An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa

BackgroundDespite the severe impact of HIV in sub-Saharan Africa, the health of older people aged 50+ is often overlooked owing to the dearth of data on the direct and indirect effects of HIV on older people's health status and well-being. The aim of this study was to examine correlates of health and well-being of HIV-infected older people relative to HIV-affected people in rural South Africa, defined as participants with an HIV-infected or death of an adult child due to HIV-related cause. MethodsData were collected within the Africa Centre surveillance area using instruments adapted from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE). A stratified random sample of 422 people aged 50+ participated. We compared the health correlates of HIV-infected to HIV-affected participants using ordered logistic regressions. Health status was measured using three instruments: disability index, quality of life and composite health score. ResultsMedian age of the sample was 60 years (range 50-94). Women HIV-infected (aOR 0.15, 95% confidence interval (CI) 0.08-0.29) and HIV-affected (aOR 0.20, 95% CI 0.08-0.50), were significantly less likely than men to be in good functional ability. Women's adjusted odds of being in good overall health state were similarly lower than men's; while income and household wealth status were stronger correlates of quality of life. HIV-infected participants reported better functional ability, quality of life and overall health state than HIV-affected participants. Discussion and Conclusions The enhanced healthcare received as part of anti-retroviral treatment as well as the considerable resources devoted to HIV care appear to benefit the overall well-being of HIV-infected older people; whereas similar resources have not been devoted to the general health needs of HIV uninfected older people. Given increasing numbers of older people, policy and programme interventions are urgently needed to holistically meet the health and well-being needs of older people beyond the HIV-related care system. <br/

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

<p>Abstract</p> <p>Background</p> <p>End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence.</p> <p>Methods</p> <p>Relevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format.</p> <p>Results</p> <p>Of the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process.</p> <p>Conclusions</p> <p>The data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.</p

‘An elephant cannot fail to carry its own ivory’: Transgenerational ambivalence, infrastructure and sibling support practices in urban Uganda

This article examines how urban Ugandans navigate family support systems through a focus on the under-researched area of sibling care practices. We conceptualise such systems as transgenerational infrastructure to capture the complex flows, negotiations and dilemmas of both inter- and intra-generational relationships, orderings and power, situating family support practices within their spatial, structural and social contexts. Drawing on grounded narratives of lived experience collected in Jinja, Uganda, the article offers an alternative interpretation to what is commonly portrayed as a weakening of family support systems in sub-Saharan Africa. We develop a transgenerational ambivalence perspective which allows for a deeper understanding of the heterogeneity and fluidity of family support as an ethical practice replete with complex emotions and dilemmas shaped in the junctures between social norms, agency, resources and material conditions. Through focusing on working-age Ugandans, we demonstrate the potential for a transgenerational ambivalence approach to make visible contradictions at structural and subjective levels and focus greater attention on the importance of sibling relationships and birth order than is evident in the existing intergenerational literature. This can help researchers in the task of linking family dynamics to the growing precarity and uncertainties of life in the marginal socio-economic contexts of urban sub-Saharan Africa

The Impact of a Community-based Pilot Health Education Intervention for Older People as Caregivers of Orphaned and Sick Children as a Result of HIV and AIDS in South Africa

The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders

Effective Adaptation to Global and Humanitarian Challenges

Problem If current trends in disasters are anything to go by, we can expect more complex disasters in the future as a population, perhaps already weakened by conflict, climate or disease, is hit by a natural disaster.  This then requires a multifaceted and complex intervention of humanitarian actors. Therefore, the adaptations increasingly require identification of themes to mitigate the complex vulnerabilities that come with these challenges like reforms, collaboration and specialization of tasks between humanitarian organizations inter alia. Purpose The purpose of this thesis is to identify the underlying factors that lead to global and humanitarian challenges in order to suggest effective adaptations to address them in the preparedness phase. Methodology The paper takes a qualitative approach, adopting a phenomenological research. In depth interviews are used to identify the most outstanding themes and patterns in sync with the humanitarian challenges and adaptations identifies in the AlertNet Poll (2011) and DARA humanitarian response index (2011). The themes are used to narrate solutions to the research questions Findings The results suggest that the adaptations identified in the reports regulate humanitarian and global challenges. The humanitarian challenges effective adaptations to overcome these challenges have been identified but not limited to collaboration of humanitarian logistics actors, emphasis on preparedness and disaster risk reduction and the unification of relief and developmental policies and frameworks to ensure long term planning and assessment of disasters Conclusion The research concludes that disaster risk reduction and preparedness, humanitarian logistics reforms and collaboration in all humanitarian aspects are the most effective adaptation to the global and humanitarian challenges. If current trends in disasters are anything to go by, we can expect more complex disasters in the future as a population, perhaps already weakened by conflict, climate or disease, is hit by a natural disaster. This then requires a multifaceted and complex intervention of humanitarian actors. Therefore, the adaptations increasingly require identification of themes to mitigate the complex vulnerabilities that come with these challenges like reforms, collaboration and specialization of tasks between humanitarian organizations inter alia. Purpose The purpose of this thesis is to identify the underlying factors that lead to global and humanitarian challenges in order to suggest effective adaptations to address them in the preparedness phase. Methodology The paper takes a qualitative approach, adopting a phenomenological research. In depth interviews are used to identify the most outstanding themes and patterns in sync with the humanitarian challenges and adaptations identifies in the AlertNet Poll (2011) and DARA humanitarian response index (2011). The themes are used to narrate solutions to the research questions Findings The results suggest that the adaptations identified in the reports regulate humanitarian and global challenges. The humanitarian challenges effective adaptations to overcome these challenges have been identified but not limited to collaboration of humanitarian logistics actors, emphasis on preparedness and disaster risk reduction and the unification of relief and developmental policies and frameworks to ensure long term planning and assessment of disasters Conclusion The research concludes that disaster risk reduction and preparedness, humanitarian logistics reforms and collaboration in all humanitarian aspects are the most effective adaptation to the global and humanitarian challenges

