Ghana. Three undergraduate nursing programs with gerontological nursing courses were purposively selected for the study. Descriptive statistics were used to analyze the data in order to present quantitative descriptions of variables in this study. Results The response rate in the study was 42%. Findings of the study show graduating undergraduate nursing students have inadequate knowledge on ageing. Several gaps in knowledge regarding ageing were identified. Although undergraduate nursing schools had gerontological nursing courses in their programs, over 90% of participating graduating nursing students indicated pain, anxiety and depression are normal aspects in the ageing process. Conclusion It is imperative to improve the current curricula content on gerontological nursing in Ghanaian nursing schools to equip nurses with knowledge and skills needed to provide quality healthcare to older people in Ghana. Improving knowledge on ageing through evidence-informed gerontological nursing curricula content will lead to better nursing care of older Ghanaians. Providing educational opportunities for improved quality nursing care of older Ghanaians is in line with the United Nations (UN) Sustainable Development Goal 3, which aims at providing equal and quality healthcare to all age groups by 2030.
... 3 Currently, in Africa, prevalence of dementia in people aged 50+ is estimated to be about 2.4%, with variances from 1% to 10% among SSAcountries. 3,4 Besides, there is a lack of awareness and knowledge on dementia so that persons afflicted by this and any other neurological disorder are experiencing stigmatization, discrimination and/or exclusion from society, [5][6][7] as are their families, friends, and healthcare providers. 5,8 In SSA, such stigmatization and negativity towards people with cognitive impairment is highly prevalent, [9][10][11][12][13][14][15] and this creates a distance between patients and the general community, at times resulting in exclusion from society. ...
... The concept that dementia is seen as a work of "witches" is a common problem in SSA. 5,6 In most African cultures, there is no "name" for dementia, which ultimately results in older people being accused of exercising witchcraft to harm other people. 14,36 Alarmingly, we also found that signs and symptoms typically manifesting with dementia were frequently seen as behaviors of "witches" and "wizards." ...
Article
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The survey focuses on identifying dementia awareness challenges among Ghanaian school students. Data were generated in a cross-sectional survey (n = 1137). 9.3% of school students showed dementia awareness whilst the community respondents, representing both higher age and level of education, showed greater awareness (32.2%, P < .001). 45% of respondents believed in witchcraft and 57% were afraid of potentially being harmed by witchcraft. Age and education did not influence people’s belief in witchcraft. Moreover, dementia symptoms were often mistaken for witchcraft, especially by those who had encountered a person accused of witchcraft: “swearing at others” (24%), displaying “memory loss” and “confused speech” (22%), “forgetfulness” and who was seen “roaming around” (19%). Lack of dementia awareness was particularly evident among school students whereas belief in witchcraft was similar in both respondent groups. There was a correlation between low dementia awareness rates and misinterpretation of dementia symptoms with attribution to witchcraft.
... Some Indigenous Peoples view dementia and memory loss as an accepted part of the normal ageing process, as a spiritual phenomenon, or as a "second childhood" on the circle of life's continuum (Jacklin & Walker, 2019;Hulko et al., 2010;Lanting et al., 2011). In some cases, dementia has evoked fear and mistrust, causing people with dementia to be accused of witchcraft (Zeilig, 2014;Brooke & Ojo, 2020). In some parts of the world, such as Congo, dementia is perceived as a mysterious disease that requires treatment and care through traditional and faith or religious healers (Kehoua, 2019). ...
Thesis
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Access to culturally-safe dementia assessment, diagnosis, and care in Indigenous populations worldwide is an emerging challenge. In 2018, the World Health Organization recognized traditional healers as stakeholders in dementia care and prevention. Traditional healers contribute to dementia assessment, diagnosis, and care in unique ways, and play a catalytic role in the process of culturally-safe dementia care planning and assessment with health care providers at the community level. The purpose of this scoping review was to understand the roles and experiences of traditional healers, to evaluate strategies for integration between Indigenous traditional healing and western dementia care approaches, and to examine the policy barriers and research gaps in North America (Canada and United States), Australia, and New Zealand. The scoping review methodology used was the Joanna Briggs Institute (JBI) approach that included six steps: protocol development based on participants, content and context framework, development of a search strategy, selection of relevant studies, charting of relevant data, synthesis, and reporting of results, and conducting stakeholder consultation. We searched English literature in select bibliographic databases, including CINAHL, EMBASE, Medline and PsycINFO. The initial search identified 516 papers published between 2000 and 2020 that met the search criteria. After 164 duplicates were removed, we screened 352 titles and abstracts, excluding the 209 that did not meet the inclusion criteria. Our second stage review of 143 full-text studies resulted in the further exclusion of 141 studies. Only two studies from Canada ii met all inclusion criteria for this scoping review and explored the potential integration of traditional healing in dementia care and the roles and perceptions of traditional healers. The two studies were conducted in Southwestern Ontario in an urban First Nations community and Saskatchewan with Cree, Salteaux, and Metis populations in rural and remote communities. The studies indicated that the inclusion of traditional healers, Elder knowledge-holders, Grandmother groups, and emerging Indigenous scholars and researchers can contribute to building an evidence-based dementia care decision-making process for Indigenous people with dementia. Hence, integrating Indigenous traditional healing and medicine in dementia care is a path to culturally-safe dementia care and social support systems for people with dementia.
... Although most legislation, politics and economics in South Africa generally views witchcraft and beliefs in it as nothing of value, a wild imagination embedded in people's backwardness and obliviousness, the existence of witchcraft as lived experiences remains a reality for many Africans (Schnoebelen, 2009;Brooke & Ojo, 2020). Belief in witchcraft enables some individuals to explain their misfortunes by linking it to acts of evil (Agyapong, 2020). ...
Article
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In South Africa, there is no adequate research that explored mathematics learning and teaching within rural schools and classrooms. Various literature posits that mathematics education research has virtually over-concentrated on urban and township schools and consistently ignored rural contexts and schools. Arguments exist that rural education and rural education research have been understudied in South Africa. Presumably, this would include mathematics education research as well. This paper explores the relationship between witchcraft beliefs, which is considered as an entrenched cultural phenomenon, and learners' mathematics learning within rural classrooms. In this paper, the local influences include that the learners end up not demonstrating their full understanding of mathematics contents because of the beliefs that if they exhibit their knowledge of the subject, they may be bewitched. Cultural Relativism was used to theorise the study within qualitative critical phenomenology as a methodology for the study. The study comprises 12 mathematics learners from a rural Acornhoek region in Mpumalanga Province, and data were collected using individual semi-structured interviews while the collected data were analysed using Critical Discourse Analysis. Findings from this study illuminated that local beliefs and knowledge such as witchcraft exert significant influence on schools and learners' learning, including learners' not demonstrating their optimum understanding of mathematics.
... Dementia was also commonly attributed to witchcraft, a prevalent ascription in Africa (Brooke & Ojo, 2020;C. Musyimi, Mutunga, & Ndetei, 2019). ...
Article
Objectives: We aimed to explore the perceptions towards dementia and related care across three stakeholder groups in rural Kenya. Methods: A total of 38 key stakeholders (carers of persons with dementia, health care providers and the general public) participated in focus group discussions. Additional five individual interviews were held with carers. Thematic analysis was used to analyse the data. Findings: Across the three participant groups, a total of four themes were identified: (i) negative stereotypes of dementia, (ii) limited knowledge about dementia, (iii) diagnostic pathway and (iv) neglect and abuse. Conclusions: We found a general lack of knowledge of dementia amongst family carers, healthcare professionals and the general public. The combination of poor awareness and ill-equipped healthcare systems leads to stigma manifested in the form of patchy diagnostic pathways, neglect and abuse. Local governments could take advantage of the existing family- and community-based systems to improve understanding of dementia nationally.
... In the review, Oppong (2006) highlighted how older people had lost their social value and reverence due to the value shift from collectivism to individualism. Religion plays a critical role in the social tagging of older persons as witches and wizards across different African communities (Asamoah-Gyadu, 2015;Brooke & Ojo;Crampton, 2013). With decades of economic challenges, social ills, health challenges, and insecurity, religiosity has engulfed the minds of young and old in search of solutions (Rotimi et al., 2016). ...
