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Living arrangements and health at older ages in rural Malawi

Published online by Cambridge University Press:  29 December 2016

JACOB KENDALL  and
PHILIP ANGLEWICZ
JACOB KENDALL*
Affiliation:
Center for Aging, Tulane University, New Orleans, Louisiana, USA.
PHILIP ANGLEWICZ
Affiliation:
Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.
*
Address for correspondence: Jacob Kendall, Center for Aging, Tulane University, 1430 Tulane Avenue, 8513, New Orleans, LA 70112, USA E-mail: jkendall@tulane.edu
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Abstract

Sub-Saharan Africa's older population is projected to nearly double in size by 2030. At the same time, demographic changes have caused major shifts in the units primarily responsible for the care of older adults: the family and household. The purpose of this paper is to examine the relationship between household composition and health at older ages in rural Malawi. We use data from the Malawi Longitudinal Study of Families and Health, which contains detailed information on household and family structure, along with measures of mental and physical health (from the Short Form-12). We focus on several measures of living arrangements that are expected to be associated with health: overall household size, sex composition and kin structure (based on co-residence with offspring and grandchildren). Results show that: (a) older women who co-reside with offspring have better mental and physical health compared to those living only with grandchildren; (b) older men who live in larger households or in households with a higher proportion of females have better physical health.

Keywords

living arrangementshouseholdageingmental healthphysical healthMalawi
Type
Article
Information
Ageing & Society , Volume 38 , Issue 5 , May 2018 , pp. 1018 - 1040
Copyright
Copyright © Cambridge University Press 2016 

