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Contemporary views on dementia as witchcraft in sub-Saharan Africa: A systematic literature review
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.
... age, spirituality and religion, 3 and cultural contexts that are socially transmitted from one generation to another 4,5 These sociocultural contexts, such as witchcraft 6 or spirituality and religion impacted African people's understandings, meanings, and beliefs about dementia, 7-10 drawing upon values, customs, relationships, and practices that shape the way Africans communicate, think, and behave that characterize Black Africans, particularly with people with dementia and caregiving for dementia. [11][12][13] Thus, this current work is designed to understand and improve the health of BAME (defined as all ethnic groups except White ethnic groups) communities in the UK focused on dementia and the Black African populations to inform dementia practice and policy. ...
... 5 Armstrong et al (2022) The study identified four main themes, and the findings suggested that participants' relationships with their community, knowledge of dementia services, identity and faith influenced their experience of dementia. 6 Baghirathan et al (2020) ...
... Belief in witches' crafts is widespread in Africa. 6 They are part of a complex body of inherited folklore, 4 and dementia identity is constituted through differences in social identity based on relationships with others in the Black African community. 82 In addition, dementia identity theory is situated with the mind/brain and body constructions. ...
Background: The high prevalence of dementia among Black Africans, coupled with their lower engagement with dementia specialist services in the UK, underscores the urgency of understanding lay knowledge and beliefs about dementia in the group. Studies reporting lay knowledge of dementia in the UK tended to conclude that Black Africans lack dementia knowledge, presumably based on biomedical assumptions, without taking into consideration the Black Africans’ lay dementia knowledge and beliefs about dementia. The current study, therefore, investigated the Black African populations’ lay knowledge and beliefs toward dementia in Africa, comparing how this relates to the findings in the UK literature. Methodology: The researcher thoroughly searched electronic databases from September 2017 to October 2022 for qualitative research exploring how Black African populations perceived and experienced dementia, which informed the Black Africans’ dementia knowledge in Africa and the UK. The review included qualitative studies with African populations published in peer-reviewed journals with available abstracts and full text in English. Studies outside the UK and Africa, as well as quantitative research and studies with health practitioners, were excluded. A grounded theory approach informed the thematic analysis. The researcher reported the Black Africans’ lay knowledge and beliefs toward dementia, informed by participants’ experiences and meanings of dementia. Results: Twenty-two studies (n = 22) met the eligibility criteria and were appraised and included in the review. All the UK papers were a multi-modeling of ethnicity in the study. Nine studies (n = 9) were conducted in the UK. Thirteen studies (n = 13) are conducted in Africa, (5 [n = 5] studies from South Africa, 2 [n = 2] from Tanzania, 1 [n = 1] from Congo, 2 [n = 2] from Uganda, 2 [n = 2] from Nigeria, and 1 [n = 1] from Ghana). All the studies were valuable. The researcher identified and developed 4 themes as they emerged from the studies: (i) Dementia witchcraft paradigm, (ii) Dementia older age paradigm, (iii) Dementia disease and illness paradigm, and (iv) Dementia identity paradigm. Discussion/Conclusion: The lay knowledge and beliefs about dementia among Black African populations were foregrounded in sociocultural distinctiveness, and some understanding intersected with biomedical knowledge about dementia. Further empirical study in the UK is essential. Implications for policy and practice: A better understanding of lay knowledge and beliefs about dementia among Black African populations can improve dementia care, providing culturally sensitive and tailored support for Black African communities.
... For example, a study conducted in the United Kingdom investigating stigma among primarily Black African and Caribbean communities found that there was a general perception that dementia was a "white person's illness" [72]. A systematic review by Brooke and Ojo (2020) revealed that there is a common belief in Sub-Saharan Africa that PwD are witches, resulting in abuses and improper care [73]. African American and Latino populations in the USA consistently show higher risk rates for MCI and AD and it is theorized that cultural aspects such as ethnicity, language, country of origin, immigration status, acculturation and healthcare disparities can be associated with these higher rates [74]. ...
... For example, a study conducted in the United Kingdom investigating stigma among primarily Black African and Caribbean communities found that there was a general perception that dementia was a "white person's illness" [72]. A systematic review by Brooke and Ojo (2020) revealed that there is a common belief in Sub-Saharan Africa that PwD are witches, resulting in abuses and improper care [73]. African American and Latino populations in the USA consistently show higher risk rates for MCI and AD and it is theorized that cultural aspects such as ethnicity, language, country of origin, immigration status, acculturation and healthcare disparities can be associated with these higher rates [74]. ...
... Just four of the thirty included studies in this review utilized the assistance of an implementation framework or theory, and very few provided a quality description of implementation strategies used [29,34,36,59]. The included frameworks within the review were: United Theory of Acceptance and Use of Technology (UTAUT), Measurement Instrument for Determinants of Innovation (MIDI), Twigg and Atkin's typology, and the Medical Research Council (MRC) framework [46,[71][72][73]. ...
Background
One of the most pressing issues in our society is the provision of proper care and treatment for the growing global health challenge of ageing. Assistive Technology and Telecare (ATT) is a key component in facilitation of safer, longer, and independent living for people with dementia (PwD) and has the potential to extend valuable care and support for caregivers globally. The objective of this study was to identify promotors and barriers to implementation and adoption of ATT for PwD and their informal (family and friends) and formal (healthcare professionals) caregivers.
Methods
Five databases Medline (Ovid), CINAHL, Web of Science, APA PsycINFO and EMBASE were searched. PRISMA guidelines have been used to guide all processes and results. Retrieved studies were qualitative, mixed-method and quantitative, screened using Rayyan and overall quality assessed using Critical Appraisal Skills Programme (CASP) and Mixed Methods Assessment Tool (MMAT). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria and assigned within categories of high, moderate, or low. NVivo was used for synthesis and analysis of article content. A narrative synthesis combines the study findings.
Results
Thirty studies (7 quantitative, 19 qualitative and 4 mixed methods) met the inclusion criteria. Identified primary promotors for the implementation and adoption of ATT were: personalized training and co-designed solutions, safety for the PwD, involvement of all relevant stakeholders, ease of use and support, and cultural relevance. Main barriers for the implementation and adoption of ATT included: unintended adverse consequences, timing and disease progress, technology anxiety, system failures, digital divide, and lack of access to or knowledge of available ATT.
Conclusion
The most crucial elements for the adoption of ATT in the future will be a focus on co-design, improved involvement of relevant stakeholders, and the adaptability (tailoring related to context) of ATT solutions over time (disease process).
... 4 As the world's most rapidly aging population is located in sub-Saharan Africa, people there will be especially at risk for dementia. 40 As in Latin America, digital biomarkers may address issues around access to resources and ultimately improve care. There is also a similar need to expand available cognitive assessments for those with low education levels. ...
... A widely reported challenge to dementia diagnosis in sub-Saharan Africa is socio-cultural stigma tied to traditional spiritual beliefs that draw a link between unusual behavior and witchcraft. 40 Accusation of witchcraft, especially for older women, has not only negative connotations but can also lead to social and physical isolation. 40 Individuals in the early stages of dementia may not seek health care in an effort to avoid this social stigma and accusations of witchcraft, delaying patient presentation. ...
... 40 Accusation of witchcraft, especially for older women, has not only negative connotations but can also lead to social and physical isolation. 40 Individuals in the early stages of dementia may not seek health care in an effort to avoid this social stigma and accusations of witchcraft, delaying patient presentation. 40 In some regions of sub-Saharan Africa, symptoms of dementia are considered normal parts of aging and are associated with a loss of authority and child-like behavior. ...
Alzheimer's disease (AD) and other dementias are a global challenge. Early diagnosis is important to manage the disease. However, there are barriers to diagnosis that differ by region. Researchers from Brazil, China, Nigeria, Spain, and Sweden have identified key barriers to AD diagnosis in their countries. In Brazil, socioeconomic inequalities and poor recognition of dementia by physicians can prevent diagnosis. In China, a very large population and lack of physician training in dementia make diagnosis problematic. In Nigeria, socioeconomic inequalities and cultural stigma can stand in the way of diagnosis. In Spain, patient hesitancy and an overloaded health‐care system are barriers to diagnosis. In Sweden, inconsistent use of biomarkers is a prominent barrier to diagnosis of AD. To support diagnosis, more focus is needed on education of patients and physicians, increased use of support services, and improved access to biomarkers to accurately diagnose AD.
... Though promotion of awareness and understanding of dementia, the strategy can contribute to dispelling myths and misconceptions surrounding cognitive disabilities, fostering a more inclusive and supportive society. Furthermore, there is a plethora of media portrayals of people living with dementia as demeaning, socially excluded, and spiritually possessed [28,29]. Beyond the individual, dementia has far-reaching implications for families, communities, and the nation as a whole. ...
... The existing empirical evidence on dementia awareness within sub-Saharan African countries underscores a substantial knowledge gap, with awareness levels varying across populations [1,36,37]. Notably, in Nigeria, elucidation of behaviors related to individuals with dementia often attributes such manifestations to supernatural phenomena, such as witchcraft and evil spirits, prompting recourse to traditional healing practices [15,29]. Furthermore, the lack of comprehension regarding dementia signs and symptoms among family members contributes to delayed diagnoses and inadequate support for affected individuals and their families [4,28]. ...