Article
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Older people's views, experiences and explanations on abuse and neglect in later life is marginal in the literature. With more cases of physical abuse and neglect in old age in sub-Saharan Africa, this study explored the views and positions of older people and community stakeholders like religious leaders on why physical elder abuse and neglect and preventive measures within community settings in Nigeria. An exploratory research design that consisted of two focus group discussions with older Yoruba men and women (60+) and six semi-structured interviews with religious leaders (Christianity, Islam, and Traditional) guided the study. Based on thematic analysis, the findings revealed that older persons and religious leaders have multiple interpretations of physical elder abuse and neglect. Social ills, poor economic situation, evil machinations, and stereotypes and misconceptions of old age and spirituality are possible explanations for physical abuse and neglect. The intersecting nature of the factors promoting vulnerability to physical abuse and neglect in later life also emerged in the preventive measures suggested by older persons and community members. As such, the participants affirmed that most older persons are becoming conscious of vulnerability to abuse and do contest actions, relationships, and contexts that can reduce their vulnerability and earn more social acceptance. Nonetheless, the participants expressed worries over the absence of policies and legal frameworks that can protect older people against physical abuse and neglect. More worrisome was the growing spread of social ills, stereotypes around old age, poverty in old age, witchcraft accusations and ageism. These developments are compounding ageing experiences, including physical abuse and neglect in urban spaces in Nigeria.
... Three existing systematic literature reviews analyse awareness challenges for mental health, witchcraft beliefs around dementia and the challenges of living with dementia in Sub-Saharan Africa (Alzheimer's Disease International, 2019;Spittel, et al., 2019;Brooke and Ojo, 2020); however, no systematic review was made specifically for South Africa, neither the literature focuses on rural-urban disparities in dementia perceptions. In South Africa, the research on societal views about dementia is not broad (Jacobs, et al., 2019) and from the literature it is possible to understand that the interest in dementia perception in this country has been increasing only in the last years. ...
Thesis
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Dementia represents globally one of the main burdens to society; nonetheless, in resource-poor regions such as South Africa the problems are enormous and are emphasized by beliefs around dementia. The literature recognizes that beliefs like witchcraft are present especially in rural South Africa. There is yet no comprehensive study about rural-urban differences in dementia perceptions in South Africa and the publications do not explain why witchcraft is more associated with rurality. This research aims at understanding the different dementia perceptions in rural-urban South Africa and deepening the knowledge of why some traditional beliefs are more associated with rural communities, seeking what are the implications. Through semi-structured online individual interviews, I analysed the different types of perceptions, causes and consequences, giving particular attention to the rural-urban dichotomy. The thematic analysis shows that rural-urban differences in dementia perceptions exist in South Africa and in rural areas, perceptions go far beyond witchcraft. On the other hand, in urban areas, dementia is seen more as normal process of ageing. The presence of beliefs is stronger in rural areas: the main causes found are culture, religion and lack of knowledge, creating negative implications for diagnosis, treatment and attitudes in rural areas compared to urban ones. Finally, this study arises from the idea that it is important to understand dementia perceptions and how these affect people to better apply specific policies for dementia care in rural versus urban areas of South Africa.
... There is a scarcity of knowledge relating to local understandings of dementia in SSA Brooke & Ojo, 2020). There are four main explanatory models of dementia: as a neuropsychiatric condition; as a form of interplay between biological, psychological and social factors; as a spiritual experience; and as a part of the normal ageing process (Downs et al., 2006). ...
Chapter
As life expectancy increases around the world, dementia has become a global challenge, impacting the social and economic structure of low- and middle-income countries. Due to the limited number of studies in developing regions, there is a need to increase efforts to identify and discuss the regional realities of dementia in non-Western cultures. In this work, epidemiological data, cultural expressions, regional challenges and future directions of dementia are reviewed in Sub-Saharan Africa, Asia and Latin America. Similar patterns across these regions emerge, such as challenges associated with demographic transitions, competing health demands and limited resources, the misconception that dementia is a natural consequence of ageing, the influence of the supernatural when attributing causes for dementia and the general stigmatization around the condition. Exploring the experience of people living with dementia in those regions shows how that is heavily influenced by the way the community understands the condition, how their services work and by socio-cultural and economic factors. The data reviewed and discussed in this chapter highlight the importance of developing national plans for dementia taking into consideration each regional reality. Also, findings reinforce the need for additional studies, focusing on fostering the quality of life of people with dementia and their caregivers.
... Instead, it is a cultural observation which included carers in Poland, albeit Polish carers utilised more day care centres than Indian carers. Research into various LMICs suggests that dementia care is mostly, if not solely, provided by the family [12,25]. There are a number of reasons for this, including lack of available or affordable social support services, lack of diagnoses of the condition, which is a key to accessing care in the first place, as well as religious and cultural duties [26]. ...
Article
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Background Emerging evidence shows an impact of the COVID-19 pandemic on people living with dementia and informal carers, without any evidence-based global comparison to date. The aim of this international study was to explore and compare the perceived impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries. Methods Informal carers and people living with dementia who were residing in the community in the UK, Australia, Italy, India, and Poland were interviewed remotely between April and December 2020. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using inductive thematic analysis. Results Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were very limited in benefit and usability for those with dementia. As a result, carers appeared to notice reduced cognitive and physical health in people with dementia. Particular differences were noted between India and Poland vs. the UK, Italy, and Australia, with less impact on care provision in the former due to limited uptake of support services pre-pandemic based on cultural settings. Conclusions The pandemic has amplified dementia as a global public health problem, and people affected by the condition need support to better access vital support services to live well.
Article
Quelle image nous vient-il à l’esprit lorsque l’on pense à une personne atteinte de troubles neurologiques ? Les stéréotypes abondent : soit c’est une personne qui hurle et fracasse tout autour d’elle, soit c’est une personne, assise, silencieuse, sans voix. Pour le premier cas, on l’appellera un fou ou dans le langage mauricien ou le créole « fouca » ou « pagla » ; et pour le deuxième cas, on pense à un vieux, atteint d’Alzheimer. L’Autre, atteint de démence, est souvent perçu comme ayant une identité fragmentée. Il perd ainsi toute sa dignité humaine lorsqu’il est vu comme un personnage inquiétant ou qui fait honte, et lorsqu’il doit être enfermé ou caché de la société. Déconnecté du monde humain, il devient un mort-vivant. Notre étude, toujours dans un état embryonnaire, a pour objectif à court terme de faire un état des lieux des personnes âgées atteintes de troubles neurologiques à Maurice. Nous avons contacté les ONG, des chercheurs travaillant sur le sujet et nous avons aussi fait un sondage sur la perception des Mauriciens sur les personnes âgées atteintes de troubles neurologiques. Les résultats et analyses nous amènent à conclure que davantage d’effort doit être fait pour sensibiliser les gens afin de réduire les stigmates et ainsi créer une société plus inclusive.
Chapter
Alzheimer’s disease is a neurodegenerative disease resulting in gross damage of brain areas mainly involved in cognitive function manifesting as cognitive impairment and memory loss. This chapter describes the key molecular hallmarks that are associated with the formation of amyloid beta and hyper-phosphorylated tau, with their effects on mitochondrial and tubulin function and the role of autophagy in bulk protein degradation, the clearing of toxic protein aggregates and its failure and dysfunction in the pathogenesis of Alzheimer’s disease. The chapter also discusses public perceptions of the disease and associated stigma which may affect integration into society. In doing so, we highlight not only the importance of science communication, but also the disconnect between public perceptions and scientific assessments of Alzheimer’s disease.
Article
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In tandem with the ever‐increasing aging population in low and middle‐income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person‐years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome–associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome‐wide association studies are needed to relate to dementia phenotypes. Validated culture‐sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium.
Chapter
The global population aging is the most evident, ongoing demographic phenomenon and is involving both migrants and their native counterparts in host countries. As a result, migrants are growingly dealing with age-related pathological conditions with important societal, clinical, and public health implications. Specifically, the occurrence of dementia and cognitive disturbances in individuals with a migration background may assume special relevance. Indeed, the migrant status can affect the individual’s dementia risk, the accessibility and use of dedicated healthcare resources, the clinical and diagnostic approach, the cognitive and neuropsychological assessments, and the whole process of care and support. Accordingly, the development of intercultural care and support for people with a migration background living with dementia should increasingly be regarded as a priority for our healthcare systems. In the present chapter, the main complexities surrounding the issue of dementia among aging migrants are outlined and discussed. Moreover, recommendations/points for reflection are provided with the aims of (1) ensuring an equitable and culturally-competent provision of dementia care and support, (2) reducing disparities in the access to dedicated healthcare resources, and (3) improving the situation of patients, families and professional caregivers from minority ethnic backgrounds.
