Journal of Public Health | pp. 1–10 | doi:10.1093/pubmed/fdz013 A systematic review of physical and psychological health and wellbeing of older women in Sub-Saharan Africa Sowmya Mangipudi 1 , Theodore Cosco 2 , Sarah Harper 3 1 Oxford Institute of Population Ageing, University of Oxford, UK 2 Gerontology Research Center, Simon Fraser University, Vancouver, Canada 3 Oxford Institute of Population Ageing, University of Oxford, 66 Banbury Rd. Oxford OX1 6PR, UK Address correspondence to Sarah Harper, E-mail: sarah.harper@ageing.ox.ac.uk ABSTRACT Background Sub-Saharan Africa (SSA) has the fastest growing proportion of older adults in the world, the majority of whom are women. Global health agendas, however, continue to deprioritise older women’s health issues, including the incidence of and mortality from non- communicable disease (NCDs). This is the first systematic review to address the health, wellbeing and healthcare utilization of older SSA women. Methods Studies with primary analysis of health, wellbeing and/or healthcare utilization outcomes for women over the age of 50 from SSA countries were included. Databases searched include EMBASE, Scopus and Psycinfo. Findings About 26 studies from six SSA countries met inclusion criteria. Studies regarding NCDs predominated (n = 12), followed by healthcare utilization (n = 4), disability (n = 4), wellbeing (n = 2), depression (n = 2) and HIV (n = 2). Every study indicated significantly lower self-rated health and wellbeing, higher rates of depression, hypertension, obesity, disability or weakness for women compared with men. The studies also indicated that older women use healthcare more often, and choose public over private facilities more often. Interpretation The studies in the review had large, diverse samples. This review demonstrates the need for more gender-specific studies to better understand the unique challenges older women face in managing NCDs in particular. Keywords ageing, disabilities, women’s health Introduction Global interest in women’ s health and associated policy has focused almost exclusively on sexual and reproductive health due to high rates of maternal mortality and sexually trans- mitted diseases. 1 However, a rapidly ageing global popula- tion brings new challenges regarding non-communicable disease (NCD) to add to the existing issue of communicable disease, creating a ‘double burden’ in low and middle income countries. 2 The health and infrastructure challenges asso- ciated with an ageing population are uniquely pressing for in Sub-Saharan Africa (SSA): in 2005, SSA had an older adult population (60 years+) of 34 million, and that number is expected to reach 67 million by 2030. 3 Older SSA women in particular have unique health and wellbeing needs that have not been explicitly acknowledged in global health forums. For example, the Sustainable Development Goals (SDGs) only call for general measures to improve gender equality, such as ‘equal access to education, healthcare, decent work and representation in political and economic decision- making processes. ’ 4 While there have been a number of studies focused on the ‘double burden’ of disease among older adults in SSA, few of these studies have distinguished between male and female risk factors or outcomes, have presented gender-disaggregated data, nor have focused exclusively on older women’ s health Sowmya Mangipudi, Research Officer, Oxford Institute of Population Ageing, University of Oxford Theodore Cosco, Assistant Professor, Gerontology Research Centre, Department of Gerontology, Simon Fraser University; Research Fellow, Oxford Institute of Population Ageing, University of Oxford Sarah Harper, Professor of Gerontology, Oxford Institute of Population Ageing, University of Oxford © The Author(s) 2019. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 1 Downloaded from https://academic.oup.com/jpubhealth/article/42/2/294/5371151 by guest on 08 July 2022