Journal of Cross-Cultural Gerontology

, Volume 23, Issue 2, pp 111–129 | Cite as

Health and Health Perceptions Among Kenyan Grandparents

  • Gillian H. Ice
  • Amy Zidron
  • Elizabeth Juma
Original Article


The dramatic increase in the aging population in developed countries has led to an explosion of research on health and aging in the United States. Few studies, however, have been conducted in developing countries, even though many of these populations are experiencing a faster rate of growth in the 65+ population. Thus, although our knowledge of health and aging has increased, our knowledge of the variation in health as people age is limited. While the numbers of older adults is increasing in Africa, very little is known about the health and well-being of African elders. Recently, a growing number of researchers have focused on the plight of elders who find themselves caring for orphaned grandchildren. While several anecdotal reports have suggested that this new burden negatively impacts their health, there are few studies that systematically examine the health of African elders. As part of the Kenyan Grandparents Study, the health of 287 grandparents (age 73 ± 8) was examined using multiple methods including objective measures, clinical history, physical examination, and a modified version of the SF-36. Although all health variables were correlated with each other, different patterns were found between predictor variables and the various measures of health. Caregiving status was only associated with mental health, with caregivers having better mental health than non-caregivers. Age was associated with poorer health as measured by several SF-36 scales, physical exam, and body mass index (BMI). Women generally had a greater number of health complaints and lower quality of life as measured by the SF-36. Higher socioeconomic status was associated with better health as measured by physical exam, clinical history, SF-36, and BMI. Caring for a greater number of orphans was associated with better health on examination but no other measure of health. More social support was associated with better physical function and general health as measured by the SF-36. These data suggest that there is no strong evidence that caregiving results in poor health.


Africa Caregiving HIV/AIDS Orphans Aging Health Function 



This project was funded by the Ohio University Baker Fund, Ohio University College of Osteopathic Medicine Research Award, the National Science Foundation under Grant No. 0515890 and in collaboration with the Kenya Medical Research Institute. Thanks to our Kenyan Field team: Monica Audi Liech, Beryl Awour Ogot, Antoney Odhiambo Juma, Agness Atieno Aluodo, Fredrick Awili, Jack Omondi Gao, Nancy Auma Ndiege, Brenda Loice Omondi, Jared Onyango, Kennedy Otieno Nyangwara, Danish Odie Agal and Yuanita Hongo. The following medical students were integral to the data collection on this project: Chelsea Crabtree, Jennifer Drost, Sarah Schillig, and Kristina Yoder. A special thanks to the communities in Nyando and Kisumu Rural Districts. We also thank the Director of the Kenya Medical Research Institute for his permission to publish this manuscript.


