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Article Excerpt
In order to develop strategies to improve the health status of older persons and enhance their potential as providers of traditional and cultural knowledge and as caregivers, more information is needed about older persons' health and health risks. Few studies have addressed health issues of older persons in Botswana. However, it has been shown that alcohol consumption in older persons in Botswana is associated with tobacco use and being underweight (Clausen et al., 2005).
Studies, mainly from European and North American countries, have demonstrated that alcohol consumption and heavy drinking may cause a range of severe health and social problems in the drinker himself (Babor et al., 2003) and may also affect children's health and well-being by its adverse impact on caregiving and family functioning (Rossow, 2000). It is therefore relevant to assess the drinking patterns in the older age groups and to explore the importance of alcohol as a health hazard among older persons as well as a hazard to their role as caregivers for children and orphans. Previous surveys on drinking habits in Botswana and other southern African countries have shown that men generally drink more and more often than women. A trend is that younger drinkers commonly drink more, and typically with a "modern" or "Western" drinking pattern of consuming commercial beverages (Giesbrecht, 1989; Maula et al., 1990; Molamu & Manyeneng, 1988). However, in the research literature little attention has been paid to the drinking habits and drinking problems of older persons in this region. This national health survey of older persons in Botswana is a contribution to extend our knowledge of older Africans' drinking patterns. According to the "global burden of disease," the global morbidity from alcohol, measured in years lost to disability, has a greater impact on health than does malnutrition, poor sanitation, or unsafe sex (Lopez & Murray, 1996; WHO, 1999). In southern Africa, alcohol accounts for 3.5% of all disease burden among males and 0.8% among females (Babor et al., 2003).
Homemade beers have been consumed in many African countries for centuries. Pre-colonially, alcoholic beverages were given to people who were respected as gifts during ceremonies such as weddings and rituals. Traditionally during plowing and harvesting seasons, "beer-for-work parties" were arranged, where laborers were "paid" with homemade beer. Alcohol was traditionally not a commodity for sale. Women usually brewed, but mostly elderly men drank alcoholic beverages (Mania et al., 1990; Willis, 2002). Changes in drinking patterns did, however, occur with the influence of the European settlers. In developing countries in general, the annual per capita consumption of alcoholic beverages has increased in recent years, according to available data (Willis, 2002; WHO, 1999). In Botswana at the end of the 1990s, the annual per capita recorded alcohol consumption was 2.7 liters pure alcohol per adult above 15 years. The corresponding figures for Zimbabwe, Zambia, and South Africa were 2.8, 0.6, and 7.7 liters, respectively.
Botswana, with a total population of 1.6 million, is among the sub-Saharan countries hardest hit by the HIV/AIDS epidemic. Over 30% of the adult population (between 15 and 49 years of age) is HIV positive in Botswana, and 60,000 children are officially registered as orphaned by AIDS (2001), whereas in sub-Saharan Africa as a whole as many as approximately 11 million children are orphaned by AIDS (AVERT, 2004; WHO, 2002).
One prominent effect of AIDS on the lives of older persons has been a sharp rise in caregiving duties. Older persons already had caregiving duties before AIDS, but as the middle generation now is hard hit by the AIDS epidemic, this leaves older persons typically without any caregivers to look after them in old age, and at the same time the grandparent generation has been left with the major burden of caregiving responsibilities for AIDS orphans (Akinsola, 2000; Ferreira et al., 1999; Ferreira, 2000; Hunter, 1990; Ingstad, 2004; Tlou, 1996; Wilson and Adamchak, 2001). In Africa the extended family has traditionally taken on care duties whenever necessary, as public care institutions such as orphanages are rare, and grandparents may be the only adult family members left to serve as care providers.
A ratio of seven children below 15 years of age per adult above 60 years for Botswana in 1998 was calculated; the equivalent ratio for Western Europe is 0.8 (U.S. Census Bureau, 2003). The high ratio in Botswana gives a rough indication of the potential caregiving burden facing the grandparent generation, as large parts of the "parent generation" of the children below 15 are dying from AIDS.
In this paper, Botswana serves as an example of drinking patterns and their associations with basic sociodemographic variables in older persons in sub-Saharan Africa. Our paper reports from a national study on health and living conditions of older persons in Botswana. Our aim was to describe drinking patterns and analyze factors associated with different drinking habits, and to relate this information to older persons' role as caregivers for children.
The specific objectives of this paper are to present new data about the following:
1. Distribution of current drinkers, abstainers, and former drinkers among the elderly in Botswana.
2. Self-reported reasons for drinking and reasons for abstaining.
3. Patterns of drinking for moderate and hazardous drinkers--e.g., what were the preferred beverages, and when did people drink during the day?
4. Adjusted associations between drinking status--moderate drinkers, hazardous drinkers, abstainers, and previous drinkers--and the sociodemographic characteristics gender, age, socioeconomic status and religious affiliation.
Sample and methods
Results from a study on health and living conditions of older persons in Botswana in 1991/92 (Ingstad et al., 1992; Mugabe et al., 1994) led to a call by the Ministry of Health for national data on this population. This paper reports on the findings of a national survey subsequently conducted. Data were collected in 1998...
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