European Journal of Population

, Volume 34, Issue 4, pp 637–662 | Cite as

Cognition, Health, and Well-Being in a Rural Sub-Saharan African Population

  • Collin F. PayneEmail author
  • Iliana V. Kohler
  • Chiwoza Bandawe
  • Kathy Lawler
  • Hans-Peter Kohler


Cognitive health is an important dimension of well-being in older ages, but few studies have investigated the demography of cognitive health in sub-Saharan Africa’s growing population of mature adults (= persons aged 45+). We use data from the Malawi Longitudinal Study of Families and Health to document the age and gender patterns of cognitive health, the contextual and life-course correlates of poor cognitive health, and the understudied linkages between cognitive and physical/mental well-being. Surprisingly, the age pattern of decline in cognitive health is broadly similar to that observed in the USA. We also find that women have substantially worse cognitive health than men and experience a steeper age gradient in cognitive ability. Strong social ties and exposure to socially complex environments are associated with higher cognitive health, as is higher socioeconomic status. Poor cognitive health is associated with adverse social and economic well-being outcomes such as less nutrition intake, lower income, and reduced work efforts even in this subsistence agriculture context. Lower levels of cognitive health are also strongly associated with increased levels of depression and anxiety and are associated with worse physical health measured through both self-reports and physical performance. Our findings suggest that cognition plays a key—but understudied—role in shaping late-life well-being in low-income populations.


Cognitive health Aging Sub-Saharan Africa Mental health Physical health 



The first wave of the MLSFH was funded by the Rockefeller Foundation. Subsequent funding has been provided by the NICHD (Grants R01 HD053781, R01 HD/MH041713, R01 HD37276, R01 HD044228, R21 HD050652, R03 HD058976, R21 HD050652, R21 HD071471) and has been supported by pilot grants from the Population Studies Center (PSC), Population Aging Research Center (PARC), the Boettner Center for Pensions and Retirement Security, the Institute on Aging and the Center for AIDS Research (CFAR), all at the University of Pennsylvania, supported by among other sources NIH Grants NICHD R24 HD044964, NIA P30 AG12836, NIAID AI 045008. The project also received funding from the University of Pennsylvania Research Foundation. We are also grateful for pilot funding received through the Penn Center for AIDS Research (CFAR), supported by NIAID AI 045008, and the Penn Institute on Aging. Part of this research was also supported by the Swiss Agency for Development and Cooperation (SDC) and the Swiss National Science Foundation through the Swiss Programme for Research on Global Issues for Development (SFF R4d Programme, Grant Number: 400640_160374). NICHD R01HD053781 is the only grant that provided direct support for the writing of this manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare no competing interests, and the funders had no role in the design of the study, the analysis of the data, or the decision to present the results.

Ethical Approval

The data collection and research conducted by MLSFH was approved by the Institutional Review Board (IRB) at the University of Pennsylvania and, in Malawi, by the College of Medicine Research Ethics Committee (COMREC) or the National Health Sciences Research Committee (NHSRC).

Supplementary material

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Supplementary material 1 (PDF 1332 kb)


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Collin F. Payne
    • 1
    Email author
  • Iliana V. Kohler
    • 2
  • Chiwoza Bandawe
    • 3
  • Kathy Lawler
    • 4
  • Hans-Peter Kohler
    • 5
  1. 1.Center for Population and Development StudiesHarvard UniversityCambridgeUSA
  2. 2.Population Studies CenterUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Mental HealthCollege of MedicineBlantyreMalawi
  4. 4.Department of NeurologyPerelman School of Medicine University of PennsylvaniaPhiladelphiaUSA
  5. 5.Department of SociologyUniversity of PennsylvaniaPhiladelphiaUSA

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