HIV/AIDS and the health of older people in the slums of Nairobi, Kenya: results from a cross sectional survey

Background: the proportion of older people is increasing worldwide. Globally, it is estimated that older people (those 60 years or older) constitute more than 11% of the population. As the HIV/AIDS pandemic rages in sub-Saharan Africa (SSA), its impact on older people needs closer attention given the increased economic and social roles older people have taken on as a result of increased mortality among adults in the productive age groups. Few studies have looked at older people and their health in SSA or indeed the impact of HIV/AIDS on their health. This study aims to assess the effect of being directly or indirectly affected by HIV/AIDS on the health of older people in two Nairobi slums.Methods: data were collected from residents of the Nairobi Urban Health and Demographic Surveillance area aged 50 years and above on 1st October 2006. Health status was assessed using the short SAGE (Study on Global AGEing and Adult Health) form and two outcome measures – self-rated health and a composite health score – were generated. To assess HIV/AIDS affected status, respondents were asked: Have you personally been affected by HIV/AIDS? If yes, a follow up question: "How have you been personally affected by HIV/AIDS?" was asked. Ordinallogistic regression was used in models with self-rated health and linear regression in models with the health score.Results: about 18% of respondents reported being affected by HIV/AIDS in at least one way, although less than 1% reported being infected with HIV. Nearly 60% of respondents reported being in good health, 27% in fair health and 14% in poor health. The overall mean health score was 70.6 (SD: 13.9) with females reporting worse health outcomes than males.Respondents directly or indirectly affected by HIV/AIDS reported worse health outcomes than those not affected: mean health score: 68.5 and 71.1 respectively (t = 3.21, p = 0.0007), and an adjusted odds ratio of reporting poor health of 1.42 (95%CI: 1.12–1.80).Conclusion: poor health outcomes among older people affected by HIV/AIDS highlight the need for policies that target them in the fight against HIV/AIDS if they are to play their envisaged care giving and other traditional role

Migration Analysis using Demographic Surveys and Surveillance Systems

Although migration analysis is not a core objective of Demographic and Health Surveys (DHS) and Health and Demographic Surveillance Systems (HDSS), these demographic sources can be quite helpful for the study of migration, either as the event of interest or as a determinant. This chapter presents useful criteria on the basis of sampling and data collections procedures to evaluate such data sources as regard to migration analysis. This chapter justifies a number of advices illustrated with examples from DHS and HDSS data: Limiting the analysis to three years before the survey and to large geographical areas is important to analyze migration matrices without biases; Analyses of interactions between migration and another event should check for the order of these events; Migration as a determinant should be a time-varying covariate that includes information on origin and destination and reasons for migration; Migration is a major source of bias through informative censoring for the analysis of other events of interest; Information prior to migration and follow-up after migration are important improvements that should be encouraged in existing data collection programs

Despondency among HIV-positive older men and women in Uganda.

Forty people over 60 years of age took part in longitudinal research over the course of a year on the impact of the HIV epidemic in southern Uganda. In this paper we focus mainly on the data from 26 of the 40 who were HIV-positive. While we observed that feelings of depression were frequently experienced by many of the people in our study, the state of 'being depressed' was not constant. Participants regularly expressed economic frustration (because of a lack of money to buy food and other commodities including sugar and soap); medical problems (including those related to HIV) as well as old age, the burden of dependents (including concerns about school fees for grandchildren), feelings of sadness and isolation, and a lack of support from others, as well as stigma, whether real or perceived. However, while worries, sorrow and despondent thoughts were reported in many of the interviews across the study, moods fluctuated moving from happiness and hope, to sadness and despair, from month to month. Concerns regarding the psychological wellbeing amongst older people, including those living with HIV and older carers in Uganda deserve greater attention