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References

Adhvaryu, A. R. and Beegle, K. 2012. The long-run impacts of adult deaths on older household members in Tanzania. Economic Development and Cultural Change, 60, 2, 245–77.Google Scholar
Ainsworth, M. and Dayton, J. 2000. Is the AIDS epidemic having an impact on the coping and health status of the elderly? Evidence from Northwestern Tanzania. Background paper for the 2000 African Development Forum, Addis Ababa, Ethiopia. UNAIDS, Geneva.Google Scholar
Anglewicz, P. and Reniers, G. 2014. HIV status, gender, and marriage dynamics among adults in rural Malawi. Studies in Family Planning, 45, 4, 415–25.Google Scholar
Beegle, K., Filmer, D., Stokes, A. and Tiererova, L. 2010. Orphanhood and the living arrangements of children in sub-Saharan Africa. World Development, 38, 12, 1727–46.Google Scholar
Bongaarts, J. and Casterline, J. 2013. Fertility transition: is sub-Saharan Africa different? Population and Development Review, 38, s1, 153–68.Google Scholar
Bongaarts, J. and Zimmer, Z. 2002. Living arrangements of older adults in the developing world: an analysis of demographic and health survey household surveys. Journals of Gerontology: Psychological Sciences and Social Sciences, 57B, 3, S145–57.Google Scholar
Bor, J., Herbst, A. J., Newell, M. L. and Bärninghausen, T. 2013. Increases in adult life expectancy in rural South Africa: valuing the scale-up of HIV treatment. Science, 339, 6122, 961–5.Google Scholar
Cernin, P. A., Cresci, K., Jankowski, T. B. and Lichtenberg, P. A. 2010. Reliability and validity testing of the Short-Form Health Survey in a sample of community-dwelling African American older adults. Journal of Nursing Management, 18, 1, 49–59.Google Scholar
Chabal, P. 2009. Africa: The Politics of Suffering and Smiling. Zed, London.Google Scholar
Chen, F. and Short, S. E. 2008. Household context and subjective well-being among the oldest old in China. Journal of Family Issues, 29, 10, 1379–403.Google Scholar
Chin, B. 2010. Income, health, and well-being in rural Malawi. Demographic Research, 23, 35, 997–1030.Google Scholar
Clausen, T., Wilson, A. O., Molebatsi, R. M. and Holmboe-Ottesen, G. 2007. Diminished mental- and physical function and lack of social support are associated with shorter survival in community dwelling older persons of Botswana. BMC Public Health, 7, 144, 1–8.Google Scholar
Cliggett, L. 2005. Grains from Grass: Aging, Gender, and Famine in Rural Africa. Cornell University Press, Ithaca, New York.Google Scholar
Cohen, B. and Menken, J. (eds) 2006. Aging in Sub-Saharan Africa: Recommendations for Furthering Research. The National Academic Press, Washington, DC.Google Scholar
Collinson, M. A. 2010. Striving against adversity: the dynamics of migration, health and poverty in rural South Africa. Global Health Action, 3, 5080, 1–14.Google Scholar
Crimmins, E. M., Hayward, M. D., Hagedorn, A., Saito, Y. and Brouard, N. 2009. Change in disability-free life expectancy for Americans 70 years old and older. Demography, 46, 3, 627–46.CrossRefGoogle ScholarPubMed
Davies, S. 2007. Remittances as insurance for idiosyncratic and covariate shocks in Malawi: the importance of distance and relationship. MRPA Paper No. 4463, University Library of Munich, Germany. http://mpra.ub.uni-muenchen.de/4463Google Scholar
Dayton, J. and Ainsworth, M. 2002. The Elderly and AIDS: Coping Strategies and Health Consequences in Rural Tanzania. Policy Research Division, Population Council, New York.Google Scholar
Filmer, D. and Pritchett, L. H. 2001. Estimating wealth effects without expenditure data – or tears: an application to educational enrollments in states of India. Demography, 38, 1, 115–32.Google Scholar
Fischer, C. S. 1982. To Dwell Among Friends: Personal Networks in Town and City. University of Chicago Press, Chicago.Google Scholar
Freeman, E. and Anglewicz, P. 2012. HIV prevalence and sexual behaviour at older ages in rural Malawi. International Journal of STD & AIDS, 23, 7, 490–6.Google Scholar
Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., Bullinger, M., Kaasa, S., Leplege, A., Prieto, L. and Sullivan, M. 1998. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. Journal of Clinical Epidemiology, 51, 11, 1171–8.Google Scholar
Golaz, V. and Rutaremwa, G. 2011. The vulnerability of older adults: what do census data say? An application to Uganda. African Population Studies, 25, 2, 605–22.Google Scholar
Gómez-Olivé, F., Angotti, N., Houle, B., Klipstein-Grobusch, K., Kabudula, C., Mencken, J. and Clark, S. 2013. Prevalence of HIV among those 15 and older in rural South Africa. AIDS Care, 25, 9, 1122–8.Google Scholar
Goode, W. J. 1963. World Revolution and Family Patterns. Free Press of Glencoe, London.Google Scholar
Hadley, C., Belachew, T., Lindstrom, D. and Tessema, F. 2011. The shape of things to come? household dependency ratio and adolescent nutritional status in rural and urban Ethiopia. American Journal of Physical Anthropology, 144, 4, 643–52.Google Scholar
Hoddinott, J. 1992. Rotten kids or manipulative parents: are children old age security in Western Kenya? Economic Development and Cultural Change, 40, 3, 545–65.Google Scholar
