: Over the last decades, countries in Sub-Saharan Africa (SSA) have experienced a demographic and epidemiological transition with declines in mortality from infectious diseases and increases in the prevalence of non-communicable disease. Many adults in SSA are now surviving with chronic diseases whether they are communicable or non-communicable. While we have data resources to understand the challenges of aging in the context of high income countries, little is understood of the nature of aging in the SSA context. Our project aims to establish longitudinal surveys of health, aging, and well-being allowing estimation of the prevalence and incidence of major chronic conditions in 3 population-based health and demographic surveillance sites (HDSS) at different stages of health transitions (in South Africa, Ghana and Tanzania) in adults age 50 and over (n=12,000). Participants are surveyed in each year 2014 to 2017 with continuous mortality monitoring. Baseline surveys are introduced in one country per year, with South Africa in year 2, Ghana in year 3 and Tanzania in year 4. A 3 year follow up occurs in South Africa in year 5. Through intensive monitoring and follow up, migrants will be maintained in the cohort at very high levels. Our survey is comparable to that of the Health and Retirement Study (HRS) and sister surveys, yet is adapted to capture characteristics specific to SSA. With 4 subprojects on 1.physical and cognitive function, 2.cardiometabolic disorders, 3.HIV, and 4.economic well-being, our goal is to understand the determinants of health in the elderly and in turn find the consequences of health for productivity and well-being.
Our specific aims are: 1. To establish three cohorts of 4,000 men and women aged 50 and over based on random stratified samples of the HDSS populations in the INDEPTH sites of Agincourt in South Africa, Navrongo in Ghana and Ifakara in Tanzania (n=12,000). A clinical substudy is conducted in a 10% subsample to look intensively at HIV and CVD. 2. To identify social, economic and biologic predictors of mortality, the incidence of disease (particularly cardiovascular disease and HIV) and changes in physical and cognitive function over three years. 3. To identify the effects of ill health on the economic well-being and productivity of the three cohorts.
We aim to identify the ways in which behavioral and biologic risks are embedded in the social and policy context and are driven by social and economic conditions. Health policies, in the broadest sense, will need to rest on a strong evidence base and our study will provide valid and reliable assessments of phenotypic disorders and risk factors.

Public Health Relevance

Sub-Saharan Africa (SSA) has experienced a demographic and epidemiological transition with declines in mortality from infectious diseases and increases in the prevalence of non-communicable diseases. Many adults in SSA now survive with chronic diseases. While we have resources to understand aging in high income countries, little is understood of the nature of aging in the SSA context The relevance of our program project is related to our identification of tfie magnitude of and risk factors for chronic conditions for planning purposes and identification of potential avenues for intersectoral interventions to improve adult health in Africa.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
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Special Emphasis Panel (ZAG1)
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Patmios, Georgeanne E
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Harvard University
Schools of Public Health
United States
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Harling, Guy; Morris, Katherine Ann; Manderson, Lenore et al. (2018) Age and Gender Differences in Social Network Composition and Social Support Among Older Rural South Africans: Findings From the HAALSI Study. J Gerontol B Psychol Sci Soc Sci :
Chetty, Terusha; Yapa, H Manisha N; Herbst, Carina et al. (2018) The MONARCH intervention to enhance the quality of antenatal and postnatal primary health services in rural South Africa: protocol for a stepped-wedge cluster-randomised controlled trial. BMC Health Serv Res 18:625
Gómez-Olivé, F Xavier; Montana, Livia; Wagner, Ryan G et al. (2018) Cohort Profile: Health and Ageing in Africa: a Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Int J Epidemiol :
Yapa, H Manisha; Bärnighausen, Till (2018) Implementation science in resource-poor countries and communities. Implement Sci 13:154
Harling, Guy; Gumede, Dumile; Shahmanesh, Maryam et al. (2018) Sources of social support and sexual behaviour advice for young adults in rural South Africa. BMJ Glob Health 3:e000955
Geldsetzer, Pascal; Fink, Günther; Vaikath, Maria et al. (2018) Sampling for Patient Exit Interviews: Assessment of Methods Using Mathematical Derivation and Computer Simulations. Health Serv Res 53:256-272
Gómez-Olivé, F Xavier; Rohr, Julia K; Roden, Laura C et al. (2018) Associations between sleep parameters, non-communicable diseases, HIV status and medications in older, rural South Africans. Sci Rep 8:17321
Kobayashi, Lindsay C; Berkman, Lisa F; Wagner, Ryan G et al. (2018) Education modifies the relationship between height and cognitive function in a cross-sectional population-based study of older adults in Rural South Africa. Eur J Epidemiol :
Payne, Collin F; Davies, Justine I; Gomez-Olive, F Xavier et al. (2018) Cross-sectional relationship between haemoglobin concentration and measures of physical and cognitive function in an older rural South African population. J Epidemiol Community Health 72:796-802
Hontelez, Jan A C; Bor, Jacob; Tanser, Frank C et al. (2018) HIV Treatment Substantially Decreases Hospitalization Rates: Evidence From Rural South Africa. Health Aff (Millwood) 37:997-1004

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