Despite the growing prevalence of dementia, driven by an ageing population and compounded by cultural misunderstandings and stigma, Nigeria lacks a coherent national plan to address this issue. The article points out that although Nigeria has enacted policies such as the National Aging Policy, which do not sufficiently address the specific needs of people living with dementia. It underscores the necessity of integrating a dementia strategy within the broader health and social care systems of Nigeria. The article draws on the World Health Organization's Global Dementia Action Plan to elaborates on several critical areas for action, including public health prioritization of dementia, awareness and stigma reduction, improved diagnosis, treatment, care, and support, alongside bolstering support for caregivers. It stresses the importance of a dementia‐friendly infrastructure, research and innovation, and leveraging community support to foster a more inclusive society. Furthermore, the article outlines current state of healthcare and social support systems in Nigeria, pointing to significant gaps in infrastructure, healthcare workforce, and financial mechanisms that hinder effective dementia care. Hence, elevating dementia care as a national health priority, and increasing access to quality care and support, Nigeria is well positioned to mitigate the impact of dementia on families and the person with dementia. The call to action is clear: a national dementia strategy, informed by global best practices and tailored to Nigeria's unique cultural and societal context, is essential for addressing the challenges of dementia care and improving the well‐being of affected individuals and their families in Nigeria.
... Studies conducted in Nigeria and Africa have highlighted religion's role in the (predominantly negative) perception of and attitudes towards people with dementia (Brooke & Ojo 2020;Hindley et al. 2017;Ogunniyi et al. 2005). However, the voices of people with dementia are missing from these studies, as the experience of religion is reported from the perspective of carers and traditional and/or faith leaders. ...
... The spiritualisation of dementia in Africa is often regarded negatively, such as instances where people with dementia are considered witches (Adebiyi et al. 2016;Brooke & Ojo 2020;Khonje et al. 2015;Mkhonto & Hanssen 2018;Mushi et al. 2014;Ndamba-Bandzouzi et al. 2014). However, as the results of this study have shown, religious beliefs and practices do not always necessarily affect the lives of people with dementia negatively. ...
Background: Research on the lived experience of dementia is burgeoning across the social and health sciences. Yet, very little is still known about the experience of dementia for many tribes and ethnoreligious groups, as most studies are conducted in Western countries.
Objective: The aim is to advance the understanding of the role of faith and prayer in the lives of people with dementia in Nigeria through a lens of everyday citizenship.
Method: Interviews were conducted with 17 older people with dementia in a low-income, Yoruba-speaking community in Southwestern Nigeria. After transcription, the data were analysed thematically.
Results: The major theme identified in participants’ accounts was that prayer served as a space for active and agentic participation. This theme was further elaborated upon through four subthemes: (1) agency in routine and daily prayer, (2) cognitive (re)framing through prayer, (3) prayer as a vehicle for active social interaction and support, and (4) prayer as work and transaction.
Conclusion: Participants described religious practices as important to their acceptance of the situations, their feelings of hope in everyday lives, and their connection and contributions to the community. Analysis also shows the centrality of relationality in the everyday experiences of people with dementia.
Contribution: This article contributes to advancing the understanding of the socially orientated everyday experience of dementia. It contributes to a small body of literature on the social aspect and everyday experiences of living with dementia in Africa and stands out as the first of its kind study in Nigeria.
Keywords
dementia; citizenship; religion; Africa; lived experience
... Moreover, Ghanaians do not support the concept of care homes despite the break in the traditional care process (Akinny, 2016). Research over the last couple of years on dementia in Ghana has focused on dementia prevalence (Agyeman, 2019;De Langavant et al., 2020), challenges (Gyimah et al., 2019;Nyame et al., 2019;Spittel et al., 2018) and perceptions Brooke & Ojo, 2019;Dai et al., 2020;Larnyo et al., 2020;Spittel et al., 2019) and never on the physical environment as an alternative care option. Therefore, there exists a gap in research on the adaptation of dementia-friendly design principles in the design of spaces for persons living with dementia, not only within the care home setting but also private residences. ...
... Cultural beliefs were discussed by over half of the participants as a challenge to the quality of life for persons living with dementia, with associations between dementia and witchcraft identified by several participants. This finding has also been observed in similar studies (Brooke & Ojo, 2019;Spittel, 2014). The general misconceptions and misinformation as substantiated by studies including WHO (2015) and Nyame et al. (2019) was also a key finding in the research. ...
In Sub-Saharan African, specifically Ghana, the prevalence of dementia, has made the lack of care options available for the aged, a pressing issue. Combined with the slow deterioration of the traditional family system in Ghana and the rapid ageing of the population, the situation seems dire. Experts related to dementia are also severely lacking with care predominantly provided through mental health services. The research supports the provision of a better quality of life for persons living with dementia through dementia-friendly architectural interventions. Data was obtained through the review of 277 publications focused on dementia in Ghana, 2 case studies, as well as the thematic analysis of 15 semi-structured interviews of purposively sampled respondents. The study identified that persons living with dementia in Ghana face challenges with care, with design modifications made based on the needs of the individuals, but without specific guidance. Thus, a design framework is necessary to maximise the effects of design on the quality of life of persons living with dementia. Hitherto, no previous study in Ghana has focused on the living space as an alternative care option for dementia. The Ghanaian context allows for replication of results in other developing nations due to similar socio-economic characteristics.
... The main point is that Ubuntu has a strong cultural place to understand better caregiving for persons with dementia in the African region if well explored. Although one of the critical tenets of Ubuntu is peaceful coexistence with one another and commitment to sharing local resources, ideologies, and customs within their social environment for the attainment of collective gain , however, stigma, ostracization, and social exclusion of families of persons with dementia has made Ubuntu loses its purpose in the African region (Brooke & Ojo, 2020;Epps et al., 2018;Spittel et al., 2019) Although western principles and approaches to caregiving have attempted to offer some effective solutions to the challenges facing caregivers of persons with dementia from the global north for example: (the person-centered approach) (Fazio et al., 2018;Barbosa et al., 2015;Chenoweth et al., 2019;Parmer et al., 2021;Vernooij-Dassen & Moniz-Cook, 2016);, relationshipcentered approach (McCormack et al., 2010;McConnell & Meyer, 2019;Morrison et al., 2019;Witt & Fortune, 2019), yet, these approaches might not be applicable in all situation of caregiver's challenging experiences in the global south where stigma and discrimination are prevalent (Nwakasi et al., 2019;Nwakasi et al., 2019;Ogunniyi, 2018). These western approaches to solving caregiver's challenging experiences are not a complete fit for addressing the everyday challenges of caregivers of persons with dementia in African communities; this is because of the diversity in culture and religious affiliations (Bekhet, 2015;Gurayah, 2015;Napoles et al., 2010;Oyinlola & Olusa, 2020;Hansen et al., 2019). ...
... When communities live according to the philosophy of Ubuntu, they develop a sense of shared will to survive through the journey of caregiving for persons with dementia through personal responsibilities, sacrifice, service, and accountability . Evidence suggests that family caregivers of persons with dementia in the African region are made to undergo struggles, stigma, and social exclusion because persons with dementia are viewed as witches and wizards (Brooke & Ojo, 2020;Kane et al., 2021;Adedeji et al., 2022). Also, literature has suggested the negative impact of the stereotypic behaviour of caregivers on stigma experiences for people with dementia (Gureje et al., 2011;Musyimi et al., 202;Kehoua et al., 2019). ...
Prior to the COVID-19 pandemic, formal structures to address the issue of homelessness did not exist in the Provincial sphere of Government in Gauteng. Services available were offered by faith-based communities and Non-Profit Organisations (NPOs) on an ad hoc and voluntary basis at the local government level. The pandemic and lockdown restrictions that followed meant that the Provincial government - which has as its main function legislative and executive authority, had to devise a temporary strategy to accommodate the homeless. A homelessness programme grounded on ubuntu philosophy was developed to assist with the provision of food, sanitation, and shelter for the homeless. Services were expanded to include park homes that provided temporary shelter and holistic services to capacitate the homeless with skills to become self-sufficient and self-reliant in the long run, as well as provision of health care and reunification services. Using a case study of the Gauteng Province homelessness programme, this chapter will explore the use of the ubuntu approach to draw lessons from the programme and the implications for social work practice.
... 9 Emerging evidence from Sub-Saharan Africa pertaining to all-cause dementia has shown that people may simultaneously hold a number of different beliefs about dementia and its causes. 206 For example, a study in South Africa found that participants, on the one hand, often believed that dementia was related to witchcraft or punishments from ancestors or God, while on the other they also believed dementia to be a medical condition. 207 Help was therefore often sought from multiple sources simultaneously, typically faith healers and traditional medicine practitioners, and to a lesser degree allopathic medicine providers. ...
... In cases of suspected witchcraft, caregivers may be shunned by community, and even family, due to fear. 206 It is not hard to imagine that the "strange" behavior displayed by individuals with bvFTD may be misconstrued as caused by such forces in environments where religio-magical explanatory models are commonly used. In much of Africa, there is a culturally entrenched reliance on informal care from younger relatives-and residential programs are uncommon. ...
Frontotemporal dementia (FTD) is one of the leading causes of dementia before age 65 and often manifests as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). FTD's exact clinical presentation varies by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer's Sanne Franzen and Karen Nuytemans have shared first authorship. Ganesh M. Babulal and Chiadi U. Onyike have shared last authorship.
... 9 Emerging evidence from Sub-Saharan Africa pertaining to all-cause dementia has shown that people may simultaneously hold a number of different beliefs about dementia and its causes. 206 For example, a study in South Africa found that participants, on the one hand, often believed that dementia was related to witchcraft or punishments from ancestors or God, while on the other they also believed dementia to be a medical condition. 207 Help was therefore often sought from multiple sources simultaneously, typically faith healers and traditional medicine practitioners, and to a lesser degree allopathic medicine providers. ...
... In cases of suspected witchcraft, caregivers may be shunned by community, and even family, due to fear. 206 It is not hard to imagine that the "strange" behavior displayed by individuals with bvFTD may be misconstrued as caused by such forces in environments where religio-magical explanatory models are commonly used. In much of Africa, there is a culturally entrenched reliance on informal care from younger relatives-and residential programs are uncommon. ...