Preprint
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Background Emerging evidence shows an impact of the COVID-19 pandemic on people living with dementia and informal carers, without any evidence-based global comparison to date. The aim of this international study was to explore and compare the perceived impact of COVID-19 and associated public health restrictions on the lives of people living with dementia and informal carers and access to dementia care across five countries. Methods Informal carers and people living with dementia who were residing in the community in the UK, Australia, Italy, India, and Poland were interviewed remotely between April and December 2020. Participants were asked about their experiences of the pandemic and how restrictions have impacted on their lives and care. Transcripts were analysed by researchers in each country using inductive thematic analysis. Results Fifteen people living with dementia and 111 informal carers participated across the five countries. Four themes emerged: (1) Limited access and support; (2) Technology and issues accessing remote support; (3) Emotional impact; and (4) Decline of cognitive and physical health reported by carers. Whilst variations were noted, the pandemic has indirectly affected people with dementia and carers across all five countries. The pandemic removed access to social support services and thus increased carer burden. Remote services were not always provided and were very limited in benefit and usability for those with dementia. As a result, carers appeared to notice reduced cognitive and physical health in people with dementia. Particular differences were noted between India and Poland vs. the UK, Italy, and Australia, with less impact on care provision in the former due to limited uptake of support services pre-pandemic based on cultural settings. Conclusions The pandemic has amplified dementia as a global public health problem, and people affected by the condition need support to better access vital support services to live well.
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Recent estimates of the prevalence of dementia in Sub-Saharan Africa indicate that it is set to increase considerably. There is therefore an urgent need for large-scale studies of dementia risk factors in this context, including genomic studies of the most common form of dementia, late-onset Alzheimer’s disease. While studies have increased our knowledge of the genetic architecture of late-onset Alzheimer’s disease, there is significant underrepresentation of populations with African ancestry. This underrepresentation has ethical implications, given the long-term potential of genetic knowledge for predicting risk, improved diagnosis, and possibly novel treatment approaches for Alzheimer’s disease. Such studies may, nevertheless, pose indirect risks to participants in contexts where the symptoms associated with dementia are highly stigmatized. On the other hand, large-scale studies may offer unique opportunities to address dementia stigma through providing the infrastructure for further empirical ethics research, community engagement and collaboration with nonspecialized health care providers, including traditional and faith healers. In this chapter, we commence with an introduction of relevant background to frame these issues, followed by an overview of conceptual interpretations of dementia-related stigma and dominant explanatory models of dementia-related symptoms in sub-Saharan African contexts, with special attention paid to a prevalent explanatory model that links dementia symptoms with malevolent spiritual causes such as witchcraft. Given that genomic studies are often premised on a biogenetic model of disease, we then look at findings from studies that have assessed the impact of such explanatory models on stigma. In particular, we highlight the possibility that biogenetic approaches to mental disorder may be interpreted in essentializing and dehumanizing ways in sub-Saharan African contexts. We then outline some commonalities in Afro-Communitarian moral frameworks and the implications for a deeper understanding of dementia stigma. We conclude with some suggestions of ways in which large-scale genomic studies can avoid exacerbating dementia stigma.
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Stigma and discrimination in relation to dementia has a range of implications for people living with dementia and their families worldwide, including help-seeking, quality of life, social rejection and isolation. Few studies consider the perceptions and stigma towards dementia from multiple perspectives, such as people living with dementia, carers, general public and health-care workers. South Africa has limited evidence on the stigmatisation of people living with dementia, with responses to people living with dementia being driven by poor understanding of the condition, cultural beliefs about causes and social interaction problems associated with memory and cognitive impairment. This study explored the experiences of stigma among people living with dementia and their carers through understanding their own knowledge, attitudes and beliefs as well as those of the public and health-care workers. Qualitative data (N = 52) were collected across two provinces and in four languages (English, Afrikaans, Sesotho and isiZulu), with semi-structured interviews and focus groups with the following stakeholder groups: people living with dementia and their carers, the general public and health-care workers. Inductive thematic analysis generated themes across stakeholder groups. The study shows that people living with dementia and carers experienced high levels of internalised stigma, related to negative public attitudes, which were associated with high levels of isolation, health system unpreparedness and limited access to support. The study contributes to the evidence base needed in South Africa but also extends its relevance by contributing to a growing global evidence base on stigma and dementia in low- and middle-income contexts.
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Background South Africa introduced the world’s largest antiretroviral treatment (ART) program in 2004 and since 2016 the Department of Health implemented a universal Treatment as Prevention (TasP) strategy. However, some studies have shown that increasing the availability of ART is insufficient for the comprehensive treatment of HIV, since many people still use traditional health practitioners (THPs) to avoid being identified as HIV positive, and for reasons unrelated to HIV/AIDS. This qualitative study explored the factors influencing how both HIV-negative and HIV-positive people choose amongst multiple sources of healing and how they engage with them, in the context of HIV/AIDS and wide availability of ART.Methods Data were collected as part of a larger TasP trial at the Africa Health Research Institute, KwaZulu-Natal. Repeat in-depth individual interviews were conducted with 10 participants. Repeat group discussions were conducted with 42 participants. Group discussion data were triangulated using community walks and photo-voice techniques to give more insight into the perceptions of community members. All data were collected over 18 months. Thematic analysis was used to analyze participants’ narratives from both individual interviews and group discussions.FindingsIn the context of HIV/AIDS and wide availability of ART, use of biomedical and traditional healing systems seemed to be common in this locality. People used THPs to meet family expectations, particularly those of authoritative heads of households such as parents or grandparents. Most participants believed that THPs could address specific types of illnesses, especially those understood to be spiritually caused and which could not be addressed or cured by biomedical practitioners. However, it was not easy for participants to separate some spiritually caused illnesses from biological illnesses in the context of HIV/AIDS. These data demonstrate that in this context, the use of THPs continues regardless of the wide availability of ART. To meet the health care needs of those patients requiring a health care system which combines biomedical and traditional approaches, collaboration and integration of biomedical and traditional health care should be considered.
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Background Dementia is a growing concern for low- and middle-income countries where longevity is increasing and service provision is poor. Global prevalence estimates vary from 2% to 8.5% for those aged 60 years and older. There have been few dementia studies in sub-Saharan Africa, and prevalence data are lacking for South Africa. Objective To conduct a large dementia prevalence study in a low income rural population in South Africa. Methods 1,394 Xhosa-speaking community dwellers, aged ≥60 y (mean age±sd 71.3±8.3 y), in three clinic catchment areas, were screened at home. Trained community health workers administered the brief Community Screening Instrument for Dementia (CSID) to participants and informants to assess cognitive and functional capacity. Depressive symptoms were assessed with three questions from the EURO-D. Results The prevalence estimate using published CSID sensitivity/specificity values was 0.8 (95% CI: 0.06–0.09). Using CSID cut-off scores the estimated prevalence was 0.12 (95% CI: 0.10–0.13), with 161 screen-positives. Both methods gave a rate of 0.11 (95% CI: 0.09–0.13) for those over 65 years (n = 1051). 68.6% of participants were female and 69.8% had less than 7 years of education. Dementia risk was associated with older age and symptoms of depression, but not with sex. The association with education was not significant when controlled for by age. Conclusions Dementia prevalence estimates were higher than expected for this low-income rural community. There is a need for increased dementia awareness and feasible support interventions. We also need further studies of regional prevalences, dementia subtypes, and modifiable risk factors in South Africa.