  1. Abboud, L., Beyar, R., Battler, A., Rat, M., Cohen, A., & Sideman, S. (1990). Analysis and prediction of left ventricular performance under load changes during cardiac catheterization. Annals of Biomedical Engineering, 18, 445–461.CrossRefGoogle Scholar
  2. Agyarko, R. D., Kalache, A., & Kowal, P. (2000). Older people, children and the HIV/AIDS nexus. Geneva: UNAIDS.Google Scholar
  3. Agyarko, R. D., Madzingira, N., Mupedziswa, R., Mujuru, N., Kanyowa, L., & Matorofa, J. (2002). Impact of AIDS on older people in Africa. Zimbabwe Case Study. Geneva: World Health Organization.Google Scholar
  4. Ainsworth, M., & Dayton, J. (2000). Is the AIDS epidemic having an impact on the coping behavior and health status of the elderly? Evidence from Northwestern Tanzania.Google Scholar
  5. Ainsworth, M., & Filmer, D. (2002). Poverty, AIDS and children’s schooling: A targeting dilemma. World Bank Policy Research Working Paper 2885.
  6. Ainsworth, M., & Semali, I. (2000). The impact of adult deaths on children’s health in northwestern Tanzania.Google Scholar
  7. Bureau, U. S. C. (2006). International Data Base (IDB): Summary Demographic Data for Kenya.Google Scholar
  8. Buzzard, S. (1982). Women’s status and wage employment in Kisumu, Kenya. Washington, DC: The American University.Google Scholar
  9. Charlton, K. E., & Rose, D. (2001). Nutrition among older adults in Africa: The situation at the beginning of the millenium. American Society for Nutritional Sciences, 131, 2424S–2428S.Google Scholar
  10. Cliggett, L. (2005). Grains from Grass. Aging, gender and famine in Rural Africa. Ithaca: Cornell University Press.Google Scholar
  11. Cohen, B., & Menken, J. (2006). Aging in Sub-Saharan Africa: Recommendations for furthering research. Washingon, DC: The National Academies Press.Google Scholar
  12. Cook, K. D. (1990). Determinants of female time allocation in agricultural households in southwestern Kenya. PhD thesis, Cornell University, Cornell.Google Scholar
  13. Cooper, R. S., Wolf-Maier, K., Luke, A., Adebowale, A., Banegas, J. R., Forrester, T., et al. (2005). An international comparative study of blood pressure in populations of European vs. African descent. BMC Medicine, 3, 2–10.CrossRefGoogle Scholar
  14. Dayton, J., & Ainsworth, M. (2004). The elderly and AIDS: Coping with the impact of adult death in Tanzania. Social Science & Medicine, 59, 2161–2172.CrossRefGoogle Scholar
  15. Ezeh, A., Chepngeno, G., Kasiira, A., & Woubalem, Z. (2006). The situation of older people in poor urban settings: The case of Nairobi, Kenya. In B. Cohen, & J. Menken (Eds.) Aging in sub-Saharan Africa: Recommendations for furthering research pp. 189–213. Washington, DC: National Academies Press.Google Scholar
  16. Frolkis, W. (1993). Stress-age syndrome. Mechanisms of aging and development, 69, 93–107.CrossRefGoogle Scholar
  17. Geissler, P. W., Nokes, K., Price, R. J., Achieng’ Odhiambo, R., Aagaard-Hansen, J., & Ouma, J. H. (2000). Children and medicines: Self-treatment of common illnesses among Luo school children in western Kenya. Social Science & Medicine, 50, 1771–1783.CrossRefGoogle Scholar
  18. Gilborn, L. Z., Nyonyintono, R., Kabumbuli, R., & Jagwe-Wadda, G. (2001). Making a difference for children affected by AIDS: Baseline findings from operations research in Uganda. New York: Population Council.Google Scholar
  19. Grundy, E., & Sloggett, A. (2003). Health inequalities in the older population: The role of personal capital, social resources and socio-economic circumstances. Social Science & Medicine, 56, 935–947.CrossRefGoogle Scholar
  20. HelpAge International (2002). HIV/AIDS and older people: The African situation. Nairobi: HelpAge International.Google Scholar
  21. Kahn, K., Tollman, S., Thorogood, M., Connor, M., Garenne, M., Collinson, M., et al. (2006). Older adults and the health transition in Agincourt, rural South Africa: New understanding, growing complexity. In B. Cohen, & J. Menken (Eds.) Aging in sub-Saharan Africa. Recommendation for furthering research pp. 166–188. Washington, DC: National Academies Press.Google Scholar
