By Professor Karen Charlton
Although the proportion of elders in African populations is much smaller than that in European or North American countries, the absolute numbers of older Africans are rapidly increasing. The huge majority of Africans are in poor economic circumstances and few countries are able to offer social assistance programmes. The health and well being of older persons largely depend on the integral existence of informal services, social support networks and kin support. African gerontologists have urged social welfare policy makers to take cognizance of self-organized intergenerational help systems already present on the continent, and to make public sector finance available to support these systems. Nutrition service programmes should be included in such support systems.
These themes were some of those deliberated in the Third African Regional Workshop of the African Gerontological Association (AGES International) held in Nairobi, Kenya from 12-17 April 1999. AGES is presently chaired by Professor Nana Apt, Head of the Centre for Social and Policy Studies at the University of Ghana. Dr Alexandre Kalache, Chief of Ageing and Health at WHO, gave the keynote address "Healthy Ageing as a Key Development Issue for Africa." The workshop, which was attended by 140 participants from 11 countries, showed that Africa has become an important new global player in the field of ageing, nutrition and health status, and that there is much to be learned from the continent in this regard.
Food Security: Much of Africa is plagued by drought, famine, civil strife, poverty, and more recently the devastating effects of the AIDS epidemic. As a result of these problems food is scarce and is regarded as a priority basic need. NGOs such as HelpAge International play an important role in promoting meal programmes and in developing food security initiatives. These international agencies work together with local NGOs and church groups in various countries. The regional office of HelpAge International is in Nairobi with branches in Zimbabwe, Ghana, Tanzania and South Africa.
Poverty/Social Security: Only two countries in Africa -South Africa and Namibia - provide formal economic support for older citizens. In South Africa, nearly 90% of older blacks receive a non-contributory, means-tested, state old-age pension which is paid monthly. The social pension contributes substantially to household budgets, and pension monies are used collectively to support kin (three generations commonly co-reside in African households), with food being the major expenditure item. A large survey, funded by the US National Institute of Aging and coordinated at the Centre for Gerontology at the University of Cape Town, is currently investigating the impact of South Africa's state pension scheme on the health, well being, coping strategie, and household income and expenditure of not only pensioners, but also other household members.
Indicators of Malnutrition: HelpAge International and the London School of Hygiene and Tropical Medicine have recently conducted a three-centre study in subjects aged 50 years and over (Rwandan refugees in Tanzania; rural elders in Malawi; and poverty-stricken older persons living in slum areas of India) to identify anthropometric indicators of malnutrition for use in older people in developing countries. A summary of the findings has been published. [See book review on page 50 in this issue.]
Urbanization, Nutrition Transition and Emergence of Chronic Diseases: The nutrition transition in Africa, associated with increasing urbanization, will be accompanied by an increase in chronic diseases in present and future cohorts. Preliminary data from a birth cohort study is showing that, already at the age of five years, black African children in Johannesburg have higher arterial blood pressure than age-matched white children. Research efforts to improve the health of future elders need to focus on the nutrition transition.
An ILSI/IUNS Urban Nutrition Workshop was held in Durban, South Africa from 5-7 March 1999, in conjunction with local affiliated nutrition groups. The topic "Urban Nutrition: Lifespan and Lifestyle Issues for Africa" incorporated three broad age bands, namely childhood, adulthood and later life, The IUNS Committee on Nutrition and Ageing was represented in the workshop by three members: Professor Mark Wahlqvist (Australia), Dr Noel Solomons (Guatemala) and Professor Karen Charlton (South Africa). The workshop was an historic event as it was the first of its kind to be hosted in an African country.
Health Services/Traditional Healers: A finding that emerged from the aforementioned workshop was that the preferred treatment agency for older Africans, especially in rural areas, is the traditional healer or "sangoma". A strong reason for this preference appears to be related to good communication channels between healer and patient, and a mutually negotiated "diagnosis" and treatment regimen, as well as a social explanation that is provided for an illness. Similarly, reliance on the use of herbal remedies to treat and prevent illness, as well as the contribution of indigenous plant sources to nutrient intake, warrants inclusion in the methodology of any dietary or health survey of older African populations. In this regard, an Institute of Traditional Medicine (TRAMED) has been established at the University of Cape Town, and a database of the chemical composition and uses of indigenous plants is being compiled.
Older Women: In African culture, the grandmother is a central figure in the daily management of the household, responsible for housework, food purchases, meal preparation and child care. In rural areas, women are additionally responsible for tilling the soil, planting crops, growing food, etc. Thus, nutrition education activities targeted at older household female members may impact on the family unit as a whole.
Research-networking Opportunities: There are a number of initiatives in the African region which include nutrition, health and ageing as a primary focus of research. The African Foundation for Research and Interdisciplinary Training in Ageing (AFRITA) is based in Harare, Zimbabwe. The Director of AFRITA, Dr Adrian Wilson, has recently been appointed to the Chair of Geriatrics at the University of Cape Town (UCT). Professor Wilson is committed to conducting nutrition-related research, in conjunction with UCT's Nutrition and Dietetics Unit, headed by Professor Karen Charlton. Also based in the Faculty of Health Sciences of the University of Cape Town is the only dedicated research centre on ageing in Africa, the HSRC/UCT Centre for Gerontology. Networking links and collaboration with other African researchers, as well as with researchers in countries elsewhere, are urgently needed in order to allow cross-cultural perspectives on ageing to be strengthened.
Dr K Charlton, Medical Research Council, PO Box 19070, Tygerberg 7505, South Africa; tel: +27 21 938 0345; fax +27 21 933 5519; email kcharlton@mrc.ac.za