Hoddinott, J. 1993. Family size and support to the elderly in western Kenya. In Lloyd, C. B. (ed.), Fertility, Family Size, and Structure: Consequences for Families and Children. The Population Council, New York, 41–73.Google Scholar
Hontelez, J. A., Vlas, S. J. D., Baltussen, R., Newell, M.-L., Bakker, R., Tanner, F., Lurie, M. and Bärnighausen, T. 2012. The impact of antiretroviral treatment on the age composition of the HIV epidemic in sub-Saharan Africa. AIDS, 26, 1, 1–20.Google Scholar
Hughes, M. E. and Waite, L. J. 2002. Health in household context: living arrangements and health in late middle age. Journal of Health & Social Behavior, 43, 1, 1–21.Google Scholar
Ice, G. H. 2011. Caregiving, gender, and nutritional status in Nyanza province, Kenya: grandmothers gain, grandfathers lose. American Journal of Human Biology, 23, 4, 435–44.CrossRefGoogle ScholarPubMed
Ice, G. H., Sadruddin, A. F. A., Vagedes, A., Yogo, J. and Juma, E. 2012. Stress associated with caregiving: an examination of the stress process model among Kenyan Luo elders. Social Science & Medicine, 74, 12, 2020–7.Google Scholar
Ice, G., Zidron, A. and Juma, E. 2008. Health and health perceptions among Kenyan grandparents. Journal of Cross-cultural Gerontology, 23, 2, 111–29.Google Scholar
Institute for Health Metrics and Evaluation (IHME). 2013. GBD profile: Malawi. In Global Burden of Diseases, Injuries, and Risk Factors Study 2010. Institute for Health Metrics and Evaluation, Seattle, WA.Google Scholar
Jahn, A., Floyd, S., Crampin, A. C., Mwaungulu, F., Mvula, H., Munthali, F., McGrath, N., Johnbosco, M., Mwinuka, V., Mangongo, B., Fine, P. E. M., Saba, B. and Glynn, J., , R. 2008. Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in Malawi. Lancet, 371, 9624, 1603–11.Google Scholar
Jenkinson, C., Layte, R., Jenkinson, D., Lawrence, K., Petersen, S., Paice, C. and Stradling, J. 1997. A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? Journal of Public Health Medicine, 19, 2, 179–86.Google Scholar
Kamya, H. and Poindexter, C. C. 2009. Mama Jaja: the stresses and strengths of HIV-affected Ugandan grandmothers. Social Work in Public Health, 24, 1/2, 4–21.Google Scholar
Kaseke, E. 2005. Social security and older people: an African perspective. International Social Work, 48, 1, 89–98.Google Scholar
Kautz, T., Bendavid, E., Bhattacharya, J. and Miller, G. 2010. AIDS and declining support for dependent elderly people in Africa: retrospective analysis using demographic and health surveys. BMJ, 34, c2841, 1–6.Google Scholar
Kim, J. and Waite, L. 2015. Complex households and the distribution of multiple resources in later life: findings from a national survey. Research on Aging, 38, 2, 150–77.Google Scholar
Kimuna, S. R. 2005. Living arrangements and conditions of older people in Zimbabwe. Etude de la Population Africaine, 20, 2, 143–63.Google Scholar
Kohler, H.-P., Watkins, S. C., Behrman, J. R., Anglewicz, P., Kohler, I. V., Thornton, R. L., Mkandawire, J., Honde, H., Hawara, A., Chilima, B., Bandawe, C. and Mwapasa, V. 2015. Cohort profile: The Malawi Longitudinal Study of Families and Health (MLSFH). International Journal of Epidemiology, 44, 2, 394–404.Google Scholar
Kohler, I. V., Kohler, H.-P., Anglewicz, P. and Behrman, J. R. 2012. Intergenerational transfers in the era of HIV/AIDS: evidence from rural Malawi. Demographic Research, 27, 27, 775–834.Google Scholar
Lee, Y., Parish, W. and Willis, R. 1994. Sons, daughters, and intergenerational support in Taiwan. American Journal of Sociology, 99, 4, 1010–41.Google Scholar
Lillard, L. A. and Willis, R. J. 1997. Motives for intergenerational transfers: evidence from Malaysia. Demography, 34, 1, 115–34.Google Scholar
Madhavan, S. and Schatz, E. J. 2007. Coping with change: household structure and composition in rural South Africa, 1992–2003. Scandinavian Journal of Public Health, 35, supplement 69, 85–93.Google Scholar
Maharaj, P. 2013. Introduction. In Maharaj, P. (ed.), Aging and Health in Africa. Springer, New York, 1–9.Google Scholar
Mann, G. 2004. Family Matters: The Care and Protection of Children Affected by HIV/AIDS in Malawi. Save the Children, Stockholm.Google Scholar
Merli, M. G. and Palloni, A. 2006. The HIV/AIDS epidemic, kin relations, living arrangements, and the African elderly in South Africa. In Cohen, B. and Menken, J. (eds), Aging in Sub-Saharan Africa: Recommendations for Furthering Research. The National Academic Press, Washington DC, 117–65.Google Scholar
Munthree, C. and Maharaj, P. 2010. Growing old in the era of a high prevalence of HIV/AIDS: the impact of AIDS on older men and women in KwaZulu-Natal, South Africa. Research on Aging, 32, 2, 155–74.Google Scholar
Murgai, R., Winters, P., Sadoulet, E. and Janvry, A. 2002. Localized and incomplete mutual insurance. Journal of Development Economics, 67, 2, 245–74.Google Scholar
National Statistical Office (NSO) and ICF Macro. 2011. Malawi Demographic and Health Survey 2010. NSO and ICF Macro, Zomba, Malawi and Calverton, Maryland.Google Scholar
Negin, J. and Cumming, R. G. 2010. HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. Bulletin of the World Health Organization, 88, 11, 847–53.Google Scholar
