Bandawe, Chiwoza

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Now showing 1 - 3 of 3
  • Publication
    The Demography of Mental Health Among Mature Adults in a Low-Income High HIV-Prevalence Context
    (2015-04-21) Kohler, Iliana V; Payne, Collin F.; Bandawe, Chiwoza; Kohler, Hans-Peter
    While a nascent body of research investigates the shift in sub-Saharan Africa's (SSA's) disease burden towards non-communicable diseases (NCDs), very few studies have investigated mental health, specifically depression and anxiety (DA), in SSA. Using the 2012--13 Malawi Longitudinal Study of Families and Health (MLSFH), this paper provides a first picture of the demography of DA among mature adults (= persons aged 45+) in a low-income high HIV-prevalence context. DA are more frequent among women than men, and individuals are often affected by both. DA are associated with adverse outcomes, such as less nutrition intake and reduced work efforts. DA also increase substantially with age for both females and males, and mature adults can expect to spend a substantial fraction of their remaining life time---for instance, 52% for a 55 year old woman---affected by DA. The positive age-gradients of DA are not due to cohort effects, and they are in sharp contrast to the age pattern of mental health that have been shown in high-income contexts where older individuals often experience lower levels of DA and better subjective well-being than middle-aged individuals. While socioeconomic and risk/uncertainty-related stressors are strongly associated with DA, they do not explain the positive age gradients and gender gap in DA. Stressors related to physical health, however, do. Hence, our analyses suggest that the general decline of physical strength and health with age, as is indicated by hand grip strength, and the interference of poor physical health with daily activities, are key drivers of the rise of DA with age among mature adults.
  • Publication
    Aging and Hypertension among the Global Poor—Panel Data Evidence from Malawi
    (2022-02-10) Kohler, Iliana V.; Sudharsanan, Nikkil; Bandawe, Chiwoza; Kohler, Hans-Peter
    Background: Hypertension has a rapidly growing disease burden among older persons in low-income countries (LICs) that is often inadequately diagnosed and treated. Yet, most LIC research on hypertension is based on cross-sectional data that does not allow inferences about the onset or persistence of hypertension, its correlates, and changes in hypertension as individuals become older. Data and methods: The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) is used to provide among the first panel analyses of hypertension for older individuals in a sub-Saharan LIC using blood pressure measurements obtained in 2013 and 2017. Findings: High blood pressure is very common among mature adults aged 45+ in rural Malawi, and hypertension is more prevalent among older as compared to middle-aged respondents. Yet, in panel analyses for 2013-17, we find no increase in the prevalence of hypertension as individuals become older. Hypertension often persists over time, and the onset of hypertension is predicted by factors such as being overweight/obese, or being in poor physical health. Otherwise, however, hypertension has few socioeconomic predictors. There is also no gender differences in the level, onset or persistence in hypertension. While hypertension is associated with several negative health or socioeconomic consequences in longitudinal analyses, cascade-of-care analyses document significant gaps in the diagnosis and treatment of hypertension. Conclusions: Our findings indicate that hypertension and related high cardiovascular risks are widespread, persistent, and often not diagnosed or treated in this rural sub-Saharan population of older individuals. Prevalence, onset and persistence of hypertension are common across all subgroups-including, importantly, both women and men. While age is an important predictor of hypertension risk, even in middle ages 45-55 years, hypertension is already widespread. Hypertension among adults aged 45+ in Malawi is thus more similar to a "generalized epidemic" than in high-income countries where cardiovascular risk has strong socioeconomic gradients and untreated hypertension particularly prevalent in vulnerable subsets of older persons.
  • Publication
    Cognitive Health among Older Adults: Evidence from Rural Sub-Saharan Africa
    (2016-07-26) Payne, Collin F.; Kohler, Iliana V.; Bandawe, Chiwoza; Lawler, Kathy A.; Kohler, Hans-Peter
    Cognitive health is an important dimension of well-being in older ages, but few studies have investigated cognitive health in sub-Saharan Africa’s (SSA) growing population of mature adults (= persons age 45+). We use data from the Malawi Longitudinal Study of Families and Health (MLSFH) to document the age and gender patterns of cognitive health, the contextual and life-course correlates of poor cognitive health, and the understudied linkages between cognitive and physical/mental well-being. Surprisingly, the age-pattern of decline in cognitive health for both men and women is similar to that observed in the U.S. We also find that women have substantially worse cognitive health than men, and experience a steeper decline of cognitive ability with age. Strong social ties and exposure to socially complex environments are associated with higher cognitive health, as is higher socioeconomic status. Poor cognitive health is associated with adverse social and economic well-being outcomes such as less nutrition intake, lower income, and reduced work efforts even in this subsistence agriculture context. Lower levels of cognitive health are also strongly associated with increased levels of depression and anxiety, and are associated with worse physical health measured through both self-reports and physical performance.