Frontotemporal dementia (FTD) is one of the leading causes of dementia before age
65 and often manifests as abnormal behavior (in behavioral variant FTD) or language
impairment (in primary progressive aphasia). FTD’s exact clinical presentation varies
by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer’s Association International Society to Advance Alzheimer’s Research and Treatment examines how increasing global diversity impacts the clinical presentation, screening, assessment, and diagnosis of FTD and its treatment and care. It subsequently provides recommendations to address immediate needs to advance global FTD research and clinical practice.
... Unfortunately, traditional beliefs, inadequate awareness, and misconceptions about dementia and other age-related diseases have been contributing to poor management and understanding of these conditions in the Sub-Saharan Africa region (4)(5)(6)(7). It is crucial to educate the public and healthcare providers about the true nature of dementia and other agerelated diseases and to dispel common misconceptions. ...
... In SSA, older women are one of the most vulnerable members of the society at risk of being accused of witchcraft (27). As it could be noted, the psychological and emotional symptoms associated to witchcraft confession overlap with the symptoms of dementia disorders (6). Therefore, without clinical validation, it becomes so easy to misconceive dementia symptoms in older adults with witchcraft. ...
... The main point is that Ubuntu has a strong cultural place to understand better caregiving for persons with dementia in the African region if well explored. Although one of the critical tenets of Ubuntu is peaceful coexistence with one another and commitment to sharing local resources, ideologies, and customs within their social environment for the attainment of collective gain , however, stigma, ostracization, and social exclusion of families of persons with dementia has made Ubuntu loses its purpose in the African region (Brooke & Ojo, 2020;Epps et al., 2018;Spittel et al., 2019) Although western principles and approaches to caregiving have attempted to offer some effective solutions to the challenges facing caregivers of persons with dementia from the global north for example: (the person-centered approach) (Fazio et al., 2018;Barbosa et al., 2015;Chenoweth et al., 2019;Parmer et al., 2021;Vernooij-Dassen & Moniz-Cook, 2016);, relationshipcentered approach (McCormack et al., 2010;McConnell & Meyer, 2019;Morrison et al., 2019;Witt & Fortune, 2019), yet, these approaches might not be applicable in all situation of caregiver's challenging experiences in the global south where stigma and discrimination are prevalent (Nwakasi et al., 2019;Nwakasi et al., 2019;Ogunniyi, 2018). These western approaches to solving caregiver's challenging experiences are not a complete fit for addressing the everyday challenges of caregivers of persons with dementia in African communities; this is because of the diversity in culture and religious affiliations (Bekhet, 2015;Gurayah, 2015;Napoles et al., 2010;Oyinlola & Olusa, 2020;Hansen et al., 2019). ...
... When communities live according to the philosophy of Ubuntu, they develop a sense of shared will to survive through the journey of caregiving for persons with dementia through personal responsibilities, sacrifice, service, and accountability . Evidence suggests that family caregivers of persons with dementia in the African region are made to undergo struggles, stigma, and social exclusion because persons with dementia are viewed as witches and wizards (Brooke & Ojo, 2020;Kane et al., 2021;Adedeji et al., 2022). Also, literature has suggested the negative impact of the stereotypic behaviour of caregivers on stigma experiences for people with dementia (Gureje et al., 2011;Musyimi et al., 202;Kehoua et al., 2019). ...
Ubuntu has gained momentum in the global arena after being emphasized
in the Global Agenda (GA) of the social work profession. Ubuntu, is the
African philosophy of sharing and caring. This philosophy has had profound
implications for the elderly in sub-Saharan Africa. Ubuntu can best be
described as an African philosophy that emphasizes ‘being self through
others’. Elderly people in this paper are defined as those
persons aged 60 years and above. Their humane (ubuntu) spirit has made
them do tremendous contributions to society as guardians of traditions and
cultural values which are passed on from generation to generation,
contribute immensely to wealth creation, support and care for children,
conflict resolution, problem solving among others. Therefore, the focus of
this paper was to explore ubuntu as an effective strategy for improving the
wellbeing of the elderly in Uganda. The study was exploratory and
descriptive, using experiences of older persons in Kabale District. Data were
collected using interviews and focused group discussions. The study found
strong acquaintances between ubuntu and older person’s wellbeing. The
study found that ubuntu is a very important aspect because it gives the elderly
a sense of self-worth, self-respect, individual wellbeing, life-satisfaction and
achievement. Ubuntu further enables the elderly to transfer the humanistic
values to the next generation as well as helping the current generation to deal
with their difficulties in a more effective manner by applying the humanistic values they have inherited from the elderly. This paper concludes that the
elderly can thus impart these values to the rest of humankind and the
younger generation to ensure effectiveness in the practice of ubuntu. The
study recommended that improving the wellbeing of the elderly does not
require just one strategy but a combination of several strategies including
involvement of all stakeholders especially the older persons themselves
following the saying “nothing for us without us”, family members,
community members, caregivers, civil society, as government takes lead in
promoting wellbeing
... The main point is that Ubuntu has a strong cultural place to understand better caregiving for persons with dementia in the African region if well explored. Although one of the critical tenets of Ubuntu is peaceful coexistence with one another and commitment to sharing local resources, ideologies, and customs within their social environment for the attainment of collective gain , however, stigma, ostracization, and social exclusion of families of persons with dementia has made Ubuntu loses its purpose in the African region (Brooke & Ojo, 2020;Epps et al., 2018;Spittel et al., 2019) Although western principles and approaches to caregiving have attempted to offer some effective solutions to the challenges facing caregivers of persons with dementia from the global north for example: (the person-centered approach) (Fazio et al., 2018;Barbosa et al., 2015;Chenoweth et al., 2019;Parmer et al., 2021;Vernooij-Dassen & Moniz-Cook, 2016);, relationshipcentered approach (McCormack et al., 2010;McConnell & Meyer, 2019;Morrison et al., 2019;Witt & Fortune, 2019), yet, these approaches might not be applicable in all situation of caregiver's challenging experiences in the global south where stigma and discrimination are prevalent (Nwakasi et al., 2019;Nwakasi et al., 2019;Ogunniyi, 2018). These western approaches to solving caregiver's challenging experiences are not a complete fit for addressing the everyday challenges of caregivers of persons with dementia in African communities; this is because of the diversity in culture and religious affiliations (Bekhet, 2015;Gurayah, 2015;Napoles et al., 2010;Oyinlola & Olusa, 2020;Hansen et al., 2019). ...
... When communities live according to the philosophy of Ubuntu, they develop a sense of shared will to survive through the journey of caregiving for persons with dementia through personal responsibilities, sacrifice, service, and accountability . Evidence suggests that family caregivers of persons with dementia in the African region are made to undergo struggles, stigma, and social exclusion because persons with dementia are viewed as witches and wizards (Brooke & Ojo, 2020;Kane et al., 2021;Adedeji et al., 2022). Also, literature has suggested the negative impact of the stereotypic behaviour of caregivers on stigma experiences for people with dementia (Gureje et al., 2011;Musyimi et al., 202;Kehoua et al., 2019). ...
This book shares the relevance of Ubuntu in Social work practice and starts by tracing the origin of the philosophy and how it looks like in contemporary society. We start by telling a story of Giringa as an illustration of Ubuntu. We then trace the history of Ubuntu back to about 4000 years, though it goes beyond this. We have described the five stages, and then, we present the Ubuntu social work practice, shared by Social Workers globally. The book has different chapters that are a blend of academic and practice-oriented contributions. This has intentionally been adapted to maximise contributions." Therefore, readers will see different styles and approaches to writing. At the end, an overview of the impacts of Ubuntu on international social work is presented.
Access the book here for FREE: https://www.ifsw.org/product/books/the-ubuntu-practitioner-social-work-perspectives/
... The main point is that Ubuntu has a strong cultural place to understand better caregiving for persons with dementia in the African region if well explored. Although one of the critical tenets of Ubuntu is peaceful coexistence with one another and commitment to sharing local resources, ideologies, and customs within their social environment for the attainment of collective gain , however, stigma, ostracization, and social exclusion of families of persons with dementia has made Ubuntu loses its purpose in the African region (Brooke & Ojo, 2020;Epps et al., 2018;Spittel et al., 2019) Although western principles and approaches to caregiving have attempted to offer some effective solutions to the challenges facing caregivers of persons with dementia from the global north for example: (the person-centered approach) (Fazio et al., 2018;Barbosa et al., 2015;Chenoweth et al., 2019;Parmer et al., 2021;Vernooij-Dassen & Moniz-Cook, 2016);, relationshipcentered approach (McCormack et al., 2010;McConnell & Meyer, 2019;Morrison et al., 2019;Witt & Fortune, 2019), yet, these approaches might not be applicable in all situation of caregiver's challenging experiences in the global south where stigma and discrimination are prevalent (Nwakasi et al., 2019;Nwakasi et al., 2019;Ogunniyi, 2018). These western approaches to solving caregiver's challenging experiences are not a complete fit for addressing the everyday challenges of caregivers of persons with dementia in African communities; this is because of the diversity in culture and religious affiliations (Bekhet, 2015;Gurayah, 2015;Napoles et al., 2010;Oyinlola & Olusa, 2020;Hansen et al., 2019). ...
... When communities live according to the philosophy of Ubuntu, they develop a sense of shared will to survive through the journey of caregiving for persons with dementia through personal responsibilities, sacrifice, service, and accountability . Evidence suggests that family caregivers of persons with dementia in the African region are made to undergo struggles, stigma, and social exclusion because persons with dementia are viewed as witches and wizards (Brooke & Ojo, 2020;Kane et al., 2021;Adedeji et al., 2022). Also, literature has suggested the negative impact of the stereotypic behaviour of caregivers on stigma experiences for people with dementia (Gureje et al., 2011;Musyimi et al., 202;Kehoua et al., 2019). ...
