Abstract
Background: Sub-Saharan Africa (SSA) is projected to have a rapid increase in the number of people living with dementia by 2050. Yet, there is currently no robust evidence on the risk factors for dementia in the sub-region that could inform context specific interventions.Methods: We conducted a systematic review and meta-analysis of observational studies to determine the dominant and modifiable risk factors for dementia in SSA. We searched MEDLINE, EMBASE, PsychINFO, and African Journals Online using keywords for dementia and Alzheimer's disease as well as the.mp operator for all 47 SSA countries or regions. We included peer-reviewed original studies with epidemiological designs, conducted random effect meta-analysis and determined the dominant and modifiable risk factors for dementia using the inverse of variance method.Results: A total of 44 studies out of 2,848 met criteria for syntheses. The pooled annual incidence of dementia from 5,200 cohort risk years was 2.0% [(95% Confidence Interval (CI) = 1.0–4.0%)]. The pooled prevalence was 5.0% (95% CI = 2.0–7.0%). Older age was the dominant risk factor for both prevalent [(Standard error (S.E = 0.3, weight = 25.2%)] and incident dementia (S.E = 0.02, weight = 95.8%), while low educational attainment (S.E = 0.19, weight = 32.6%) and poor predementia cognitive functioning at baseline (S.E = 0.2, weight = 20.5%) were the best ranked modifiable risk factor for incident dementia.Conclusion: Low formal educational attainment which, in SSA, may represent a stable index of low socioeconomic position and health disadvantage over the life course, was the most prominent modifiable risk factor for incident dementia. Findings have implications for deliberate policies targeted at access to education across the life course as a primary prevention strategy against dementia in SSA.
Highlights
Sub-Saharan Africa (SSA) is set to have one of the largest increases in the population of older people worldwide [1], and by 2050, approximately 161 million persons who are 60 years or older will be residents of the sub-region [2]
In our previous study [3], we found a 4% pooled prevalence of clinically diagnosed dementia from an overall sample 6964 community-dwellers who were 60 years or older
Of the Seven excluded articles, one each was from Senegal [15], Cameroun [16], South Africa [17], Tanzania [18], and Rwanda [19], while the remaining two were from Nigeria [20, 21]
Summary
Sub-Saharan Africa (SSA) is set to have one of the largest increases in the population of older people worldwide [1], and by 2050, approximately 161 million persons who are 60 years or older will be residents of the sub-region [2]. There is currently no robust evidence on the risk factors for dementia in SSA that could inform context specific interventions. Longitudinal follow-up data [5,6,7,8,9] may serve to build on evidence provided by cross-sectional surveys of dementia in SSA. Longitudinal studies may provide evidence for the relative importance of each modifiable risk factor for incident dementia, information required for the prioritization of primary prevention targets within limited resource contexts of SSA. There is currently no robust evidence on the risk factors for dementia in the sub-region that could inform context specific interventions
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