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Background Human immunodeficiency virus (HIV) substantially contributes to the burden of disease and health care provision in sub-Saharan Africa, where traditional healers play a major role in care, due to both their accessibility and acceptability. In rural, northeastern South Africa, people living with HIV often ping-pong between traditional healers and allopathic providers. Methods We conducted 27 in-depth interviews and 133 surveys with a random sample of traditional healers living in Bushbuckridge, South Africa, where anti-retroviral therapy (ART) is publicly available, to learn: (1) healer perspectives about which HIV patients they choose to treat; (2) the type of treatment offered; (3) outcomes expected, and; (4) the cost of delivering treatment. ResultsHealers were mostly female (77%), older (median: 58.0 years; interquartile range [IQR]: 50–67), with low levels of formal education (median: 3.7 years; IQR: 3.2–4.2). Thirty-nine healers (30%) reported being able to cure HIV in an adult patients whose (CD4) count was >350cells/mm3. If an HIV-infected patient preferred traditional treatment, healers differentiated two categories of known HIV-infected patients, CD4+ cell counts <350 or ≥350 cells/mm3. Patients with low CD4 counts were routinely referred back to the health facility. Healers who reported offering/performing a traditional cure for HIV had practiced for less time (mean = 16.9 vs. 22.8 years; p = 0.03), treated more patients (mean 8.7 vs. 4.8 per month; p = 0.03), and had lower levels of education (mean = 2.8 vs. 4.1 years; p = 0.017) when compared to healers who reported not treating HIV-infected patients. Healers charged a median of 92 USD to treat patients with HIV. Conclusion Traditional healers referred suspected HIV-infected patients to standard allopathic care, yet continued to treat HIV-infected patients with higher CD4 counts. A greater emphasis on patient education and healer engagement is warranted.
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OBJECTIVE: To examine the feasibility of using community health workers (CHWs) to implement cardiovascular disease (CVD) prevention programmes within faith-based organizations in Accra, Ghana. METHODS: Faith-based organization capacity, human resources, health programme sustainability/barriers and community members' knowledge were evaluated. Data on these aspects were gathered through a mixed method design consisting of in-depth interviews and focus groups with 25 church leaders and health committee members from five churches, and of a survey of 167 adult congregants from two churches. FINDINGS: The delivery of a CVD prevention programme in faith-based organizations by CHWs is feasible. Many faith-based organizations already provide health programmes for congregants and involve non-health professionals in their health-care activities, and most congregants have a basic knowledge of CVD.Yet despite the feasibility of the proposed approach to CVD prevention through faith-based organizations, sociocultural and health-care barriers such as poverty, limited human and economic resources and limited access to health care could hinder programme implementation. CONCLUSION: The barriers to implementation identified in this study need to be considered when defining CVD prevention programme policy and planning.
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Objectives The aim of this study was to develop a critical appraisal (CA) tool that addressed study design and reporting quality as well as the risk of bias in cross-sectional studies (CSSs). In addition, the aim was to produce a help document to guide the non-expert user through the tool. Design An initial scoping review of the published literature and key epidemiological texts was undertaken prior to the formation of a Delphi panel to establish key components for a CA tool for CSSs. A consensus of 80% was required from the Delphi panel for any component to be included in the final tool. Results An initial list of 39 components was identified through examination of existing resources. An international Delphi panel of 18 medical and veterinary experts was established. After 3 rounds of the Delphi process, the Appraisal tool for Cross-Sectional Studies (AXIS tool) was developed by consensus and consisted of 20 components. A detailed explanatory document was also developed with the tool, giving expanded explanation of each question and providing simple interpretations and examples of the epidemiological concepts being examined in each question to aid non-expert users. Conclusions CA of the literature is a vital step in evidence synthesis and therefore evidence-based decision-making in a number of different disciplines. The AXIS tool is therefore unique and was developed in a way that it can be used across disciplines to aid the inclusion of CSSs in systematic reviews, guidelines and clinical decision-making.
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The aim of the paper is to analyze the sociological factors precipitating witchcraft accusation among the Tiv people of Nigeria. The paper adopts case study as a research design while focus group discussion and key informant interview methods are used for data collection. It is discovered that scramble for power and domination plays a major role in witchcraft allegations. However, the other factors also contribute to witchcraft accusations. It is recommended that effective and efficient ways of identifying witches should include use of orthodox method of swearing swem, divination and consultation with elders who are perceived to be endowed with supernatural powers and powerful men of the Christian God.
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Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews. Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7]. In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1). Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA Completing a Systematic Review Is an Iterative Process The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
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Background: Dementia, a debilitating condition, requires particular attention in Southern Africa where there is a dearth of prevalence data. Population ageing and other risk factors are driving an increasing incidence of dementia. However, limited knowledge and understanding may impact the attitudes and practices towards persons with dementia. Aim: To investigate the relationship between the knowledge of dementia, its effect on the attitudes and practices toward people with dementia in an urban community setting. To determine the perceived availability of services for those with dementia, the awareness of elder abuse and care-giver burden. Methods: A descriptive, cross-sectional study was performed in Khayelitsha. An interviewer administered questionnaire was used with assistance from isiXhosa speaking translators. A sample of 100 individuals was surveyed door-to-door from both the informal and formal housing settlements, using cluster random sampling methods. Results: There was deficient knowledge about dementia, with an average accuracy of 53.44% on the knowledge test. Only 10% reported knowing what dementia was. Participants had generally tolerant views about people with dementia. No significant relationship was found between knowledge and attitudes about dementia. There was a significant difference between people who would share their house with a family member with dementia or send them to nursing homes (p = 0.03). 64% of participants knew what elder abuse was. 19% knew of an elder who had been abused; amongst the most common forms reported were being locked alone in their house and being deprived of food. Conclusions: This study showed that knowledge about dementia was limited with no relationship to attitudes of high tolerance towards people with dementia. Elder abuse was well recognized, but poorly reported. Appropriate health promotion strategies and education should be conducted and further research should be done into dementia in South Africa.
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In Ghana, older women may be marginalized, abused, and even killed as witches. Media accounts imply this is common practice, mainly through stories of “witches camps” to which the accused may flee. Anthropological literature on aging and on witchcraft, however, suggests that this focus exaggerates and misinterprets the problem. This article presents a literature review and exploratory data on elder advocacy and rights intervention on behalf of accused witches in Ghana to help answer the question of how witchcraft accusations become an older woman’s problem in the context of aging and elder advocacy work. The ineffectiveness of rights based and formal intervention through sponsored education programs and development projects is contrasted with the benefit of informal conflict resolution by family and staff of advocacy organizations. Data are based on ethnographic research in Ghana on a rights based program addressing witchcraft accusations by a national elder advocacy organization and on rights based intervention in three witches camps.
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Dementia is one of the biggest challenges to society today, with an increasing prevalence as the global population ages. The 2013 worldwide estimate was 44 million persons with dementia, with predictions that about 70% of new cases will occur in low- and middle-income countries (LMICs). With negligible published prevalence data for South Africa, little is known about the impact of dementia, especially in poorer communities. Successful community dementia prevalence screening has been conducted in ten LMICs worldwide, using a one-step diagnostic procedure developed in the UK by the 10/66 group. The prevalence of dementia needs to be established locally across various communities. Awareness, education, training and skilled resources for diagnosis and care are minimal. Only once prevalence data and an assessment of care needs are available will it be possible to propose improving health services for the growing aged population, especially those with dementia in poorer rural communities. © 2015, South African Medical Association. All Rights Reserved.
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Objectives. To review epidemiologic studies on the prevalence, incidence, and risk factors of dementia in sub-Saharan Africa (SSA). Methods. A MEDLINE search (from January 1992 to December 31, 2013) of epidemiologic studies, with no language restriction, was conducted using the keywords "dementia" or "Alzheimer's" and "Africa." We selected for review population and hospital-based studies that reported the prevalence, incidence, or risk factors of dementia in SSA in people aged 60 years and above. References of selected articles were reviewed to identify additional relevant articles that met our selection criteria. Results. Of a total of 522 articles, 41 were selected and reviewed. The reported prevalence of dementia in SSA varied widely (range: 2.29%-21.60%); Alzheimer's disease was the most prevalent type of dementia. Only two studies conducted in Nigeria reported incidence data. Major risk factors identified include older age, female gender, cardiovascular disease, and illiteracy. Conclusion. Data on the epidemiology of dementia in SSA is limited. While earlier studies reported a lower prevalence of dementia in older persons, recent studies have put these findings into question suggesting that dementia prevalence rates in SSA in fact parallel data from Western countries.
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Cognitive stimulation therapy (CST) has been shown to be an useful and cost effective intervention that increases cognition and quality of life of people with mild to moderate dementia. It is increasing in popularity in the UK and worldwide, and a number of research teams have examined its effectiveness in other contexts and cultures. However, it is necessary to develop clear evidence-based guidelines for cultural modification of the intervention. This article describes a community-based developmental approach to adapt CST to different cultures, following the five phases of the formative method for adapting psychotherapy (FMAP), an approach that involves collaborating with service users as a first step to generate and support ideas for therapy adaptation. Examples based on clinical and practical experience are presented, along with suggestions for applying these changes in different cultural contexts.