... Furthermore, an important finding was the ambiguity that family caregivers still held despite their understandings described above (Brooke & Ojo, 2019). Caregivers still struggled to demonstrate a clear understanding of dementia even after receiving a diagnosis and accessing treatmentalthough some acknowledged progress after obtaining more information through support services such as Alzheimer's South Africa and their research efforts. ...
... Additionally, caregivers described the sacrifices and struggles associated with taking care of their family members with dementia and the life changes that this brought in various aspects of their lives. Some caregivers sacrificed their aspirations and ambitions and had to leave their jobs (Omiya et al., 2021;Owokuhaisa et al., 2020), while most caregivers expressed consciously avoiding social engagements due to the guilt, worry and stress of either managing dementia-related behaviours in public or leaving their family member with dementia at home (Brooke & Ojo, 2019;Gurayah, 2015;Khonje et al., 2015). ...
This study was undertaken to understand South African family caregivers’ lived experiences of individuals living with dementia in a predominantly Black African township. A homogenous sample of thirty family caregivers was recruited using purposeful sampling methods and interviewed using a semi-structured approach. Reflective Thematic Analysis (RTA) yielded four broad themes: Understanding Dementia, Struggles and Sacrifice, Mental Health and Protective Factors. Findings reflect how dementia is understood by family caregivers and their community, the struggles and sacrifices that they endure, the impact of caregiving on caregiver mental health and the protective factors that enable caregivers to cope, despite their difficulties. Our findings lead to new insights regarding dementia caregiving amongst family caregivers in South Africa. First, there appears to be a shift in perception – away from a cultural/spiritual paradigm – and a lack of pressure to conform to community conceptualizations of dementia among individual caregivers. Second, dementia caregiving had a negative effect on caregiver mental health and elicited stress, anxiety and grief reactions. Third, caregivers did not feel emotionally supported and expressed not receiving any assistance with their daily practical tasks. Fourth, before receiving a diagnosis, family caregivers were viewed as the perpetrators of abuse and/or neglect against their family members with dementia, instead of individuals with dementia being stigmatized by the community due to their behavioural symptoms. Additionally, help-seeking was not hindered by fear or stigma, but was motivated by caregiver distress as dementia-related behaviours began to manifest and caregivers feared being perceived as perpetrators of abuse. Psychoeducational interventions should be tailored to targeted population groups that are in need of further training to address the lack of awareness in communities, insufficient knowledge of dementia amongst healthcare professionals and the practical, emotional and psychological difficulties that family caregivers endure to facilitate mental health care and resilience.
... 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." ...
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.
... In addition, dementia incidence and prevalence in SSA might be under-reported due to a number of factors, including a lack of awareness in the community, a healthcare system centered on infectious diseases, and a lack of healthcare resources, including a shortage of healthcare professionals. 38,39 In addition, though functional limitation is a major criterion for the diagnosis of dementia, the daily activities and social functioning of the living environment of many older people in Malawi are simple and often less cognitively demanding than those of people living in HICs. [40][41][42] Consequently, some people who would be diagnosed with dementia in middle-and high-income countries might not be diagnosed in Malawi. ...
BACKGROUND
Sub‐Saharan Africa (SSA) is experiencing a rapid increase in its aging population, including people living with human immunodeficiency virus (HIV) (PLHIV). The purpose of this study was to determine the prevalence of dementia among PLHIV and people without HIV (POHIV) in Malawi.
METHODS
We conducted a retrospective medical record review of 400 consecutive patients from a single tertiary health center (200 PLHIV from an HIV clinic and 200 POHIV from an outpatient clinic) in Lilongwe, Malawi.
RESULTS
The overall rate of dementia was higher in PLHIV than that in POHIV (22% vs 10%; p = 1.4e). Older age, unknown employment or unemployed, and depression were significant risk factors for dementia for PLHIV, while older age and depression were significant among POHIV.
DISCUSSION
Our study confirmed the increased risk of dementia in PLHIV and provides valuable groundwork for future dementia studies to accurately examine the prevalence and risk factors of dementia in SSA, including Malawi.
Highlights
Malawians, in SSA, face the double burden of HIV AD and related dementias.
We conducted a retrospective medical record review to assess dementia prevalence and risk factors.
Dementia prevalence was higher in PLHIV than in POHIV.
Older age, unknown employment or unemployed, and depression were risk factors for dementia in PLHIV.
Our findings, reflecting the current diagnosing and medical documenting practice in Malawi, provide valuable groundwork for future dementia research in Malawi.
... Many people turn to traditional healers, faith healers or alternative medicine for treatment (Hindley et al., 2017;Mushi et al., 2014). Additionally, many individuals do not recognise dementia as a medical condition; instead, they may perceive it as a normal part of ageing or a condition caused by witchcraft or 'God's punishment' (Brooke & Ojo, 2020;Hindley et al., 2017). ...
Cognitive Stimulation Therapy (CST) is a group psychosocial intervention for people with mild-to-moderate dementia. Despite evidence supporting its effectiveness, cost-effectiveness, and cultural adaptation internationally, CST has yet to be implemented in routine practice outside of the UK. This study consisted of multiple phases. In the first phase, we engaged stakeholders to explore the barriers and facilitators to CST implementation in Tanzania. In the second phase, we developed implementation strategies. In the third phase, we tested these strategies in a study of CST in a tertiary hospital in northern Tanzania. The Consolidated Framework for Implementation Research (CFIR) guided the study. We conducted stakeholder engagement with decision-makers, healthcare professionals, people with dementia and their family caregivers (n = 49) to identify barriers and facilitators to implementation. We developed an implementation plan that included 20 implementation strategies related to 12 CFIR constructs. Subsequently, we tested these strategies by running eight CST groups with 49 participants. In follow-up interviews with people with dementia, carers and healthcare professionals, we identified 18 key CFIR constructs as barriers or facilitators to successfully implementing CST. CST was compatible with the standards of care in a tertiary referral hospital in northern Tanzania. To implement CST in low-resource settings, we recommend running dementia awareness initiatives, screening for dementia in outpatients and community settings, developing a train-the-trainer model, employing a task-shifting approach, and creating a dementia-friendly space for dementia services. Our findings can inform future efforts to implement CST and other psychosocial interventions for dementia in low-resource settings.
Supplementary Information
The online version contains supplementary material available at 10.1007/s43477-024-00142-6.
... Cultural and societal beliefs about the causes of dementia include witchcraft and punishments by God for sinning among others, and this stigma leads to a reluctance in help-seeking and withdrawal from the wider community (Brooke & Ojo, 2020;Bruinsma et al., 2022;De Jager et al., 2015;Mahomed & Pretorius, 2022). ...
The main aim of this article is to describe a new understanding of challenging behaviour, missed care and abuse in nursing homes. Challenging behaviour from residents and missed care and abuse from staff in nursing homes are complex and interrelated phenomena. These factors will also influence each other in an unpredictable manner. Challenging behaviour from residents, missed care and abuse from healthcare staff are phenomena that are closely linked, partly overlapping and often part of the same phenomenon with common triggering and maintaining factors. The scientific division of these phenomena into different research disciplines is therefore problematic. This division reduces the possibility for a common holistic understanding and the development of shared approaches in practice. In addition, the field also needs to move away from a culture where the responsibility or causes of these phenomena are mainly placed on the individual, whether it is a resident or an employee in a nursing home. Challenging behaviour has often been solely linked to individual characteristics of the resident, such as cognitive decline or dementia, and abuse and missed care have been linked to the individual staff members poor attitudes, using the term “perpetrators.”
... Indigenous communities view dementia as part of the normal aging process, 4 as a spiritual phenomenon, 5 or as a "second childhood" on the circle of life's continuum. 6 In some cases globally, dementia has evoked fear and mistrust, 7 causing people with dementia to be accused of witchcraft, 8 or to suffer abuse and extreme violence. 9 Access to culturally-safe dementia care (CSDC) for Indigenous populations is an emerging priority worldwide. ...
INTRODUCTION
In 2018, the World Health Organization recognized traditional healers as community stakeholders in dementia care. This scoping review aimed to summarize the existing dementia care literature regarding strategies for the integration of traditional healing in dementia care and the roles of traditional healers.
METHODS
A group of Indigenous Elders from Northern Ontario, Canada, guided, reviewed, and validated the research process and findings. The Joanna Briggs Institute approach was applied to a structured search strategy across the CINAHL, Embase, MEDLINE, and PsycINFO databases. A title and abstract screening were completed, followed by a full‐text assessment of the identified manuscripts.
RESULTS
A total of 143 full manuscripts were reviewed, of which two studies fully met the community‐determined inclusion/exclusion criteria.
DISCUSSION
The integration of traditional healing practices into dementia care offers a pathway to culturally‐safe care for people with dementia. The findings identified policy advocacy as key to engage, educate, and empower traditional healers.
Highlights
The WHO recognized traditional healers as community stakeholders in dementia care and prevention worldwide in 2018; however, traditional healers are underrepresented and marginalized in healthcare systems due to the lack of culturally‐safe dementia care (CSDC) policies at community and national levels globally.
Community‐based CSDC models were critically reviewed and validated by local Indigenous community stakeholder consultations.
The result is a call to action to assist the WHO and Alzheimer's Disease International in developing guidelines for CSDC policy improvements with the global Indigenous community for the engagement and empowerment of traditional healers to navigate dementia care and to implement the WHO Global Action Plan on the Public Health Response to Dementia (2017–2025).
Integration of Western biomedical and Indigenous traditional healing and medicine in dementia care in the healthcare system can reduce health disparities and empower traditional healers on a global scale. Indigenous‐led models that include traditional healers in dementia care are critical for improving equity gaps in dementia care for Indigenous Peoples.