Nyambedha, E. O., Wandibba, S. and Aagaard-Hansen, J. 2003. ‘Retirement lost’ – the new role of the elderly as caretakers for orphans in Western Kenya. Journal of Cross-cultural Gerontology, 18, 1, 33.Google Scholar
Obtel, M., Rhazi, K. E., Elhold, S., Benjelloune, M., Gnatiuc, L. and Nejjari, C. 2013. Cross-cultural adaptation of the 12-Item Short-Form survey instrument in a Moroccan representative survey. South African Journal of Epidemiology and Infection, 28, 3, 166–71.CrossRefGoogle Scholar
Palloni, A. 2002. Living arrangements of older persons. Population Bulletin of the United Nations, special issue, 1–54.Google Scholar
Payne, C. F., Mkandawire, J. and Kohler, H.-P. 2013. Disability transitions and health expectancies among adults 45 years and older in Malawi: a cohort-based model. PLoS Medicine, 10, 5, 1–15.Google Scholar
Pelham, L. 2007. The politics behind the non-contributory old age social pensions in Lesotho, Namibia and South Africa. CPRC Working Paper 83, Chronic Poverty Research Centre, Manchester, UK.Google Scholar
Peltzer, K. and Pengpid, S. 2012. Alcohol use and health-related quality of life among hospital outpatients in South Africa. Alcohol and Alcoholism, 47, 3, 291–5.Google Scholar
Pettit, T., Livingston, G., Manela, M., Kitchen, G., Katona, C. and Bowling, A. 2001. Validation and normative data of health status measures in older people: the Islington study. International Journal of Geriatric Psychiatry, 16, 11, 1061–70.Google Scholar
Rahman, M. O. 2001. Living arrangements and the health of older persons in developing countries: evidence from rural Bangladesh. Population Bulletin of the United Nations, special issue, 1–20.Google Scholar
Reniers, G. 2003. Divorce and remarriage in rural Malawi. Demographic Research, 1, 6, 175–206.Google Scholar
Rossi, A. S. and Rossi, P. H. 1990. Of Human Bonding: Parent–Child Relations Across the Life Course. de Gruyter, New York.Google Scholar
Salomon, J. A., Wang, H., Freeman, M. K., Vos, T., Flaxman, A. D., Lopez, A. D. and Murray, C. J. 2012. Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet, 380, 9859, 2144–62.Google Scholar
Seeley, J., Wolff, B., Kabunga, E., Tumwekwase, G. and Grosskurth, H. 2009. ‘This is where we buried our sons’: people of advanced old age coping with the impact of the AIDS epidemic in a resource-poor setting in rural Uganda. Ageing & Society, 29, 1, 115–34.Google Scholar
UNICEF 2006. Africa's Orphaned and Vulnerable Generations: Children Affected by AIDS. UNICEF, New York.Google Scholar
United Nations 2005. Living Arrangements of Older Persons Around the World. Population Division, Department of Economic and Social Affairs, United Nations, New York.Google Scholar
United Nations 2009. World Urbanization Prospects: The 2009 Revisions. Population Division, Department of Economic and Social Affairs, United Nations, New York.Google Scholar
United Nations 2011. World Population Prospects: The 2010 Revision. CD-ROM edition, Population Division, Department of Economic and Social Affairs, United Nations, New York.Google Scholar
United Nations 2013. World Population Prospects: The 2012 Revision – Key Findings and Advance Tables. Population Division, Department of Economic and Social Affairs, United Nations, New York.Google Scholar
United Nations 2014. World Fertility Report 2013: Fertility at the Extremes. Population Division, Department of Economic and Social Affairs, United Nations, New York.Google Scholar
United Nations 2015. World population prospects: the 2015 revision, key findings and advance tables. Working Paper ESA/WP.241, United Nations, New York.Google Scholar
United Nations Development Programme 2010. The Real Wealth of Nations: Pathways to Human Development. Human Development Report. United Nations Development Programme, New York.Google Scholar
Velkoff, V. A. and Kowal, P. R. 2007. Population Aging in Sub-Saharan Africa: Demographic Dimensions 2006. US Department of Health and Human Services, National Institutes of Health, National Institute on Aging, Washington DC.Google Scholar
Wachter, K. W., Knodel, J. E. and VanLandingham, M. 2002. AIDS and the elderly of Thailand: projecting familial impacts. Demography, 39, 1, 25–41.Google Scholar
Ware, J. E. Jr, Kosinski, M. and Keller, S. D. 1996. A 12-item Short-Form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 3, 220–33.Google Scholar
World Bank 2013. Africa Development Indicators 2012/2013. World Bank, Washington DC.Google Scholar
Zimmer, Z. 2009. Household composition among elders in Sub-Saharan Africa in the context of HIV/AIDS. Journal of Marriage & Family, 71, 4, 1086–99.Google Scholar
Zimmer, Z. and Das, S. 2014. The poorest of the poor: composition and wealth of older person households in sub-Saharan Africa. Research on Aging, 36, 3, 271–96.Google Scholar
Zimmer, Z. and Dayton, J. 2005. Older adults in sub-Saharan Africa living with children and grandchildren. Population Studies, 59, 3, 295–312.Google Scholar
Zimmer, Z., Korinek, K., Knodel, J. and Chayovan, N. 2008. Migrant interactions with elderly parents in rural Cambodia and Thailand. Journal of Marriage and Family, 70, 3, 585–98.Google Scholar