  22. Kakooza, J., & Kiumuna, S. R. (2005). HIV/AIDS orphans’ education in Uganda: The changing role of older people. Journal of Intergenerational Relationships, 34, 63–81.Google Scholar
  23. Kerry, S. M., Michah, F. B., Plange-Rhule, J., Eastwood, J. B., & Cappuccio, F. P. (2005). Blood pressure and body mass index in lean rural and semi-urban subjects in West Africa. Journal of Hypertension, 23, 1645–1651.CrossRefGoogle Scholar
  24. Labarthe, D. R., Blaufox, M. D., Smith, W. M., Lacy, C. R., Schnaper, H., LaBaw, F., et al. (1991). Systolic Hypertension in the Elderly Program (SHEP). Part 5: Baseline blood pressure and pulse rate measurements. Hypertension, 17, II62–II76.Google Scholar
  25. Lima-Costa, M. F., Barreto, S. M., Firmo, J. O. A., & Uchoa, E. (2003). Socioeconomic position and health in a population of Brazilian elderly: The Bambuí Health and Aging Study (BHAS). Revista Panamericana de Salud Públuca/Pan American Journal of Public Health, 13, 387–394.Google Scholar
  26. Lima-Costa, M. F., Firmo, J. O. A., & Uchoa, E. (2004). The structure of self-rated health among older adults: The Bambuí Health and Ageing Study (BHAS). Revista de Saúde Pública, 38, 827–834.Google Scholar
  27. Lima-Costa, M. F., Firmo, J. O. A., & Uchoa, E. (2005). Differences in self-rated health among older adults according to socioeconomic circumstances: The Bambuí Health and Aging Study. Cadernos de Saúde Pública, 21, 830–839.CrossRefGoogle Scholar
  28. Lima-Costa, M. F., Uchoa, E., Buerra, H. L., Firmo, J. O. A., Vidigal, P. G., & Barreto, S. M. (2000). The Bambuí Health and Ageing Study (BHAS): Methodological approach and preliminary results of a population based cohort study of the elderly in Brazil. Revista de Saúde Pública, Sao Paula/Journal of Public Health, 34, 126–134.Google Scholar
  29. Lohman, T. G., Roche, A. F., & Martorell, R. (1989). Athropometric standardization reference manual. Champaign: Human Kinetics Books.Google Scholar
  30. McEwen, B. (2001). From molecules to mind. Stress, individual differences, and the social environment. Annals New York Academy of Sciences, 935, 42–49.CrossRefGoogle Scholar
  31. McEwen, B. (2002). The end of stress as we know it. Washington, DC: Joseph Henry Press.Google Scholar
  32. McEwen, B., & Wingfield, J. (2003). The concept of allostatis in biology and biomedicine. Hormones and Behavior, 43, 2–15.CrossRefGoogle Scholar
  33. Nalagoda, F., Wawer, M., Konde-Lule, J., Menon, R., Gray, R., Serwadda, D., et al. (1997). HIV infection in rural households, Rakai District, Uganda. Health Transition Review, 7, 3–17.Google Scholar
  34. National Council for Population and Development (1999). Demographic and health survey 1998. Calverton, MD: Macro International Inc.Google Scholar
  35. Nyambedha, E., Wandibba, S., & Aagaard-Hansen, J. (2001). Policy implications of the inadequate support systems for orphans in Western Kenya. Health Policy, 58, 83–96.CrossRefGoogle Scholar
  36. Nyambedha, E., Wandibba, S., & Aagaard-Hansen, J. (2003a). Changing patterns of orphan care due to the HIV epidemic in western Kenya. Social Science & Medicine, 57, 301–311.CrossRefGoogle Scholar
  37. Nyambedha, E., Wandibba, S., & Aagaard-Hansen, J. (2003b). “Retirement lost”—The new role of the elderly as caretakers for orphans in western Kenya. Journal of Cross-Cultural Gerontology, 18, 33–52.CrossRefGoogle Scholar
  38. Oburu, P. O., & Palmerus, K. (2005). Stress related factors among primary and part time caregiving grandmothers of Kenyan grandchildren. International Journal of Aging and Human Development, 60, 273–282.CrossRefGoogle Scholar
  39. Ochieng’, W. (1985). People round the Lake. London: Evans Brothers Limited.Google Scholar
  40. Ocholla-Ayayo, A. B. C. (1999). Traditional ideology and ethics among the Southern Luo. Uppsala, Sweden: Scandinavian Institute of African Studies.Google Scholar