... 155 A pluralistic approach to health care and dementia education and awareness are required to overcome stigma and challenge cultural beliefs of dementia as a prejudiced condition 156 and an adscription of witchcraft. 144 As a long-term strategy, mobilising resources across regions and disciplines using a brain health diplomacy model 156,157 can inform policy around biomarkers and health care. 156 One such example of this type of model is the Global Brain Health Institute (GBHI), 158 In Africa, the African Dementia Consortium brings together over 100 researchers in a multidisciplinary framework to generate clinical and socioeconomic datasets to improve the characterisation of dementia in Africa, 162 and the Brain Research Africa Initiative is focused on the translation of brain health evidence for policy and development. ...
Research on neurodegenerative diseases has predominantly focused on high-income countries in the Global North. This Series paper describes the state of biomarker evidence for neurodegeneration in the Global South, including Latin America, Africa, and countries in south, east, and southeast Asia. Latin America shows growth in fluid biomarker and neuroimaging research, with notable advancements in genetics. Research in Africa focuses on genetics and cognition but there is a paucity of data on fluid and neuroimaging biomarkers. South and east Asia, particularly India and China, has achieved substantial progress in plasma, neuroimaging, and genetic studies. However, all three regions face several challenges in the form of a lack of harmonisation, insufficient funding, and few comparative studies both within the Global South, and between the Global North and Global South. Other barriers include scarce infrastructure, lack of knowledge centralisation, genetic and cultural diversity, sociocultural stigmas, and restricted access to tools such as PET scans. However, the diverse ethnic, genetic, economic, and cultural backgrounds in the Global South present unique opportunities for bidirectional learning, underscoring the need for global collaboration to enhance the understanding of dementia and brain health.
... It is known that a common problem in LMICs for people living with dementia is dealing with stigmatization 3 . As this cultural or supernatural stigmatization is rooted in belief systems 35,36 , cognitively impaired patients are thought to be witches. This may help explain this high refusal rate. ...
Dementia is a global public health issue, with 57.5 million people living with at least one type of dementia in 2019 worldwide, and projected to rise to 152 million by 2050.
Objective
We assessed the cognitive function in diabetic patients aged 60 or older in Bukavu city, in the eastern Republic of the Congo (DRC).
Methods
This case-control study involved 123 patients with established diabetes mellitus (DM) and 123 controls over 60-year-olds also with high rates of illiteracy. Cognitive function was assessed using the Swahili version of the Community Screening Instrument for Dementia (CSI-D).
Results
Foremost, our study revealed language-related differences between Swahili spoken in other eastern African countries such as Tanzania and Kenya, where the Swahili CSI-D is readily applied, compared to the Swahili spoken in Bukavu (DRC). Our results also showed that cognitive impairment was present in 18.7% of the total 246 participants. Remarkably, the prevalence rate of cognitive impairment was higher in the non-diabetic group (12.2 versus 25.2%; p=0.009). Participants aged 80 or older were more likely to present with cognitive impairment compared to those aged less than 80 (adjusted odds ratio — aOR=70.27; 95% confidence interval — 95%CI 3.94–125.15; p=0.004). We also found that patients living with DM for more than 20 years were three times more likely to be impaired compared to those who were recently diagnosed with DM (aOR=3.63; 95%CI 1.70–18.81; p=0.026).
Conclusion
This study revealed that cognitive impairment was relatively high in Bukavu city. It emphasizes the lack of effective tools to assess cognitive function. This requires, therefore, that research be adapted to the intellect and cultural experiences of the patients.
Keywords:
Cognitive Dysfunction; Dementia; Diabetes Mellitus; Neuropsychology; Africa
... This implies that patients who develop disorders manifested by the above signs and symptoms may not be taken to healthcare institutions. Other authors also stated that mental health illnesses, including malaria, dementia, stroke, and the like, were believed to be related to evil spirits and witchcraft (8,24,25). This interpretation of the supernatural causation of illnesses causes communities to seek religious care or to consult witches. ...
Introduction: Socio-cultural beliefs heavily influence individuals' perceptions of health and illness, with witchcraft notably shaping how causation is attributed and impacting healthcare-seeking behavior and health outcomes. Objective: The purpose of this study was to delve into the health-related beliefs and practices surrounding witchcraft in the Tach Gayint district of northwest Ethiopia. Methods: A qualitative study with a phenomenological approach was conducted in Tach Gayint district from April 15 to May 25, 2021. A purposive sampling technique was employed to select individuals who have ever been witches, consulted witches for health-related problems, and community and religious leaders. The collected data was transcribed in Amharic language, and translated to English. It was then critically reviewed, combined into themes, and finally thematic analysis was done. Results: Health-related beliefs and practices towards witchcraft are very common, especially in the rural sub-districts. The strong belief in ill health causedby supernatural forces like ancestor spirits, evil eye, jinnee, and the act of witches themselves derives individuals from seeking treatment from witches. Witches try to manage health problems by instructing patients to make the spirits that possessed them happy, animal sacrifice, and prayer ceremonies. Conclusion: Witchcraft is affecting the health care-seeking behavior of individuals, delaying medical treatment, and ultimately contributing to permanent sequelae and death. Therefore, policymakers, healthcare authorities and providers, community and religious leaders, and other sectors must struggle for it. [Ethiop. J. Health Dev. 2023; 37(3) 000-000] Introduction Diverse socio-cultural beliefs and practices heavily influence the way individuals perceive health and illness. These socio-cultural norms play a vital role in shaping behaviors, from the choice of seeking traditional healers to the adoption of particular remedies or rituals. Among these factors, witchcraft stands out as a significant influencer of how people attribute causation to ill health and approach healthcare-seeking behaviors, ultimately impacting health outcomes (1-5).
... [7][8][9][10][11][12] While some literature touches on perceptions and attitudes towards dementia and cognitive aging within MENA and African non-refugee communities, few contextualize these attitudes and perceptions as they intersect with the migration and refugee experience specifically. [13][14][15] Refugees have multiple risk factors for dementia, including high rates of uncontrolled hypertension, post-traumatic stress disorder (PTSD), and depression all of which are linked to cognitive decline in other populations. [16][17][18][19][20][21][22][23] Despite this, refugee groups are rarely included in dementia research and prevalence rates remain unknown in this population. ...
Background
Forced migration results in exposure to trauma, interrupted access to healthcare, and loss of social support and may increase dementia risk. Literature on refugees’ knowledge of dementia and its risk factors is scant. This study investigates refugee perspectives on dementia and their access to cognitive healthcare in the United States (US).
Methods
We conducted 6 focus groups and 30 individual in-depth interviews (total of 69 participants) with Arab, African, and Afghan refugees resettled in San Diego, California. Data was coded using inductive thematic analysis.
Results
Organized by the socioecological model of health, the following themes emerged: (1) mental trauma due to migration was linked to dementia (individual); (2) fear of dementia and burdening caregivers due to limited support systems (interpersonal); (3) reliance on virtual communities for dementia information and the stress of local community loss increasing dementia risk (community); (4) healthcare providers, both in the US and in refugee camps, didn’t address cognitive health concerns (institutions); and (5) discriminatory immigration and healthcare policies as barriers to healthy aging (policy).
Discussion
Despite being a heterogeneous group, refugees share specific experiences, knowledge gaps, and barriers to healthy aging. Tailored interventions and policies are needed to address this population’s cognitive health needs. This includes addressing their mental health and social support concerns as well as training clinicians to screen for/discuss dementia with aging refugee patients.
... Studies have shown that there is a poor understanding of dementia, and the belief that it is witchcraft has contributed to many older women being accused of witchcraft and persecuted in their communities (Brooke & Ojo, 2020b;Kehoua et al., 2019;Khonje et al., 2015;Mkhonto & Hanssen, 2018b;Mushi et al., 2014). These accusations leave older women vulnerable to violent acts, with many cases of witchcraft accusations resulting in harm to these vulnerable individuals (Meel, 2009a). ...
Background: Witchcraft accusations have occurred in Ghanaian society and elsewhere in Sahara, Africa, for many decades. Witchcraft accusations commonly reveal a cultural predisposition to apportion blame for mishaps in the community, such as a disability or misconceptions surrounding ageing and dementia. Such labelling severely curtails the lives of the women, who are banished to live in the “witches” camps with resultant social isolation and accompanying stressors impacting their well-being. Yet, little is known specifically about these women’s mental health and emotional well-being. This research aimed to understand the factors influencing older women’s mental and emotional well-being in the witches’ camps in northern Ghana.
Methodology: A two-phase exploratory sequential mixed methods design was employed, using the socio-ecological model, Kleinman's explanatory model, and the social determinants of health as framing lenses. In phase one, an interpretive descriptive approach was used, drawing on purposive sampling to recruit and interview 15 women from one of the "witches' camps" in northern Ghana, along with three allied stakeholders. Additionally, observational photos of the camp's facilities were taken to provide further triangulated data to supplement the interviews. The precise ages of the women were unavailable due to their unknown birth dates. The participants stayed in the camp for a period ranging from 8 to 30 years.
Phase two aimed to investigate anxiety and depression symptoms among a cohort of women from the camps and validate the Dagbani Hospital Anxiety and Depression Scale (HADS). A cross-sectional descriptive method was applied, utilizing the cross-culturally translated HADS. A total of 168 women were recruited through random sampling from the witches' camps, and 100 women from the general population completed the Dagbani version of the HADS.
