Saturday, October 20, 2012

Dementia: Not Just The “White Man’s Disease”

Author: Staff Writer

Dementia is soon to be a problem in African countries. This class of diseases is not well diagnosed because much of the continent’s health systems lack the tools. But the biggest problem is that little attention is being paid to dementia’s potential cost in the near future.

Africa’s traditional family structure and its dearth in national health services have made it difficult to investigate dementia’s prevalence on the Continent. I have heard many Africans brag about how the old in African communities live with dignity through their old age. Western nursing homes, to a people with a different social philosophy, seem quite strange and a bit inhumane – to separate the old from their family. With its non-nuclear family structure, where third cousins refer to themselves as brothers and sisters, its expectations and investments in the family unit are extraordinary. However, this particular attribute has contributed to why the true extent of dementia’s prevalence in Africa has gone unnoticed, though not for long now. For, if current demographic trends continue, dementia will be a force to reckon with for developing countries in general, and Africa in particular.

Dementia has long been thought of as a rich world’s disease, one that strikes those in their old age in developed countries with per capita GDPs Africa still had a long way to achieve. Recent studies on this class of diseases in Africa, of which Alzheimer’s is the most common, have proven otherwise. In fact, this small group of studies have shown that the prevalence rate in Africa is comparable to the West – old “rich” white people and old “poor” black people all have comparable prevalence within their populations. It is estimated that roughly 35.6 million people worldwide live with dementia. Although experts expect the prevalence of dementia to increase globally, many see the greatest increase happening in less developed regions as a greater percentage of their populations grow older.

One of the most noticeable features of the 20th century was the absolute increase in live expectancy globally. As the world brought to scale a lot of the gains in medicine and healthcare, more people lived longer, which in turn made the world’s population a little older – a phenomenon termed “population ageing.” The global demographic change that accounted for a huge part of this shift was the reduced fertility rates in Western countries. Europe is now the “oldest” continent. Africa, as living standards increase and more people become educated, will follow suite – its fertility rate will drop and its population will grow older.

In Africa, health systems that lack the proper tools find themselves unable to diagnose and treat dementia,
a growing health issue on among the continent's elderly populations.

As of 2010, 36 million people, aged 65 and older, accounted for 3.6 percent of Africa’s population, up from 3.3 percent in 2000. By 2050, old people will make up close to 10 percent of the population on the Continent. Increasingly, studies focused on dementia in Africa are returning with the same diagnosis: Africa has a problem brewing on its hands. Governments are currently more concerned with the burgeoning youth population facing socio-economic bottlenecks capable of fuelling politically destabilizing revolutions – Arab Spring being an example. As a result, little attention has been paid to the ageing issue – old people don’t join Al Qaeda or make Molotov cocktails when they are angry with their government. And so the responsibilities for the well being of this group are often passed on to their families. Add to this the fact that old people in Africa, in contrast to their counterparts in developed countries, do not receive pensions.

Interestingly, dementia studies have found that the criteria for diagnosing dementia, which relies heavily on functional and occupational capacity and levels of social engagement, had underestimated the prevalence of the disease in Africa where old people do not engage in complex activities in their daily lives, in contrast to old people living in rich countries. It is more difficult to notice their cognitive decline because the extended family shields older people from these kinds of activities. In addition, African societies carry strong stigmas against dementia sufferers, as witchcraft and sorcery is still very popular. So sufferers who want to seek help are cautious of being ostracised, while a disproportionate amount of those who do seek help turn to native medicine men.

In one of the most comprehensive studies on the Continent, conducted on the Yoruba people of Nigeria, whose population account for 22 percent of the nation – 25 million, results suggested that dementia was present in about 1 in 10 persons aged 65 years and over. Its occurrence, according to the study, is more common in females and increases with advancing age, reaching a prevalence of about 12 percent in those aged 80 years and over. Another study, conducted in rural Tanzania, found the prevalence rate at 6.4 percent. Both studies show results comparable to high-income countries.

Though not every country in Africa is experiencing this population dynamic for the same reason, the end result is that almost all the national public health systems will be overwhelmed in due time, unless something drastic is done. South Africa, for example, is aging because HIV/AIDS disproportionately affects the young. No one is prepared for the eventuality when in 2050 old people make up close to 10 percent of the population. Economically, with the expected parallel burgeoning population of young people – 15 and younger – the working demographic will be dwarfed by the collective, economically unproductive demographic on the continent.

Will the continent be able to meet this challenge head-on? There are many issues to consider within this larger issue. Though, in stark review of the important social-economic elements dealing with dementia, it doesn’t seem the Continent will be able to deal appropriately or convincingly with this oncoming problem. In fact, one can doubt the political will to find a solution. The old have no political capital and they won’t be protesting down the streets of Abidjan or Lagos anytime soon for a pension system or medical facilities that can help slow down their cognitive degeneration. What is certain is that when 10 percent of the population is suffering from one form of dementia or another, it won’t be considered a white man’s disease anymore.

Your comments and feedback are much appreciated. To engage in further discussion with the editors and contributors of the blog on this topic and other related topics, follow us on twitter @SEADiaspora and/or leave a comment below.