  41. Ogunmefun, C., & Schatz, E. (2006). Caregivers’ sacrifices: The opportunity costs of adult morbidity and mortality on female pensioners in rural South Africa. Boulder: Institute of Behavioral Science.Google Scholar
  42. Opiyo, F. A. (1996). Rural Kenyan Luo women’s lived experiences: An interpretation. Greensboro: University of North Carolina at Greensboro.Google Scholar
  43. Reynar, A. (2000). Fertility decision making by couples amongst the Luo of Kenya. Philadelphia: University of Pennsylvania.Google Scholar
  44. Sapolsky, R. M. (1996). Why stress is bad for your brain. Science, 273, 749–750.CrossRefGoogle Scholar
  45. Sapolsky, R. M. (1999). Glucocorticoids, stress, and their adverse neurological effects: Relevance to aging. Experimental Gerontology, 34, 721–732.CrossRefGoogle Scholar
  46. Sapolsky, R., Armanini, M., Packan, D., & Tombaugh, G. (1987). Stress and glucocorticoids in aging. Endocrinology and Metabolism Clinics of North America, 16, 965–980.Google Scholar
  47. Smith, S. M., & Mensah, G. A. (2003). Population aging and implications for epidemic cardiovascular disease in sub-Saharan Africa. Ethnicity and Disease, 13, S2-77–80.Google Scholar
  48. Ssengonzi, R. (2007). The plight of older persons as caregivers to people infected/affected by HIV/AIDS: Evidence from Uganda. Journal of Cross Cultural Gerontology, 22, 339–353.CrossRefGoogle Scholar
  49. UNAIDS (2006). 2006 Report on the global AIDS epidemic. Geneva: Joint United Nations Programme on HIV/AIDS.Google Scholar
  50. UNAIDS/UNICEF (2002). Children on the brink 2002. A joint report on orphan estimates and program strategies. Washington, DC: TvT Associates/The Synergy Project.Google Scholar
  51. UNAIDS/UNICEF/WHO (2002). Epidemiological fact sheets on HIV/AIDS and sexually transmitted infections: Kenya. Gevenva: UNAIDS.Google Scholar
  52. UNICEF (2003). Africa’s orphaned generations. New York: UNICEF.Google Scholar
  53. Unwin, N., McLarty, D., Machibya, H., Aspray, T., Tamin, B., Carlin, L., et al. (2006). Changes in blood pressure and lipids associated with rural to urban migration. Journal of Human Hypertension, 20, 704–706.CrossRefGoogle Scholar
  54. Wagner, A. K., Wyss, K., Gandek, B., Kilima, P. M., Lorenz, S., & Whiting, D. (1999). A Kiswahili version of the SF-36 Health Survey for use in Tanzania: Translation and tests of scaling assumptions. Quality of Life Research, 8, 101–110.CrossRefGoogle Scholar
  55. Ware, J. E. (2007). SF-36 Health Survey Update: Rand.Google Scholar
  56. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483.CrossRefGoogle Scholar
  57. WHO. (2005). WHO Global InfoBase Online. WHO global comparable estimates: WHO.Google Scholar
  58. Williams, A., & Tumwekwase, G. (2001). Multiple impacts of the HIV/AIDS epidemic on the aged in rural Uganda. Journal of Cross-Cultural Gerontology, 16, 221–236.CrossRefGoogle Scholar
  59. Wilson, A. O., & Adamchak, D. J. (2000). AIDS in Africa: The grandmothers’ disease. Comment. Journal of Age Related Disorders, 12, 5–6.Google Scholar
  60. Wolf, H. K., Kuulasmaa, K., Domarkiene, S., Cepaitis, Z., Molarius, A., Sans, S., et al. (1997). Blood pressure levels in 41 populations of the WHO MONICA project. Journal of Human Hypertension, 11, 733–742.CrossRefGoogle Scholar
  61. Wolf-Maier, K., Cooper, R. S., Banegas, J. R., Giampaoli, S., Hense, H.-W., Joffres, M., et al. (2003). Hypertension prevalence and blood pressure levels in 6 European Countries, Canada and the United States. JAMA, 289, 2363–2369.CrossRefGoogle Scholar
  62. Woodman, R., Ferrucci, L., & Guralnik, J. (2005). Anemia in older adults. Current Opinion in Hematology, 12, 123–128.Google Scholar
  63. Wyss, K., Wagner, A., Whiting, D., Mtasiwa, D., Tanner, M., Gandek, B., et al. (1999). Validation of the Kiswahili version of the SF-36 Health Survey in a representative sample of an urban population in Tanzania. Quality of Life Research, 8, 111–120.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Social MedicineOhio University College of Osteopathic MedicineAthensUSA
  2. 2.Kenya Medical Research InstituteKisumuKenya

Personalised recommendations