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With the increasing number of people surviving into old age in Africa, dementia is becoming an important public health problem. Understanding the social dynamics of dementia in resource-poor settings is critical for developing effective interventions. We explored the socio-cultural beliefs surrounding dementia and the life experience of people with dementia (PWD) and their caregivers in the Hai District of Kilimanjaro, Tanzania. Cross-sectional qualitative design. Forty one PWD were purposively sampled from the Hai District of Kilimanjaro. Twenty five paired interviews with PWD and with caregivers, and 16 with caregivers alone, were conducted. Interviews were tape recorded, transcribed verbatim and analyzed using content analysis approach. Forty one PWD (26 females), aged 70 years and older, were recruited but due to speech difficulties only 25 participated in the interviews. Married were 13, widow in 22 and widower 6. The majority, 33/41 were illiterate. PWD and carers perceived memory problems as a normal part of ageing. Dementia was commonly referred as "ugonjwa wa uzeeni" (disease of old people) or memory loss disease. The majority of PWD 13/12 and carers 7/16 did not know what dementia is or what causes it. Dementia was felt to be associated with stroke, high blood pressure, diabetes, old age, curse/witchcraft and life stress. Half of the participants had used modern care and alternative care such as herbs, prayers or traditional healers. Caregivers complained about the burden of caring for PWD and suggested that community organizations should be involved in addressing the problem. Knowledge about dementia is low and the symptoms are accepted as a problem of old age. PWD and carers demonstrate pluralistic behaviour in seeking help from modern care, prayers and traditional healers. The disease adds significant burden to family members. Family and caregivers need more education on early recognition of symptoms and cost effective management of dementia at family level. Faith-based organizations could play an important role in dementia interventions. At a national level effective policy and improvement of the health care system to address the needs of PWD and their families are imperative.
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Purpose In Mali, epilepsy affects 15 individuals per thousand. Perceptions and attitudes have not seemingly evolved with advancing medical knowledge. The objective of this study was to assess parental beliefs and attitudes in families with and without affected children. Methods We enrolled 720 pediatric patients, half of whom had epilepsy, at Mali's largest hospital. We conducted semistructured interviews with the accompanying parent. Control families with unaffected patients and also had affected children were excluded. Results In total, 67% and 24% of families with and without epilepsy, respectively, lived in rural environments. Interviewees were mostly mothers in their 30s; 80% had not completed high school. About 22% of parents without an affected child had witnessed a seizure. During a seizure, 94% of parents with an affected child and 49% of parents without an affected child, respectively, would intervene; 7.5% and 21%, respectively, would wet the patient's face with cool water. Although parents with an affected child had more intimate knowledge of seizures, misconceptions prevailed, perhaps more so than in families without epilepsy: 79% and 66% of parents, respectively, considered epilepsy contagious; 43% vs. 69% thought that it inevitably led to psychosis; and 53% vs. 29% attributed epilepsy to supernatural causes. Finally, 63% of parents with an affected child reported consulting a traditional healer as first-line management for epilepsy. Conclusions Our study demonstrates widespread misconceptions in Mali regarding epilepsy. Our findings argue for more education initiatives focused on the entire population, including traditional healers, to provide knowledge, reduce stigma, and improve quality of life for individuals living with epilepsy.
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Educating and training diabetic patients is necessary for controlling and improving their health. It was Quasi-experimental study design study. The study aimed to determine the effects of health education on the achievements of diabetic patients regarding control and improvement of their health status; at Diabetic Health Centers in Khartoum State, Sudan; 2007-2010. The target populations were diabetic patients, who attended the diabetic health centers to receive their treatment. Using simple random sampling 152 patients were selected (58 males and 94 females). Before and after comparison was done. Data was processed using SPSS and pair t-test was used to determine the effect of health education. P-value equal or less than 0.05 was considered statistically significant. Test for before and after comparison was found to be statistically significant (p<0.05) for diabetic patients. They gained more knowledge after the implementation of the program; particularly in the areas of the nature and signs and symptoms of the disease, signs and symptoms of hypo & hyperglycemia, causes and warning signs of foot problems, foot care, and importance of exercises. Health education of diabetic patients is crucial for control of diabetes. Capacity building of diabetic health centers, strengthening diabetic patients association, and more research to study the effect of health education on diabetic patients were needed.
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Background: Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention for people with dementia consisting of 14 group sessions aiming to stimulate various areas of cognition. This study examined the effects of CST on specific cognitive domains and explored the neuropsychological processes underpinning any effects. Methods: A total of 34 participants with mild to moderate dementia were included. A one-group pretest-posttest design was used. Participants completed a battery of neuropsychological tests in the week before and after the manualised seven-week CST programme. Results: There were significant improvement pre- to post-CST group on measures of delayed verbal recall (WMS III logical memory subtest - delayed), visual memory (WMS III visual reproduction subtest - delayed), orientation (WMS III information and orientation subscale), and auditory comprehension (Token Test). There were no significant changes on measures of naming (Boston Naming Test-2), attention (Trail Making Test A/Digit Span), executive function (DKEFS verbal fluency/Trail Making Test B), praxis (WMS III visual reproduction - immediate) or on a general cognitive screen (MMSE). Conclusions: Memory, comprehension of syntax, and orientation appear to be the cognitive domains most impacted by CST. One hypothesis is that the language-based nature of CST enhances neural pathways responsible for processing of syntax, possibly also aiding verbal recall. Another is that the reduction in negative self-stereotypes due to the de-stigmatising effect of CST may impact on language and memory, domains that are the primary focus of CST. Further research is required to substantiate these hypotheses.
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In low-resource settings, patients' use of multiple healthcare sources may complicate chronic care and clinical outcomes as antiretroviral therapy (ART) continues to expand. However, little is known regarding patterns, drivers and consequences of using multiple healthcare sources. We therefore investigated factors associated with patterns of plural healthcare usage among patients taking ART in diverse South African settings. A cross-sectional study of patients taking ART was conducted in two rural and two urban sub-districts, involving 13 accredited facilities and 1266 participants selected through systematic random sampling. Structured questionnaires were used in interviews, and participant's clinic records were reviewed. Data collected included household assets, healthcare access dimensions (availability, affordability and acceptability), healthcare utilization and pluralism, and laboratory-based outcomes. Multiple logistic regression models were fitted to identify predictors of healthcare pluralism and associations with treatment outcomes. Prior ethical approval and informed consent were obtained. Nineteen percent of respondents reported use of additional healthcare providers over and above their regular ART visits in the prior month. A further 15% of respondents reported additional expenditure on self-care (e.g. special foods). Access to health insurance (Adjusted odds ratio [aOR] 6.15) and disability grants (aOR 1.35) increased plural healthcare use. However, plural healthcare users were more likely to borrow money to finance healthcare (aOR 2.68), and incur catastrophic levels of healthcare expenditure (27%) than non-plural users (7%). Quality of care factors, such as perceived disrespect by staff (aOR 2.07) and lack of privacy (aOR 1.50) increased plural healthcare utilization. Plural healthcare utilization was associated with rural residence (aOR 1.97). Healthcare pluralism was not associated with missed visits or biological outcomes. Increased plural healthcare utilization, inequitably distributed between rural and urban areas, is largely a function of higher socioeconomic status, better ability to finance healthcare and factors related to poor quality of care in ART clinics. Plural healthcare utilization may be an indication of patients' dissatisfaction with perceived quality of ART care provided. Healthcare expenditure of a catastrophic nature remained a persistent complication. Plural healthcare utilization did not appear to influence clinical outcomes. However, there were potential negative impacts on the livelihoods of patients and their households.
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Dementia will concern more and more people in the developing countries, but the perception people have of dementia in these areas has not yet been studied. During a general population survey (EDAC) carried out in Brazzaville (Republic of Congo), 27 elderly persons suspected of having dementia and 31 of their relatives, 90 cognitively impaired elderly persons and 92 of their relatives, as well as 33 hospital workers were interviewed according to the Explanatory Model Interview Catalogue. Item prominence ratings indicate that the attention was mainly on the emotional and socio-economic consequences (scores >1.0 out of 5 points). Ageing and mental stress are the main perceived causes. Hospital workers are more aware of public stigma. The socio-cultural components of the dementia phenomenon have to be taken into account to enforce public health and social measures.
