The prevalence and socio-cultural features of dementia among older people in rural Ghana, Kintampo

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Dementia has been understudied in low and middle-income countries compared to the number of older people who will be at risk in these regions. So far, no population-based studies estimating the prevalence of or exploring the experiences of those living with dementia has been undertaken in Ghana, where it is evidenced that it has the fastest growing older population in the sub-Saharan region. 
Aim: To investigate dementia in rural Ghana: prevalence, associated factors, experiences of persons living with dementia and their caregivers in the Kintampo Health Demographic Surveillance Site (KHDSS). 
Methods: A one-phase population-based cross-sectional survey was conducted, using mixed methods. A sample of 900 persons aged 70+ years was selected from the KHDSS. The 10/66 short dementia diagnostic schedule was administered to participants in their homes alongside a structured lifestyle and risk factors questionnaire. From those with probable dementia, 10 households were selected for in-depth interviews using a case-study methodology. The experience of living with dementia from the perspective of the older person with dementia, other household members involved in the care and support were of interest, as well as decision-making processes regarding the care of affected older persons. 
Results: A total of 761 participants agreed to participate and were interviewed. The response rate achieved was 84.6 %. Following the assessment, 38 people were identified with probable dementia, resulting in an overall prevalence of 5.0 % (95 % CI 3.6-6.8). The standardised prevalence for all ages was 6.6 % (95 % CI: 3.6-6.8). Dementia was associated with increasing age and more prevalent in women (6.8 %; 95 % CI 4.7-10.0) than in men (3.3 %; 95 % CI 1.9-5.5). Experiences of dementia were intertwined with other comorbidities of ageing in Kintampo. Symptoms were attributed to “normal ageing” therefore help/health seeking was most often for physical health symptoms or issues, either by western style or traditional medicine. Care was provided mainly by female family members. Stigma was not reported in this community. 
Conclusion: Dementia was prevalent in rural Kintampo, affecting more females than males. Families in Kintampo were unaware of dementia as a disease but have a coherent explanation for associated ageing health problems. They viewed the health of older people holistically and dementia was not a significant component. Hands-on care was provided mainly by women in the family and care duties appeared seamlessly absorbed within large families. There is the need to develop and provide culturally sensitive education on dementia, develop integrated health services for the care and management of dementia for older people.
Date of Award1 May 2019
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorMaelenn Guerchet (Supervisor) & Rosie Mayston (Supervisor)

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