Africa is getting older.
The continent home to humanity’s origins and countless ancient civilizations also has the world’s youngest population. But that is changing, and rapidly.
While today people over the age of 60 make up 5.6% of Africa’s population, by 2050 that is expected to increase to over 15%.1
With enabling support from Center for Global Health Equity, an international team of researchers has received a $338K grant from the National Institutes of Health (NIH) to address major gaps in population-level data on aging in Kenya, one of Africa’s most populous nations.
"When the idea for the LOSHAK study was presented, I jumped on it, because I saw that the need was there."
–Anthony Ngugi, Aga Khan University
“Kenya expects its elderly population to quadruple by 2050,” says Anthony Ngugi, interim chair of Population Health at Aga Khan University (AKU) and co-principal investigator of the NIH grant.2
It is vital, says Ngugi, to begin studying “both population-level trends and individual aging trajectories to understand risk factors for health, disability, and well-being in the Kenyan context.”
Over the next 30 years, as Kenya becomes a place where people live longer and need different kinds of care, social structures will need to change. “Kenyan researchers and our partners can provide data that informs the social and policy adjustments we need in Kenya to address the growing needs of an aging population,” Ngugi said.
The NIH grant supports pilot work to lay groundwork for future NIH grant applications aimed at launching the full-scale Longitudinal Study of Health and Aging in Kenya (LOSHAK), a cohort study of Kenyan adults aged 45 and older. The study will eventually enroll thousands of participants and will follow them over the course of years.
“Such an approach requires commitment from participants and patience to see how results unfold over years,” explained Ngugi. “But data from such a study is so valuable.”
Key focus areas include Alzheimer’s disease and related dementias, mental health, the health and economic impacts of climate change and air pollution, and factors influencing late-life economic well-being. With the rapid demographic changes and lack of corresponding research to understand them, the project seemed rather timely to Ngugi. “When the idea for the LOSHAK study was presented, I jumped on it, because I saw that the need was there,” he said.
Connecting in Coastal Kenya
The LOSHAK study utilizes an existing study platform, the Kaloleni/Rabai Community Health and Demographic Surveillance System, a population-based research platform that includes more than 14,000 individuals over the age of 45 living in coastal Kenya.3
"Relationships make all the difference in the quality of the research."
–Josh Ehrlich, University of Michigan
The Kaloleni/Rabai study is run by AKU, whose expertise and leadership “is central to the success of LOSHAK,” said Josh Ehrlich—research assistant professor with the Institute for Social Research, assistant professor of Ophthalmology and Visual Sciences at Michigan Medicine, and co-principal investigator of the NIH grant.4 “Our partners at AKU have strong relationships with communities in this region, and these relationships—the trust and understanding they’ve built—make all the difference in the quality of the research.”
Ngugi and Ehrlich will use preliminary data and findings collected during this initial phase to improve the study’s infrastructure and, eventually, to propose a larger rollout in Kenya to field a nationally representative sample. In addition to continuing to build relationships in communities that are new to working with researchers, the LOSHAK team faces logistical challenges. “Kenya is a large country with many rural areas that can be difficult to access. But it’s vital that rural as well as urban populations be represented,” said Ehrlich.
During his time with the Kaloleni/Rabai platform, Ngugi has also established relationships with leaders in local health systems, including local clinics and staff, and has ongoing collaborations with Kenya’s National Ministry of Health. “Regional and national health leaders are excited about the project, because they understand the importance of studying aging,” Ngugi said.
Models Are Important
LOSHAK is also part of the Health and Retirement Study (HRS) network, a family of studies on aging in 45 countries modeled on the US HRS that began in the 1990s. “The HRS provides extensive data to understand how health, economic, and family networks interact over time to affect aging, economic well-being, and social relations,” said Kenneth Langa, associate director of the HRS and co-investigator on the grant.5
"LOSHAK is a poster child for how to get smart, talented folks in both countries together."
–Kenneth Langa, Health & Retirement Study
Currently, the only HRS network study in Africa is in South Africa, making LOSHAK only the second such project in the region. Langa says the Kenyan study has also provided a variety of innovations. “LOSHAK is a poster child for how to get smart, talented folks in both countries together. Anthony and Josh, with support from the Center for Global Health Equity, have put together a remarkable team.”
“And the way the LOSHAK study will apply population-level data to issues like climate change will be pioneering work. Africa is already experiencing many risks related to climate, and this study will help us see in great detail the connections among climate, aging, and health,” Langa added.
Another key feature of HRS projects is that all data collected are made publicly available. “The National Institute on Aging funds the HRS and ensures that all HRS network studies make their data public for researchers all over the world,” said Langa.
Along with the population-based insights on aging and health in Kenya and the cross-national comparisons LOSHAK will provide, the study also advances the Center for Global Health Equity’s model of collaboration. “The Center is committed to fostering sustainable relationships as we pursue collaborations with international partners, such as Aga Khan University,” said Center director Joseph Kolars. “Such relationships go hand-in-hand with projects that are truly co-designed, and LOSHAK is a remarkable example of bringing together two existing studies in a creative way.”
Ngugi shares the commitment to this partnership model. “It is rare to come across a partner as developed and resourced as the University of Michigan who is truly willing to listen, truly willing to partner on an equal basis, and is even willing to learn from us,” he said. “It is encouraging to work so closely with our Michigan partners and to share our capacities so together we can do this important work in Kenya.”
Other members of the grant team include Felix Agoi (AKU), Jessica Faul (UM), Muthoni Gichu (Global Brain Health Institute), Jean Ikanga (Emory), Pamela Jagger (UM), Elisa Maffioli (UM), Alden Gross (JHU), Carlos Mendes de Leon (UM), Edward Miguel (UC-Berkeley), Muthoni Mwangi (AKU), Roselyter Rianga (Moi University), Shaheen Sayed (AKU), and Akbar Waljee (UM).
Photo above. Felix Agoi, AKU's field coordinator, with Josh Ehrlich in Kilifi, Kenya, on a site where pilot testing for LOSHAK will be conducted.
LOSHAK is funded by the National Institute on Aging (R21AG077042) and the University of Michigan Center for Global Health Equity. The project has also received additional funding from the Michigan Center on the Demography of Aging (P30AG012846) and the Harmonized Cognitive Assessment Protocol (HCAP) Network (U24AG065182).
1. Wan He, Isabella Aboderin, and Dzifa Adjaye-Gbewonyo. US Census Bureau. Africa Aging: 2020 International Population Reports P95/20-1. US Government Printing Office, Washington, DC, 2020.
2. Anthony Ngugi, Interim Chair of Population Health and Associate Professor of Epidemiology and Population Health–Aga Khan University.
3. Ngugi, Anthony, et al. “Cohort Profile: The Kaloleni/Rabai Community Health and Demographic Surveillance System.” International Journal of Epidemiology 49/3 (June 2020):758–759e.
4. Josh Ehrlich, Research Assistant Professor–Institute for Social Research, Assistant Professor of Ophthalmology and Visual Sciences–Michigan Medicine.
5. Kenneth Langa, Associate Director–Health and Retirement Study, Research Professor–Institute for Social Research, Cyrus Sturgis Professor of Medicine–Michigan Medicine, Professor of Health Management and Policy–School of Public Health, Research Scientist–VA Center for Clinical Management Research.