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To examine the feasibility of using community health workers (CHWs) to implement cardiovascular disease (CVD) prevention programmes within faith-based organizations in Accra, Ghana. Faith-based organization capacity, human resources, health programme sustainability/barriers and community members' knowledge were evaluated. Data on these aspects were gathered through a mixed method design consisting of in-depth interviews and focus groups with 25 church leaders and health committee members from five churches, and of a survey of 167 adult congregants from two churches. The delivery of a CVD prevention programme in faith-based organizations by CHWs is feasible. Many faith-based organizations already provide health programmes for congregants and involve non-health professionals in their health-care activities, and most congregants have a basic knowledge of CVD. Yet despite the feasibility of the proposed approach to CVD prevention through faith-based organizations, sociocultural and health-care barriers such as poverty, limited human and economic resources and limited access to health care could hinder programme implementation. The barriers to implementation identified in this study need to be considered when defining CVD prevention programme policy and planning.
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In 1996, the World Health Assembly declared violence a major public health issue. To follow up on this resolution, on Oct 3 this year, WHO released the first World Report on Violence and Health. The report analyses different types of violence including child abuse and neglect, youth violence, intimate partner violence, sexual violence, elder abuse, self-directed violence, and collective violence. For all these types of violence, the report explores the magnitude of the health and social effects, the risk and protective factors, and the types of prevention efforts that have been initiated. The launch of the report will be followed by a 1-year Global Campaign on Violence Prevention, focusing on implementation of the recommendations. This article summarises some of the main points of the world report.
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To demonstrate the benefits of applying meta ethnography to the synthesis of qualitative research, by means of a worked example. Four papers about lay meanings of medicines were arbitrarily chosen. Noblit and Hare's seven-step process for conducting a meta ethnography was employed: getting started; deciding what is relevant to the initial interest; reading the studies; determining how the studies are related; translating the studies into one another; synthesising translations; and expressing the synthesis. Six key concepts were identified: adherence/compliance; self-regulation; aversion; alternative coping strategies; sanctions; and selective disclosure. Four second-order interpretations (derived from the chosen papers) were identified, on the basis of which four third-order interpretations (based on the key concepts and second-order interpretations) were constructed. These were all linked together in a line of argument that accounts for patients' medicine-taking behaviour and communication with health professionals in different settings. Third-order interpretations were developed which were not only consistent with the original results but also extended beyond them. It is possible to use meta ethnography to synthesise the results of qualitative research. The worked example has produced middle-range theories in the form of hypotheses that could be tested by other researchers.
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In Africa hypertension is common and stroke is increasing. Detection, treatment and control of high blood pressure (BP) is limited. BP can be lowered by reducing salt intake. In Africa salt is added to the food by the consumer, as processed food is rare. A population-wide approach with programmes based on health education and promotion is thus possible. We carried out a community-based cluster randomised trial of health promotion in 1,013 participants from 12 villages (628 women, 481 rural dwellers); mean age 55 years to reduce salt intake and BP. Average BP was 125/74 mmHg and urinary sodium (UNa) 101 mmol/day. A health promotion intervention was provided over 6 months to all villages. Assessments were made at 3 and 6 months. Primary end-points were urinary sodium excretion and BP levels. There was a significant positive relationship between salt intake and both systolic (2.17 mmHg [95% CI 0.44 to 3.91] per 50 mmol of UNa per day, p < 0.001) and diastolic BP (1.10 mmHg [0.08 to 1.94], p < 0.001) at baseline. At six months the intervention group showed a reduction in systolic (2.54 mmHg [-1.45 to 6.54]) and diastolic (3.95 mmHg [0.78 to 7.11], p = 0.015) BP when compared to control. There was no significant change in UNa. Smaller villages showed greater reductions in UNa than larger villages (p = 0.042). Irrespective of randomisation, there was a consistent and significant relationship between change in UNa and change in systolic BP, when adjusted for confounders. A difference in 24-hour UNa of 50 mmol was associated with a lower systolic BP of 2.12 mmHg (1.03 to 3.21) at 3 months and 1.34 mmHg (0.08 to 2.60) at 6 months (both p < 0.001). In West Africa the lower the salt intake, the lower the BP. It would appear that a reduction in the average salt intake in the whole community may lead to a small but significant reduction in population systolic BP.
Article
Objectives: Our study aimed at estimating the prevalence of neuropsychiatric symptoms and investigating associated factors among older adults living in two countries in Central Africa (Central African Republic (CAR) and Republic of Congo (ROC)). Methods: The EPIDEMCA multicentre population‐based study was carried out in rural and urban areas of CAR and ROC between 2011 and 2012 among people aged 65 and over. After cognitive screening using the Community Screening Interview for Dementia, participants with low performances underwent neurological examination including the brief version of the NeuroPsychiatric Inventory (NPI‐Q). Multivariate logistic regression analyses were performed to identify factors independently associated with neuropsychiatric symptoms in this population. Results: NPI‐Q data were available for 532 participants. Overall, 333 elderly people (63.7%) reported at least one neuropsychiatric symptom. The prevalence of neuropsychiatric symptoms was 89.9% (95% CI: 84.6‐95.1) in participants with dementia, 73.4% (95% CI: 65.1‐81.7) in participants with Mild Cognitive Impairment (MCI), and 48.7% (95% CI: 42.9‐54.6) in participants with no MCI nor dementia after neurological examination” (p<0.0001). The most common symptoms were depression, anxiety and irritability. Participants living in Brazzaville, with normal hearing and with friends in the community were less likely to present neuropsychiatric symptoms. Physical disability, difficulties in eating, female sex and dementia were significantly associated with neuropsychiatric symptoms. Conclusion: Neuropsychiatric symptoms are common among older people with neurocognitive disorders in CAR and ROC. Our results confirm those from previous studies in Nigeria and Tanzania. Nevertheless, knowledge of these symptoms remains limited in sub‐Saharan Africa, hampering their appropriate management.
Article
Background and Objectives: One method of mitigating global increases in dementia prevalence involves assessing public knowledge and then educating laypeople. We measured knowledge of late-life pathological cognitive decline in a diverse, international sample using a standardized, validated instrument. Research Design and Methods: We assessed 3,619 international respondents recruited through Amazon’s Mechanical Turk with a 44-item dementia knowledge survey and 18 sociodemographic items. Results: Results suggested that the following sociodemographic variables are associated with less overall knowledge: young age, male gender, low educational attainment, born in a developing nation, of ethnic minority status, not married, and less prior dementia experience. Specific knowledge gaps emerged in cerebrovascular disease, delirium versus dementia, treatment of behavioral dementia symptoms, Alzheimer’s disease genetics, Parkinson’s disease symptoms, and characteristics of chronic traumatic encephalopathy and subjective cognitive decline. Discussion and Implications: Findings may facilitate effective multinational dementia education initiatives by providing specific recommendations as to which sociodemographic populations and content knowledge domains will benefit the most from limited resources.
Article
Belief in the existence of witchcraft has remained a social phenomenon in Igbo society, especially with aged women who are often labeled witches. This study is exploratory and explains the implication of labeling an aged woman a witch and social relations in Igbo society in South-Eastern Nigeria. Twenty interviews were conducted with aged women who are victims of the witchcraft label and their relatives using qualitative methods of data collection, key informant interviews, and in-depth interviews. Data collected were analyzed using ethnographic content analysis. Findings reveal different social views attached to witchcraft and how it relates to aged women.
Article
Background As with many other populations, abuse of older adults is a growing problem across the Africa Diaspora. Modernization and urbanization are eroding the traditional values of respect for older adults. Also, older adults living in environments with limited social and economic resources, and having no means of economic support create a recipe for elder abuse and neglect. Methods This article reviews the current literature on the epidemiology, risk factors, and interventions used for elder abuse across the African Diaspora. Results Reports of elder abuse range from 24.9% to 81.1% across the Diaspora. Risk factors include cognitive and physical impairment, social isolation, lack of resources and widowhood. Conclusion Community-based programs using the unique social networks of older populations of African descent can provide a venue to improve caregiver training and support, reinforce traditional filial and informal caregiving practices, increase the utilization of available governmental and institutional.