Findings: Thematic analysis of phase one data identified nine broad themes: ‘the presence of physical health problems impacting general health and well-being’, ‘anxiety, nervousness, and suicidal ideation’, ‘forgetfulness’, and ‘loneliness, sadness from family disconnection’. Other themes included ‘stigma – self and others’, ‘lack of resources for basic needs and social facilities’, ‘health access barriers affecting general and mental healthcare’, ‘enabling factors for improving social connections’, and ‘recommendations for improving mental health and general well-being’. These themes, in turn, were contextualised by the subthemes of ‘poor housing conditions’, ‘lack of healthcare facilities’, ‘lack of potable water’ and ‘psychological support’ and ‘problems with sleep or difficulty sleeping at night’, ‘frailty and loss of independence’, ‘feeling restless’ or ‘can’t sit still’, ‘worried and scared’, ‘expressing thoughts of suicide and anger’, ‘difficulty concentrating’, ‘confusion’, ‘being sad and alone’, ‘worries associated with separation and lack of family support in the camp’, ‘loss of respect and dignity (“Dariza”)’, ‘feelings of helplessness, unhappiness and despair’, ‘feelings of shame, hopelessness, and isolation’. Data from phase two revealed that anxiety and depression were more prevalent in women in the camps than in the general population of women. A breakdown of the mean scores by group demonstrated higher scores for both anxiety (mean 14.73, SD 1.46) and depression (mean 17.85, SD 1.55) for women in the camp when compared with women from the general population (mean 4.18, SD 2.43, and mean 6.18, SD 3.00, respectively).
Conclusion: The triangulation of the two phases provides a contextualized response to the research aim. Common mental health concerns were identified, including anxiety and depressive symptoms among women in the camps and women from the general population. Recommendations are provided for addressing mental health and general well-being, focusing on culturally targeted health and social care provision. These include providing critical and basic social and health care resources and amenities, such as good housing, food, safe drinking water, healthcare facilities, and insurance coverage. In addition, resilience training through counselling and linking the women with psychological support is highlighted. Importantly, this study constituted the first time the Dagbani HADS has been translated and validated. Further recommendations are made for the long-term reintegration of these women safely back into their communities.
... To have different stakeholders acquire a common understanding of the policy intent, appreciate each other's perspectives and find common grounds for communication and collaboration often present major challenges during the initial phase of implementation (11). During the implementation process, many countries and organizations are still trying to overcome some very common practical challenges such as negative perceptions of dementia care (12), caregivers' burden (e.g., limited chances for social interaction with other caregivers) (6), insufficient dementia knowledge and skills among healthcare professionals (13), and insufficient coordination among different healthcare settings (14). Well-informed implementation strategies and actions of dementia policies play an important role in managing foreseeable challenges to achieve intended outcomes (15). ...
Background
The implementation of dementia policy is a complex process of translating policy goals to actions to address the changing needs of people living with dementia. Leveraging on others’ experiences would help policy decision-makers and actors better prepare for the challenges.
Purpose
This study explored the development, the implementation and the impact of the dementia policy in Macao, a “role model” recognized by the Alzheimer’s Disease International.
Methods
A scoping review of policies, strategies, and news articles, as well as scholarly work from 6 scientific databases dated till March 2023 was conducted under the guidance of the Health Policy Triangle Framework.
Results
According to 284 documents, the dementia policy in Macao, driven by government leadership and supported with public-private partnership, aimed to integrate health and social services to achieve the goals of “Early prevention, Early detection, Early diagnosis, Early treatment and Early support.” Promoting the preparedness according to the dementia burden trajectory, empowering the public and the service providers with training and education, and encouraging services-related research were among the key actions. With major changes in dementia care configuration, a dementia service network, a dementia-friendly community and a one-stop service model for disease screening, diagnosis, treatment and support have been developed.
Discussion
Reconfiguring existing resources in the health and social services to form an integrated service network at the community level could be considered a priority of action. Continuous engagement, collaboration and empowerment at different levels across these sectors is crucial for the sustainability of a dementia policy.
... I would argue that the same criticism should be applied to the global health tradition of dementia research, with UK-and US-based institutions and actors generating and accumulating resources that are nominally concerned with a global problem. Moreover, racialisation tactics are echoed in the similar positioning of majority world populations as having 'bad' dementia outcomes because of problematic characteristics of those populations and nations -for example, incorrect supernatural beliefs (Brooke and Ojo, 2020) or poor governance (Ayele et al, 2023), which should be solved through further research and spreading awareness (Kantawala et al, 2023). ...
This paper offers some provocations regarding the contemporary globalisation of dementia research. I begin with a brief account of the late 20th-century genesis of the dementia research economy in the US and subsequent initiatives to extend that research across the majority world. I then trouble this political movement. I consider racialisation in dementia research as a parallel process to globalisation, with minoritised groups being positioned as new subjects for moral and knowledge claims regarding dementia. I suggest resonances with critiques of the global mental health movement as a technology of coloniality, which I argue are relevant to the current globalisation of dementia research. I contend that majority world populations are being positioned – scientifically and morally – as new research sites and as examples of why Anglo-American approaches to dementia are superior. These parallels require critical gerontologists to ask who is benefiting from the globalisation of dementia.
... However, it remains plausible that experiences of accessing health and social care may be considerably different in other settings, where health education, perception of mental health, cognition, and aging are significantly different. 32,33 Future research should also consider the perspectives of healthcare professionals. ...
Globally, systems have invested in a variety of dementia care programs in response to the aging population and those who have been diagnosed with dementia. This study is a qualitative secondary analysis of interview data from a larger study investigating stakeholder perceptions of programs that support caregivers and people living with an Alzheimer's Disease or Alzheimer's Disease-related dementia (AD/ADRD) in five North American jurisdictions. This study analyzed interviews with individuals living with an AD/ADRD and caregivers of individuals living with an AD/ADRD (n = 11). Thematic analysis was conducted to understand how the perception of dementia may have shaped their engagement and experience with healthcare systems. Our analysis resulted in three main themes of care users’ experience: (i) undesirable experience owing to the overarching negative shared understanding and stereotyping of dementia; (ii) dismissal throughout disease progression when seeking health and social care support; and (iii) dehumanization during care interactions. The findings carry critical social and clinical implications, for example, in informing person-centered approaches to care, and communication tools clinicians can use to enhance provider, patient, and caregiver well-being.
... Cultural emphasis on discouraging older people from carrying out complex tasks may contribute to worsening cognitive function, predisposing to poor outcomes . Spirituality and superstitions continue to affect health behaviours (Brooke & Ojo, 2020;Larweh, 2021). For example, dementia is seen by some as "God's will" or a punishment (Mukadam et al., 2011). ...
Introduction: Tanzania is a low-income country with an increasing prevalence of dementia, which provides challenges for the existing healthcare system. People with dementia often don’t receive a formal diagnosis, and with a lack of formal healthcare, are often predominantly supported by family relatives. There are very few published data relating to lived experiences of people with dementia in Tanzania. This study aimed to understand people with dementia, and their caregivers’ experiences of living with dementia in Tanzania and the perceived needs of people with dementia.
Methods: Qualitative, semi-structured interviews were conducted with 14 people with dementia and 12 caregivers in Moshi, Tanzania. Interviews were audio-recorded, translated, transcribed and analysed using a Framework Analysis approach.
Results: Three sub-themes were identified within data describing the experience of ‘Living with Dementia in Tanzania’: ‘Deteriorations in Health’, ‘Challenges to living with Dementia in Tanzanian Culture’, and ‘Lack of Support’: people with dementia faced challenges due to social isolation, stigmatisation, and lack of caregiver knowledge on how best to provide support. Collectively, these impacted on both the physical and mental health of people with dementia. Misconceptions about dementia aetiology related to age, stresses of daily life and other co-morbidities. People with dementia were motivated to access treatment, exhibiting pluralistic health-seeking behaviours. There was an overall preference for non-pharmacological interventions over medication, with high levels of trust in medical professional opinions.
Conclusions: Living with dementia in Tanzania is influenced by both cultural and religious factors. More work is needed to target supplementary healthcare (with efforts to promote accessibility), support for caregivers and public health education about dementia to overcome existent misconceptions and stigma.
... The factors of cost and accessibility are significant considerations in this context. The cost of advanced genetic testing and individualized treatments can be too high [22]. Ensuring equitable access to these technologies for all patients, irrespective of their socioeconomic situation, is a crucial factor to be taken into account. ...
Advanced medical facilities and research in North America, Europe, and certain regions of Asia have facilitated the early detection of Alzheimer's and Dementia through the utilization of brain imaging techniques and biomarkers [1]. The standard treatment approach frequently entails using a combination of pharmacological interventions and cognitive-based therapeutic techniques. Home care, assisted living, and nursing facilities are commonly utilized alternatives for providing care [1]. In the African context, the provision of dementia and Alzheimer's care is influenced by a range of problems, including but not limited to, restricted healthcare accessibility, prevailing social stigma, and deeply ingrained cultural beliefs [2]. The promotion of community-based therapies, awareness campaigns, and caregiver support groups is underway. Nevertheless, numerous African nations face constraints in terms of the accessibility of advanced medical resources and specialized care facilities [2]. Integrative precision medicine for dementia and Alzheimer's in Africa encompasses a comprehensive and interdisciplinary strategy that links diverse facets of healthcare and precision medicine to effectively tackle the distinctive obstacles and the need encountered by individuals affected by dementia in the African context. Precision medicine delivers precise treatment and healthcare services that take into account an individual's unique genetic, environmental, and lifestyle characteristics [3]. The utilization of genetic testing and biomarker analysis has proven to be valuable in the identification of individuals at risk for dementia or the diagnosis of specific types of dementia [4]. This information has the potential to inform treatment decisions and facilitate the development of tailored interventions. Africa exhibits a wide range of cultural and socioeconomic contexts, reflecting its inherent diversity as a continent. In the context of dementia and Alzheimer's in countries like Nigeria, and South Africa, the implementation of integrative precision medicine takes into account cultural factors, beliefs, and practices in order to ascertain the suitability and efficacy of interventions within the specific local population [3]. Access to healthcare services in various African nations like Zambia, Zimbabwe, Somalia are often constrained, particularly in rural regions [4]. The primary objective of integrative precision medicine is to enhance the availability of dementia care, encompassing
... Closely linked to the theme of ostracism and marginalization is emotional and psychological distress experienced by older adults and their immediate families. Like some other studies (Brooke & Ojo, 2020;Gershman, 2021), the findings reveal that many older adults, especially females, report feeling anxious, fearful, and stressed, as they worry about the labelling from society and the impact on their social standing and relationships. Kimotho (2018) posited, consistent with the labelling theory, that branding individuals causes experiences of shame and guilt. ...
