A groundbreaking effort to better understand changing demographics in Kenya—and the resulting pressures on the country’s health system—has received a multi-million-dollar grant from the National Institutes of Health.
The Longitudinal Study of Health and Ageing in Kenya, or LOSHAK, is a collaboration between the Department of Population Health at Aga Khan University in Nairobi and the University of Michigan Institute for Social Research.
A fieldworker interviews in Kilifi County, rural Kenya, gathering data for the LOSHAK aging study.
The project received enabling support from the U-M Center for Global Health Equity and the AKU Medical College and is co-led by Joshua Ehrlich, the Paul R. Lichter Research Professor of Ophthalmology and Visual Sciences and a Research Associate Professor at the ISR, and his collaborator, Anthony Ngugi, Associate Professor and Chair of the AKU Department of Population Health and Associate Dean for Research in the Medical College in East Africa.
“Thanks in part to improved health services and access, life expectancy in Kenya is increasing. The irony is that these trends create new challenges for the very healthcare and economic systems that enabled them. Now, there is a need to adapt and innovate,” said Ehrlich, MD, MPH.
While sub-Saharan Africa currently has one of the world’s youngest populations, the proportion of older adults is rising faster than anywhere else, thanks to increased life expectancy and the growing use of contraceptives and family planning services. By 2050, the continent’s share of people aged 60 and older is expected to nearly triple. In Kenya, where LOSHAK is focused, the number of adults aged 60 and older is projected to increase fourfold in the next 30 years.
The five-year, $23.6 million grant (R01AG093721) will be allocated between AKU and U-M, enabling Ehrlich and Ngugi to survey thousands of Kenyans as they seek to fully understand drivers of health and economic well-being in later life, in addition to the long-term implications of emerging population trends.
“These demographic shifts will stress economic systems and create new demands for healthcare delivery, from elder care to chronic disease management and cancer treatments,” said Ngugi, PhD, MSc. “Looking ahead, policy makers will need the best possible data to understand and care for LMIC populations that look much different from those typically seen today.”
At the heart of LOSHAK are two complementary surveys, each designed to align with established international research networks. The first “Core” survey will target roughly 6,500 Kenyans aged 45 and older throughout the entire country. It will gather a range of health, social, and economic information. The survey will be deployed in more than a dozen languages, reflecting the country’s linguistic diversity. It is intended to harmonize with a global family of similar aging studies modeled after the U.S. Health and Retirement Study.
Nested within the Core survey is a second study of about 2,300 individuals in the Coast Region of Kenya aged 65 and older, focused on identifying risk factors for cognitive impairment, Alzheimer’s disease, and related conditions. This cognitive survey follows the Harmonized Cognitive Assessment Protocol, connecting it to an international network of comparable health studies as well.
Finally, the research team plans to incorporate environmental and physical activity data from wearable devices, as well as biomarker data from collected blood samples, checking for signs of inflammatory diseases and other chronic health conditions. The award will allow the team to establish a long-term survey cohort, laying the foundation for future studies to examine other dimensions of population aging.
All of the information gathered through LOSHAK will be publicly available to researchers for comparison alongside harmonized studies around the world, providing insights to academics, government officials, and policymakers across the African continent and beyond. Because chronic diseases, dementia, and caregiving pressures are nearly universal, the project’s impact is not necessarily confined to Kenya—or even sub-Saharan Africa—but could inform care anywhere, including in the United States.
“Our ultimate goal is to turn data into action—helping to shape health and economic systems that are ready to care not just for today’s population, but for older adults of the future too, no matter where they live,” said Ehrlich.
Written by Craig McCool