Article
Objective: To explore and describe the link between culture and dementia care with the focus on the influence of the belief in dementia as witchcraft and people with dementia as witches. Background: In South Africa, especially in townships and rural areas, dementia is often perceived as connected to witchcraft rather than to disease. Persons labelled as witches - mostly elderly women - may be bullied, ostracised, beaten, stoned, burned, even killed. Method: One strand of findings from a larger international study is presented with in-depth qualitative interviews of one close family member and seven nurses caring for patients with severe dementia in nursing homes in Tshwane in South Africa. A hermeneutic analytic approach was used. Results: Two main themes are found, namely "Belief in witchcraft causing fear of persons with dementia" and "Need of knowledge and education". Fear of and violence towards people with dementia are based on the belief that they are witches. Some of the nurses had also held this belief until they started working with patients with dementia. There is a great need for education both among healthcare workers and the populace. Discussion: The 'witch' belief prevents seeking professional help. As nursing homes tend to be private and expensive, professional dementia care is virtually unattainable for the poor. Dementia needs a more prominent place in nursing curricula. Nurses as educators need to know the local culture and language to be accepted in the various communities. They need to visit families affected by dementia, give awareness talks in churches, schools and clinics and facilitate support groups for carers of people with dementia in the local language. Conclusion: Improved nurses' education in gerontology and geriatric care is needed. Trained specialist nurses may work as mediators, and help eradicate the witchcraft beliefs connected to severe dementia. This article is protected by copyright. All rights reserved.
Article
Introduction Many patients with Parkinson's disease (PD) in sub-Saharan Africa (SSA) are thought to be undiagnosed and untreated, leading to poor health outcomes. Increasing rates of diagnosis and treatment, with consequent improvements in the quality of life of people with PD in SSA requires an understanding of how PD is perceived and conceptualized within communities. Methods A cross-sectional survey was conducted among a group of Xhosa speaking black South Africans. The survey involved the administration of questionnaires on beliefs, knowledge and attitudes about PD to the public, people with PD (PwPD) and traditional healers (THs). Results 18% of the participants could identify PD through its symptoms. Mental illness, other diseases, stress, expressing strong emotions, consumption of certain foods or drinks and witchcraft were identified as possible causes of PD. PwPD and THs had a greater knowledge of PD than the public and greater age was a significant predictor of greater knowledge. The public and THs had a greater degree of concern about a range of symptoms of PD compared to PwPD. Conclusion There is a striking lack of knowledge about PD amongst black South Africans. Almost half the members of the general public interviewed felt that PwPD should not live amongst their community, and a third considered that witchcraft could be a cause of PD. Finding ways to effectively educate members of a community about PD would make it easier for PwPD to adapt to their condition within their communities.
Article
The author would like to apologise for an error in the originally published paper. The 'Background' section of the Abstract has been corrected to include the year '2011' rather than '2001'. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Article
Background: low diagnostic rates are a barrier to improving care for the growing number of people with dementia in sub-Saharan Africa. Many people with dementia are thought to visit traditional healers (THs) and Christian faith healers (FHs) and these groups may have a role in identifying people with dementia. We aimed to explore the practice and attitudes of these healers regarding dementia in rural Tanzania and investigate attitudes of their patients and their patients’ carers. Methods: this was a qualitative study conducted in Hai district, Tanzania. Semi-structured interviews were conducted with a convenience sample of THs and FHs and a purposive-stratified sample of people with dementia and their carers. Interview guides were devised which included case vignettes. Transcripts of interviews were subject to thematic analysis. Findings: eleven THs, 10 FHs, 18 people with dementia and 17 carers were recruited. Three themes emerged: (i) conceptualisation of dementia by healers as a normal part of the ageing process and no recognition of dementia as a specific condition; (ii) people with dementia and carer reasons for seeking help and experiences of treatment and the role of prayers, plants and witchcraft in diagnosis and treatment; (iii) willingness to collaborate with allopathic healthcare services. FHs and people with dementia expressed concerns about any collaboration with THs. Conclusions: although THs and FHs do not appear to view dementia as a specific disease, they may provide a means of identifying people with dementia in this setting.
Article
Introduction: Cognitive stimulation therapy is a non-pharmacological intervention for people with dementia. Its use has been associated with substantial improvements in cognition and quality of life in studies from high-income countries, equivalent to those achieved by pharmacological treatments. Cognitive stimulation therapy may be particularly suited to low resource settings, such as sub-Saharan Africa, because it requires little specialist equipment and can be delivered by non-specialist health workers. The aim of this study was to adapt cognitive stimulation therapy for use in sub-Saharan Africa taking into account socio-cultural differences and resource implications. Methods: Cognitive stimulation therapy is a structured programme, originally developed in the United Kingdom. Substantial adaptations were required for use in sub-Saharan Africa. The formative method for adapting psychotherapy was used as a framework for the adaption process. The feasibility of using the adapted cognitive stimulation therapy programme to manage dementia was assessed in Tanzania and Nigeria in November 2013. Further adaptations were made following critical appraisal of feasibility. Results: The adapted cognitive stimulation therapy intervention appeared feasible and acceptable to participants and carers. Key adaptations included identification of suitable treatment settings, task adaptation to accommodate illiteracy and uncorrected sensory impairment, awareness of cultural differences and usage of locally available materials and equipment to ensure sustainability. Conclusions: Cognitive stimulation therapy was successfully adapted for use in sub-Saharan Africa. Future work will focus on a trial of cognitive stimulation therapy in each setting.
Article
Background: Between 2001 and 2012 we carried out a study of dementia prevalence in central Africa throughout the EPIDEMCA (Epidemiology of Dementia in Central Africa) programme. Objective: To assess dementia related mortality among Congolese older people from the EPIDEMCA study after two years of follow-up. Design: Longitudinal population-based cohort study. Setting: Gamboma and Brazzaville, Republic of Congo. Methods: Older participants were traced and interviewed in rural and urban Congo annually between 2012 and 2014. DSM-IV and NINCDS-ADRDA criteria were required for dementia diagnosis. Data on vital status were collected throughout the follow-up. Cox proportional hazards model was used to assess the link between baseline dementia diagnosis and mortality risk. Results: Of 1,029 participants at baseline, 910 (88.4%) have a complete cognitive diagnosis. There were 791 participants (76.87%) with normal cognition, 56 (5.44%) with MCI, and 63 (6.12%) with dementia. After two years of follow-up, 101 (9.8%) participants had died. Compared to participants with normal cognition, mortality risk was more than 2.5 times higher among those with dementia (HR= 2.53, 95% CI: 1.42-4.49, p=0.001). Among those with dementia, only clinical severity of dementia was associated with an additional increased mortality risk (HR=1.91; CI 95%, 1.23-2.96; p=0.004). Age (per 5-year increase), male sex and living in an urban area were independently associated with increased mortality risk across the full cohort. Conclusion: Among Congolese older adults, dementia is associated with increased mortality risk. Our results highlight the need for targeted health policies and strategies for dementia care in sub-Saharan Africa (SSA).
Article
Introduction: Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk U.S. Population: Methods: We analyzed Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011-2013 and age ≥68 years as of December 31, 2013 (n = 21.6 million). Results: Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype. Dementia not otherwise specified was the most common diagnosis (present in 92.9%). The most common subtype was Alzheimer's (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%). The prevalence of other types of diagnosed dementia was 0.2%. Discussion: This study is the first to document concurrent prevalence of primary dementia subtypes among this U.S. Population: The findings can assist in prioritizing dementia research, clinical services, and caregiving resources.
Article
Cette communication commence par le récit d'un incident qui eut lieu en juillet, 1998 quand, dans un campement de fortune en dehors de Soweto, les gens furent avertis qu'un serpent géant connu sous le nom de Inkosi ya Manzi[Roi des eaux] était en colère et qu'il menaçait de détruire le campement. Notre but ici, c'est d'examiner des questions d'insécurité spirituelle dans un contexte de pauvreté criarde, de difficulté et de violence. Nous voulons mettre ici en lumière ces aspects d'insécurité qui ne sont pas réductibles aux seules conditions objectives de danger en examinant des questions d'épistémologie reliées aux modes d'appréhension de l'action des forces et êtres invisibles sur les heurs et malheurs de la vie de tous les jours. Il s'agit ici de cinq sources d'anxiété épistémiques en conjonction avec trois cadres d'interprétation différents. Nous suggérons que l'intensité relative de l'insécurité spirituelle à Soweto découle, dans une large mesure, du manque d'un cadre dominant d'interprétation. Opening with an account of an incident in July 1998 when warnings were circulated in a shack settlement outside Soweto that a giant snake known as Inkosi ya Manzi [King of the Waters] was angry and threatening to destroy the settlement, this paper seeks to examine questions of spiritual insecurity in a context of widespread poverty, hardship, and violence. It seeks to examine those aspects of insecurity that are not reducible simply to objective conditions of danger by examining questions of epistemology relating to modes of understanding the action of invisible forces and beings upon the fortunes and misfortunes of everyday life. Five sources of epistemic anxiety are identified, along with three distinct frames of interpretive authority. The paper suggests that the relative intensity of spiritual insecurity in contemporary Soweto derives in large part from the fact that no one framework of interpretation enjoys dominance.
