Successful ageing in Africa
- Wits University
Decade-long partnership researching ageing in rural Mpumalanga awarded major multi-year NIH grant to expand nationally and focus on dementia, cognitive health.
Researchers at Wits University in partnership with Harvard University, along with the University of Cape Town (UCT) and the South African Population Infrastructure Network (SAPRIN) in South Africa, and Columbia University in the US, received the grant from the US-based National Institute on Aging, a division of the National Institutes of Health (NIH).
The funding will enable continuation – and national expansion – of the SA and US partners’ collaborative programme, Health and Aging in Africa: A Longitudinal Study in South Africa (HAALSI), which began in South Africa in 2013.
HAALSI is an ongoing multidisciplinary population-based study with longitudinal data on social, economic, biological, physical and mental health factors in a cohort of 5 059 individuals, aged 40+, drawn from rural communities in the Agincourt-Bushbuckridge sub-district, South Africa.
Agincourt is both a large grouping of villages in Bushbuckridge sub-district in rural Mpumalanga province in South Africa and refers to the South African Medical Research Council (SAMRC)/Wits University Rural Public Health and Health Transitions Research Unit, the setting where HAALSI first began.
The SAMRC/Wits-Agincourt Unit is the research centre where more than 30 villages comprising 21 000 households and some 120 000 individuals have participated in public health and transitions research since the early 1990s. This Unit, integral to the Wits Rural Campus, is the research centre where more than 30 villages comprising 21 000 households and some 120 000 individuals have participated in public health and transitions research since the early 1990s.
Living longer but not healthier
HAALSI research addresses the critical question of successful ageing in vulnerable communities where older persons play vital roles supporting child development and schooling, and sustaining household economies. Work focuses on exploring the interrelationships between physical and cognitive functioning; Alzheimer’s Disease and related dementias; lifestyle risk factors; household income and expenditure; depression and mental health; social networks and family composition; HIV infection; and cardiometabolic disease.
Stephen Tollman directs the SAMRC/Wits-Agincourt Unit and is Research Professor and Head of the Health and Population Division in the School of Public Health at Wits University. As Co-Principal Investigator (PI) of HAALSI, Tollman works closely with PI Lisa Berkman and co-PI Thomas Gaziano at Harvard, Murray Leibbrandt at UCT, and Wits School of Public Health colleagues Chodziwadziwa Kabudula, Xavier Gómez-Olivé, Kathleen Kahn, Nomsa Mahlalela, Ryan Wagner and Jacques du Toit.
Tollman says, “South Africa is one of many African countries whose population experienced a boost in life expectancy thanks to the scale-up of antiretroviral therapy in response to the HIV epidemic, as well as general socioeconomic and health care improvements, including the older persons’ grant."
While overriding the short but significant mortality impacts of Covid-19, South Africa experienced a serious loss of the parental generation – hence the central role of older persons.
“These gains in life expectancy, unevenly spread, meant that the region also experienced unprecedented levels of chronic non-communicable diseases, such as cardiovascular and metabolic diseases and emerging dementias, among its newly ageing population.”
Cognitive health crisis affects Africa disproportionately
Cognition refers to the thought processes that take place in the brain, including thinking, attention, language, learning, memory, and perception – all essential to effective functioning.
Dementia, usually preceded by cognitive impairments that become more evident, involves progressive decline in cognitive function and behavioural ability, to the extent that it interferes with daily life, relationships, and activities.
Although Alzheimer’s Disease tends to be the most common type of dementia, there are many lifestyle-related causes. Work in Agincourt to date confirms that education, literacy, work, and social networks are all influential in delaying the onset of cognitive decline and dementias at a population level.
There is currently no cure for dementias, adding urgency to the need to research its prevalence, causal pathways, prevention, and management, particularly in Africa.
According to the World Health Organization, the number of people suffering from dementia globally is projected to rise from 55 million (with over 60% living in low- and middle-income countries) to 78 million in 2030, and to 139 million by 2050.
“In this newly funded phase, we plan to expand the focus on cognitive ageing and dementias. The resulting evidence from HAALSI will not only convey insights from a region of the world where ageing is not well understood, but can be harmonized with other studies of dementia and ageing in low-, middle-, and high-income countries, helping to shed light on the nature of ageing within a global context,” says Tollman.
For the national expansion, the HAALSI team will actively engage South African policymakers and public health researchers including the Southern Africa Labour and Development Research Unit at the UCT, SAPRIN, and the SAMRC.
Professor Glenda Gray, outgoing President and CEO of the SAMRC, was amongst the signatories who endorsed the grant proposal. She says, “The expansion of the HAALSI programme from rural Mpumalanga to the rest of South Africa is critical for us to deepen our understanding of cognitive health in Africa. This significant grant recognises the importance of prioritising rural public health and the burden of non-communicable diseases affecting increasingly ageing populations on our continent.”