In Africa, witch doctors are consulted not only for healing diseases, but also for invoking curses. There has been a paradigm
shift involving the types of people often accused of using witchcraft in response to the changing political, economic, and social landscape, and the most affected group is older adults. While efforts are being made to eliminate accusations and lynching, little attention is paid to understanding the experiences of accused older adults and their families. The study collected
data through face-to-face interviews from 12 family members
of accused older adults who are living in their communities to
identify their wellbeing challenges. The findings of this study
will offer significant contributions because a lot of attention has
been given to older adults confined in “witch” camps, but this
paper looks at those in the communities. The study found that
ostracism and marginalization, as well as emotional and psychological distress, are key wellbeing challenges experienced by older adults and their families accused of witchcraft. The findings suggest that there is a need for governmental involvement in actively enforcing existing laws that criminalize banishment of accused persons and recognizing that victims of such accusations need trauma-related support services which is currently non-existent. Specifically, a clarion call is placed on the Ministry of Gender, Children and Social Protection to spearhead reforms around trauma-related support provision.
... Besides the conventional health care in health centers and hospitals, people with health challenges in Africa also consider alternatives such as traditional healers and faith healers. The choice of faith and traditional healers is aligned with the beliefs that dementia may be supernatural or due to witchcraft [35] and the relatively cheap cost and easy access to these options. It is worth mentioning that while these supernatural beliefs may contradict conventional knowledge on the causes of dementia, they may, however, provide a means of identifying people with dementia [137]. ...
Dementia is a global public health problem with increasing prevalence and incidence worldwide. The African continent is expected to bear the biggest brunt of the burden of dementia by 2050 because of the rapid demographic changes, including rapid population growth, an increase in life expectancy, and ageing. However, French-speaking Sub-Saharan African (FS-SSA) countries are underrepresented in research on dementia in Africa. While the reasons are diverse and complex, linguistic and cultural barriers to research, disproportionately affect these countries and may be significant factors. Any efforts, therefore, to redress the burden of dementia in Africa must consider the specific demographic, cultural, and linguistic characteristics of FS-SSA countries. This scoping review explores the current state of knowledge in dementia and cognitive impairment in Sub-Saharan Africa, highlighting research gaps and specific patterns unique to FS-SSA Africa. We identify pathways for research to bridge the knowledge gaps on dementia in FS-SSA as part of the global endeavor to tackle dementia worldwide.
... This supports the reports of inadequate knowledge of dementia in sub-Saharan Africa and Asia compared with European populations. 34,35 This has important implications; it calls for intensive public awareness creation and provision of information on dementia to caregivers, aimed at bridging the knowledge gap and equipping carers to handle crisis situations. In view of the carers' lack of information on dementia, the study participants' commonest unmet needs were 'printed information material' and 'hotline where the carer can get advice in crises'. ...
Background: Carers of people with dementia (PWD) face a myriad of challenges. As dementia prevalence surges in the sub-Saharan population, the provision of data on the met and unmet needs of caregivers has become paramount.
Aim:
This study aimed to identify the needs of carers of older adults living with dementia in Ghana.
Setting:
This study was conducted in Kumasi, Ghana, among participants ≥ 18 years old, serving as carers for PWD.
Methods:
This was a multicentre cross-sectional study involving carers of patients (≥ 50 years) with dementia. The authors administered the Carer's Needs Assessment for Dementia (CNA-D) questionnaire, containing 18 problem areas with interventions for each problem area. Pearson's correlation analysis was performed to establish a relationship between demographic characteristics, problem areas and intervention score.
Results:
Fifty participants were recruited with a mean age of 48.8 (± 16.9) years, 72.0% were female participants and 98.0% were family members of PWD. The problem area most frequently identified as no/mild problem was 'legal issues' (92.0%, n = 46), and 'lack of information about dementia' was assessed as severe (48.0%, n = 24). The commonest unmet need was 'printed information material' (84.0%, n = 42), and the commonest met need was 'diagnosis and treatment of carer by a general practitioner' (42.0%, n = 21). There was a statistically negative correlation between age of carer and number of unmet needs (r = -0.308, p = 0.011) and a positive correlation between problem area score and number of unmet needs (r = 0.308, p = 0.030).
Conclusion:
Effective public education and provision of information on dementia to carers are essential interventions needed to equip them in performing their roles.Contribution: Carers in this study revealed that they lacked information on dementia but their commonest met need was accessibility to their general practitioner. This highlights the importance of promoting knowledge and awareness of dementia among primary care practitioners.
... Supernatural or spiritual explanations (e.g. witchcraft, sorcery) were often used when knowledge about medical conditions were uncommon and strange behaviours associated with dementia were interpreted as dangerous and caused by evil spirits (Mavundla et al., 2009;Brooke and Ojo, 2019;Spitte et al., 2019). ...
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.
... Toutefois, les malades sont exonérés de toute faute même s'ils devaient souvent se faire exorciser (Yanos, 2018 : 22) 6 . En outre, de la même manière qu'on différenciait les criminels et les lépreux par des signes spécifiques sur leur corps, une marque en forme de croix était aussi tatouée sur la tête des malades mentaux (Finzen, 2017 : 32). 5 C'est d'ailleurs toujours le cas dans certaines régions en Afrique (Brooke & Ojo, 2019). ...
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.
... However, there is less evidence for the prevalence of cognitive impairment and dementia across Africa among young adults [19], potentially due in part to continuing stigmatisation of people living with dementia or poor mental health [20], [21]. Despite calls for more data to raise awareness, promote help-seeking behaviour and engender political commitment to the provision of health services [18], [22] evidence remains scarce. ...
Background
The burden of hypertension in South Africa, as well as the successive cardiovascular morbidity and mortality is increasing. Hypertension presents a risk for subsequent cognitive impairment with age. This study sought to determine the association between blood pressure, arterial stiffness, using pulse wave velocity and pulse amplification pressure, and cognitive function in younger and older adults from a 30yr old urban South African birth cohort study.
Methods
We conducted a cross-sectional study among n=93 index children (now age 29yr) and their mothers (all women). We collected peripheral and central blood pressure (BP) variables, and conducted a cognitive assessment using the Montreal Cognitive Assessment (MoCA) instrument and analysed the association of BP variables with global cognitive tests and specific domains.
Results
Forty percent of the pooled sample had low MoCA total scores, and 32% of the total sample had hypertension. No associations were found in the regression analysis between BP related variables and total MoCA scores. Also, no associations were found between peripheral and central BP variables with individual cognitive domains when stratified by age. A significant relationship was found between mean pressure and low visual perception (i.e. the ability to interpret information that is seen and give it meaning; p=0.02).
Conclusion
Central mean pressure is associated with low visual perception domain among black women. These findings add to the growing evidence which suggests that central BP variables are important to explore as exposure proxies for studying the association of BP and cognitive decline especially at mid-life.
... 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]. ...
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.
... 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. ...
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). ...
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.
... In some cases, dementia has evoked fear and mistrust and people with dementia have been accused of witchcraft. 7,9 In some parts of the world, dementia is perceived as mysterious disease that requires treatment and care by traditional and faith or religious healers. 8 The World Health Organization (WHO) Dementia Plan Guide, published in 2018, indicated that people with dementia are sometimes abused and even murdered in Togo due to a lack of awareness about dementia and memory loss in family and community. ...
Objective
In this scoping review we aim to explore approaches to the integration of traditional healing and medicine in dementia care for Indigenous communities in North America, Australia, and New Zealand. We aim to understand the roles and experiences of traditional healers, strategies and their evaluation, and the barriers and opportunities for integration of Indigenous and western dementia care approaches. Introduction: Access to culturally safe geriatric care and dementia assessment, diagnosis, and care in Indigenous populations worldwide is an emerging challenge. The World Health Organization recognizes traditional healers as stakeholders in dementia care. Traditional healers can provide dementia assessment and care in unique ways and play a catalytic role in the process of dementia care planning. This scoping review will inform Indigenous health service providers about the potential integration of traditional healing and medicine into dementia care and support systems. Inclusion criteria: This review will include all types of study designs, that examine the integration of Indigenous approaches and traditional healers in dementia care in Indigenous communities in North America (Canada and U.S.), Australia and New Zealand.
Methods
In close collaboration with Indigenous community advisors, we will search for OVID MEDLINE, PsycINFO, CINAHL and EMBASE include English literature from 1990 to 2020. After two independent screens of title and abstract, and then full text, we will extract the study population, participants, intervention type, aims, methods, key findings, and knowledge gaps. The results will be summarized and presented to Indigenous community advisors for contextual interpretation and validation prior to being finalized.
Results
Our initial search of CINAHL, Embase, Medline and PsycINFO identified 516 records published between 2000 and 2020 that met our search criteria. After 164 duplicates were removed, we screened 352 titles and abstracts and excluded 209 that did not meet inclusion criteria. Our second stage review of 143 full text studies resulted in the further exclusion of 113 studies. Of these, 84 studies did not include traditional medicine and 13 did not involve Indigenous populations or meet our study design criteria. Results were extracted from the 30 eligible and relevant studies that were included in the final scoping review.