Article
This commentary offers discusses current evidence on health challenges of older persons in sub-Saharan Africa and highlights important directions for policy and research to address them
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This article describes the development of a culturally sensitive support service for people with dementia living in Kwa-Zulu Natal.
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Objective: This paper examines the notions that psychiatry can be greatly influenced by what society considers as 'normal', and that psychiatric thoughts and beliefs ebb and flow according to history and the social and cultural values of the time. Conclusions: As part of the medical profession, psychiatrists have much power in determining treatment and outcomes for patients. Unfortunately, this also means psychiatry has also been involved with the darker aspects of humanity, such as during the Nazi regime, and the abuse of patients' human rights. Huntington's disease (HD) is a neuropsychiatric illness from which observation and little knowledge reported by the medical profession spanned decades of incorrect and sensationalised documentation, that was also influenced by the values of the time. Such was the atmosphere of society during this period that the ideas and notions regarding HD disseminated by the respected medical profession were believed and accepted as fact by the general population and other professions, who would have been ignorant of any other contrary information. We need to be aware of social and cultural values as these can influence our understanding of diagnoses and treatments of our patients.
Article
Objectives: Despite the growing burden of dementia in low-income countries, there are few previous data on the prevalence of dementia in sub-Saharan Africa. The aim of this study was to estimate the prevalence of dementia in those who are 70 years and older in the rural Hai District of Tanzania. Methods: This was a two-phase cross-sectional survey. Using census data, we screened individuals aged 70 years and older from six rural villages using the Community Screening Instrument for Dementia in Phase I. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM-IV criteria. Results: Of 1198 people who fulfilled the inclusion criteria, 184 screened positive for probable dementia, and 104 screened positive for possible dementia using the Community Screening Instrument for Dementia. During clinical assessment in Phase II, 78 cases of dementia were identified according to the DSM-IV criteria. The age-standardised prevalence of dementia was 6.4% (95% confidence interval: 4.9 to 7.9). Prevalence rates increased significantly with increasing age. Conclusions: The prevalence of dementia in this rural Tanzanian population is similar to that reported in high-income countries. Dementia is likely to become a significant health burden in this population as demographic transition continues. Further research on risk factors for dementia in sub-Saharan Africa is needed to inform policy makers and plan local health services.
Article
African notions of witchcraft are neither archaic nor static but are highly flexible and deeply attuned to the conundrums of our contemporary world. Many anthropologists have recently argued that notions of the African witch provide commentaries on the meaning and merit of modernity as experienced in different historical and cultural settings. By exploring one particular type of witchcraft —that involving rain—amongst the lhanzu of Tanzania, this article suggests instead that some forms of witchcraft may be more pertinent to understanding local notions of "tradition" than "modernity." It is argued that the process of identifying rain witches provides lhanzu men and women with a way to circumscribe, contemplate, and, ultimately, reassert the veracity and significance of a conceptual category they call "tradition." The article concludes by critiquing the homogenizing effects of terms like the African witch and African witchcraft, compelling us to think in terms of pluralities rather than singulars. [Keywords: witchcraft, modernity, tradition, rainmaking, anthropological theory]
Article
Although socioeconomic status is acknowledged to be an important determinant of modern health care utilisation, most analyses to date have failed to include traditional systems as alternative, or joint, providers of care. In developing countries, where pluralistic care systems are common, individuals are likely to be using multiple sources of health care, and the order in which systems are chosen is likely to vary according to income. This paper uses self-collected data from households in Ghana and econometric techniques (biprobit modelling and ordered logit) to show that rising income is associated with modern care use whilst decreasing income is associated with traditional care use. When utilisation is analysed in order, results show rising income to have a positive effect on choice of modern care as a first provider, whilst choosing it second, third or never is associated with decreasing income. The effects of income on utilisation patterns of traditional care are stronger: as income rises, utilisation of traditional care as a first choice decreases. Policy should incorporate traditional care into the general utilisation framework and recognise that strategies which increase income may encourage wider utilisation of modern over traditional care, whilst high levels of poverty will see continued use of traditional care.
Article
Conflict between village peasants and the modern state is associated with increased concern with witchcraft. Villagers accuse one another of witchcraft and do not accuse the state bureaucrats with whom they have many unresolved grievances. The argument is that in accusing one another of witchcraft the village peasants are displacing conflicts with more powerful outsiders. [Senegal, religion, witchcraft, social change, symbolism]
Article
This article deals with witchcraft, missionisation, domestic slavery and social life on the emerging colonial ‘frontier’ of Onitsha, Nigeria, during the last years of the nineteenth century. The analysis centres on the confession of an accused witch and former domestic slave in the Waterside area of the town. It uses the document as a springboard for a larger discussion of the intersecting lives of Africans and Europeans in this marginal location at a moment when social relations there were undergoing radical transformation. By addressing such a text, taken down verbatim at the time of the confession, the author argues, we can gain a privileged insight into women's unofficial (and even prohibited) religious practice as well as the everyday lives of persons—notably female domestic slaves—who ordinarily receive little notice in the African colonial record. From Okuwan's confession we also learn something about how the increasing flows of commodities and new forms of colonial authority along this mercantile border were changing (and possibly devaluing) African women's labour as well as their religious power.
Article
The oldest old are the fastest growing segment of the US population, and accurate estimates of dementia incidence in this group are crucial for healthcare planning. Although dementia incidence doubles every 5 years from ages 65 to 90 years, it is unknown if this exponential increase continues past age 90 years. Here, we estimate age- and sex-specific incidence rates of all-cause dementia in people aged 90 years and older, including estimates for centenarians. Participants are from The 90+ Study, a population-based longitudinal study of aging and dementia. Three hundred thirty nondemented participants aged 90 years and older at baseline were followed between January 2003 and December 2007. Age- and sex-specific incidence rates of all-cause dementia were estimated by person-years analysis. The overall incidence rate of all-cause dementia was 18.2% (95% confidence interval [CI], 15.3-21.5) per year and was similar for men and women (risk ratio, 0.94; 95% CI, 0.65-1.37). Rates increased exponentially with age from 12.7% per year in the 90-94-year age group, to 21.2% per year in the 95-99-year age group, to 40.7% per year in the 100+-year age group. The doubling time based on a Poisson regression was 5.5 years. Incidence of all-cause dementia is very high in people aged 90 years and older and continues to increase exponentially with age in both men and women. Projections of the number of people with dementia should incorporate this continuing increase of dementia incidence after age 90 years. Our results foretell the growing public health burden of dementia in an increasingly aging population.
Article
This study provides preliminary evidence for the acceptability, reliability, and validity of the new Alzheimer's Disease Knowledge Scale (ADKS), a content and psychometric update to the Alzheimer's Disease Knowledge Test. Traditional scale development methods were used to generate items and evaluate their psychometric properties in a variety of subsamples. The final 30-item, true/false scale takes approximately 5-10 min to complete and covers risk factors, assessment and diagnosis, symptoms, course, life impact, caregiving, and treatment and management. Preliminary results suggest that the ADKS has adequate reliability (test-retest and internal consistency) and validity (content, predictive, concurrent, and convergent). The ADKS is designed for use in both applied and research contexts, capable of assessing knowledge about Alzheimer's disease among laypeople, patients, caregivers, and professionals.
Article
The present study evaluated knowledge of Alzheimer's disease (AD) in four ethnic groups of older adults. Ninety-six Anglo, 37 Latino, 30 Asian, and 30 African American older adults completed a short survey about AD. Results indicated that Anglo older adults are significantly more knowledgeable about AD than African American, Asian, and Latino older adults. Level of education partially accounted for differences in knowledge of AD between Latino to Anglo older adults. After controlling for age, number of years of speaking English was associated with knowledge of AD in Asian older adults. The results suggest that certain ethnic minority groups do not have sufficient information about AD, and this may explain the lack of AD service use by minorities. Extensive evaluation of barriers to knowledge of AD is needed in order to specifically target minority groups and educate them about AD and the importance of early intervention.