Aging and Health in Resource-Poor Settings in Sub-Saharan Africa: A Ghanaian Study

• Author / Creator

  Alaazi, Dominic A

• The population of older adults in Ghana is growing rapidly, and is projected to increase two-fold over the period 2015 to 2050. Despite the unprecedented growth, not much is known about the living conditions and wellbeing of older Ghanaians, in part due to a paucity of research in this area. This thesis presents the findings of a mixed methods study exploring the health and quality of life (QoL) of older adults residing in two contrasting neighbourhoods in Accra, Ghana. Data were collected in a slum and non-slum neighbourhood by means of: (1) a cross-sectional survey of community residing older adults (n = 603); and (2) in-depth qualitative interviews with a purposive sample of older adults (n = 30), community leaders (n = 2), health workers (n = 5), and policymakers (n = 5). QoL was self-assessed in four domains – physical, psychological, social, and environment – using the World Health Organization’s quality of life assessment tool (WHOQoL-BREF). Multivariable linear regression analyses of the survey data revealed statistically non-significant differences between the slum and non-slum respondents in physical QoL (Coeff: 0.6; 95% CI: -2.1, 3.4; p = 0.640) and psychological QoL (Coeff: -0.2; 95% CI: -2.0, 2.6; p = 0.893). However, the slum respondents had statistically significant better social QoL than the non-slum respondents (Coeff: -3.2; 95% CI: -5.6, -7l; p = 0.010), while the non-slum respondents had statistically significant better environmental QoL than the slum respondents (Coeff: 4.2; 95% CI: 2.3, 6.2; p < 0.001). Religious practices of almsgiving and strong social networks in the slum and a relatively better housing and service infrastructure in the non-slum accounted for the observed variations in social and environmental QoL. Thematic analyses of the qualitative data identified similar patterns of health barriers in the slum and non-slum but with remarkably very different underlying drivers. They included poor built environments, housing precariousness, insanitary conditions, defective public services, and social incivilities. Older adults residing in the two neighbourhoods also received suboptimal health services arising from resource, substantive, political, bureaucratic, and administrative constraints to the implementation of the National Health Insurance Scheme and its free healthcare policy. Health facilitators, such as affordable housing in the slum and an appealing outdoors in the non-slum, served to mitigate the adverse impacts of the barriers to health in the slum and non-slum. Thus, contrary to popular discourses that vilify slums as health-damaging milieus, these observations suggest they may actually be a resource for health in old age. The findings further suggest a need for housing and service improvements in the slums.

• Subjects / Keywords

  • Aging
  • Health
  • Neighbourhoods
  • Sub-Saharan Africa
  • Slums
  • Quality of Life
  • Ghana
  • Older Adults

• Graduation date

  Spring 2020

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-w6b0-h866

• License

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