Introdução: A Doença de Alzheimer é uma enfermidade degenerativa e progressiva que atua no sistema nervoso central. Ela acomete cerca de 10% das pessoas acima de 60 anos e 40% das pessoas com mais de 80 anos e suas complicações podem levar à morte. Ao causar declínio cognitivo moderado a severo pode ser necessária a internação do paciente. Objetivo: Analisar o perfil das internações por Doença de Alzheimer no Brasil no período de janeiro de 2003 a dezembro de 2022. Metodologia: Trata-se de um estudo ecológico, retrospectivo e quantitativo. Foram analisados dados sociodemográficos (sexo, cor ou raça e faixa etária) e clínicos (número de internações, média de permanência, valor total das internações, óbitos e taxa de mortalidade). Resultados: Foram observadas 19716 internações no Brasil, sendo a maioria do sexo feminino (64%), acima de 80 anos (56%) e da cor Branca. O Sudeste obteve a maior média de permanência (121,6 dias); o total de óbitos durante o período analisado foi de 3831, sendo o Nordeste com a maior taxa de mortalidade (26,2%). O total de gastos foi de R$ 38596519,60. Conclusão: Há evidências de um aumento progressivo de internações pela Doença de Alzheimer nas últimas décadas, o que impacta também no aumento dos gastos. Idosos a partir de 80 anos foram os mais hospitalizados, assim como as mulheres e pessoas brancas. Na região Sudeste, ocorreu à maioria dos óbitos pela Doença de Alzheimer. Estratégias pautadas na conscientização sobre a doença são necessárias para seu enfrentamento.
Aim: to explore the range of cultural understandings of dementia held by people providing nursing care globally.Background: There is a worldwide shortage of nurses and healthcare workers, resulting in extensive global mobility among the workforce. Cultural competence is expected of nurses who serve diverse populations and although self-awareness is recognised as crucial in developing this ability, the focus has tended to be on the identity of the patient and adjusting care according to their specific needs. However, taken-for-granted assumptions drive unconscious judgements and therefore behaviour so nurses’ dementia-related understandings are worthy of exploration.Design: An integrative literature review, comprising five stages: problem identification; literature search; data evaluation; data analysis; and presentation of the findings.Methods: Six databases were searched for original research published between 1997 and 2023. Studies which focus on qualified/registered and unqualified/unregistered healthcare workers’ cultural understandings of dementia were included. Studies were evaluated using a tool designed for the critical assessment of qualitative research. Data was extracted using a bespoke spreadsheet. Conventional content analysis was undertaken to develop a synthesised summary of the findings of the studies.Findings: 11 papers met the inclusion criteria. Content analysis led to identification of two main themes: ‘Stigma as a common factor in cultural perceptions of dementia’, and ‘Stigma derived from cultural perceptions has consequences for people living with dementia’.Conclusion: An international perspective facilitated insight into alternative perceptions of the nature of dementia and care responses. A version of the ‘Relationship Centred Care’ model, expanded to include the wider community, could support theoretical and practical recommendations for culturally congruent approaches to care. Further research is required to examine the usefulness of incorporating this approach internationally.Reporting Method: The authors followed the ENTREQ reporting guidelines (Tong et al., 2012).
Background
Dementia is a significant public health concern and a leading cause of disability and dependency among elderly individuals globally. However, there is currently limited research examining the perceptions and attitudes of healthcare providers, including nursing students, in Namibia.
Aim
This study aimed to examine nursing students’ perceptions and attitudes of caring for patients with dementia.
Setting
The study was conducted at two university campuses in Namibia.
Methods
A quantitative correlational design was employed to conveniently recruit 196 third- and fourth-year nursing students between April and August 2023, utilising the Geriatric In-Hospital Nursing Care Questionnaire (GerINCQ) online survey. Data were analysed using SPSSv28 for descriptive and inferential statistics.
Results
The perception score ranged from 2.26 to 2.43, indicating negative attitudes and perceptions towards dementia care. The highest mean perception of 2.43 (95% CI = 2.3–2.55) was on reacting to challenging behaviour and the lowest was on professional responsibility 2.26 (95% CI = 2.12–2.4). Correlations were observed between age and performed interventions (r = 0.66; p = 0.01) and gender and dementia-sensitive care (r = 0.52; p = 0.01).
Conclusion
The study revealed unfavourable attitudes and perceptions towards dementia care among nursing students, contrary to the optimistic anticipation. The results highlight the urgent need to develop and integrate dementia care strategies and practices into nursing education curricula.
Contribution
This study provides valuable data for informing quality assurance initiatives aimed at improving nursing training in dementia care.
Background
Many people with dementia are reliant on family caregivers to provide daily care to maintain quality of life and dignity. As a result, caregivers can experience increased burden, poorer health outcomes and increased stigma. To date, the experiences of caregivers of people with dementia has not been explored within an Indonesian context.
Aims
This study aims to understand the experience of caregivers of people with dementia in Indonesia and better understanding of the stigma associated with dementia.
Materials and Methods
This qualitative study is embedded within the Strengthening Responses to Dementia in Developing Countries project. Focus Group Discussions were held with dementia caregivers residing in Jakarta, Indonesia. Inductive thematic analysis was used to analyse the transcripts.
Results
Nineteen caregivers of people with dementia participated in the Focus Group Discussions. Themes identified included: (1) Understanding of dementia, (2) Reaction to care, and (3) Seeking a diagnosis.
Discussion
A perceived lack of understanding about dementia amongst the caregivers, ultimately shaped caregivers experience of care. This included negative reactions to care leading to internalised stigma (e.g., fear and shame). Misconceptions that dementia was due to spiritual and mystical reasons were particularly stigmatising.
Conclusion
In Indonesia, families are providing care to people with dementia in an environment in which there is a lack of understanding that can lead to misdiagnosis, feelings of fear and shame. Efforts to raise address stigma and misunderstanding among the general public and healthcare professionals could be of particular value to support people with dementia and reduce the fear and shame that they can experience.
Background
In Kenya, there is lack of evidence on existing dementia care pathways, with minimal or no presentation for dementia-related symptoms in health care settings. Understanding the services available for people with dementia as well as how communities access the services could offer a practical pattern for policy makers to identify strategies that encourage early detection, care and support for people with dementia and their families.
Objectives
To elucidate initial responses of individuals and their families to dementia and challenges encountered in help seeking through care pathways to inform dementia care-related policies and practice.
Methods
The Strengthening Responses to dementia in Developing Countries (STRiDE) Kenya team adapted case vignettes (brief hypothetical stories meant to elicit responses on how the characters would behave) developed by the entire STRiDE team. A total of 29 stakeholders were then asked to provide feedback on the completed vignettes and summarize a common pathway to dementia care in Kenya while using the proposed case vignettes.
Findings
We found four initial responses to dementia suspicion in Kenya where individuals:(i) Perceive symptoms as normal part of ageing, (ii) Consult a spiritual or traditional healer, (iii) Visit a private clinic or primary health care facilities, or (iv) No action taken. These were the first points within the care pathways which determined the care trajectory the person with dementia would follow.
Conclusions
Identification of dementia care pathways could form a basis for improving the way communities perceive dementia etiology and establish standard pathways to care whilst ensuring that some pathways do not further pose an impediment to care and treatment for dementia.
Child abuse linked to faith or belief (CALFB) is a worldwide issue that is linked to serious short-term and long-term consequences and even death. Children affected by CALFB may have undergone multiple abuses - such as ritual starvation, beatings, burns, stabbings and drowning - prompting concern in hospitals, schools and communities, including in emergency and primary care settings. Nurses have an important role in safeguarding children and young people, and their role in identifying and responding to CALFB is often challenging. This article uses a 'competemility' (cultural competence and cultural humility) approach to raise awareness of CALFB reporting and investigations in the UK. It examines medical evidence and psychosocial indicators of this form of abuse and explains the metaphorical language and thoughts associated with reported beliefs. The article aims to support nurses to be culturally sensitive to CALFB and to explore how they can contribute to preserve the safety of children in familial and community settings.
This article examines the role of cultural expertise in asylum judicial decisions in the UK by focusing on witchcraft-based persecution. The case study highlights multiple challenges to decision-making created by religious and cultural diversity, and the ensuing problems of assessing unfamiliar facts and beliefs against the often lack of corroborating evidence. Drawing on legal sources and a small number of anthropological studies, as well as analyses of judicial decisions, the article discusses how the unique characteristics of witchcraft cases, with their unfamiliar paradigms, are illustrative of the need to analyse and understand asylum claims within their broad cultural, historical, economic, and political contexts. The article exposes how cultural expertise assists judges in appreciating specific contexts and curbing their Eurocentric understanding of culture and religion, and shapes the final outcome of cases.
This case study highlights challenges such as financial strain and risk of domestic violence experienced by dementia caregivers. Using methods described by Yin (2003), two cases – a 76-year-old woman (Ada) who cared for her husband, and a 32-year old woman (Chika) who cared for her father were selected from a larger study on dementia caregiving in Anambra state. Data, including interview transcripts and field notes, were analyzed for themes. For both women, extreme financial hardship further complicated dementia caregiving challenges. For Chika, there was also the issue of physical assault by her husband who accused her of neglecting her duties at home to care for her father. Despite this, she continued caregiving at the risk of more retribution. The implications of the findings are discussed.
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.
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.
Findings
In 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Background: Educating and training diabetic patients is necessary for controlling and improving their health. Methods: 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. Findings: 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. Conclusion and Recommendations: 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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
This article describes the development of a culturally sensitive support service for people with dementia living in Kwa-Zulu Natal.
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.
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.
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]
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.
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]
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.
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.
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.
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.