Abstract
Study Background
The number and proportion of older people 60 years or older in Kenya is set to increase from 2.1 million and 4.5% in 2015 to 3.6 million and 5.5% in 2030 respectively. This is attributed to increased life expectancy at birth and a high life expectancy at age 60 of about 18 years (UN Population Division, 2015). In Kenya the population 50 years and older had the highest percentage increase (318%) during the 1999 and 2009 inter-censual period compared with young people under the age of 15 years (128%) and adults 15-49 years (139%) (CBS, 2001; KNBS, 2010). Whereas increasing life expectancy and surviving to old age represents a triumph in health and development, old age can be characterised by a high burden of disease and disability resulting in reduced healthy life expectancy, increased demand for healthcare and expenditure (Ben-Shlomo & Kuh, 2002).
Research on the health of older people is vital for designing appropriate interventions and policies. However, there has been little focus on the health of older people little attention in Kenya to understand or address the health status, and wellbeing of this segment of the population. This is hampered by lack of representative data and surveys on health and wellbeing of older people. This population is excluded from most general population due to a policy focus on improved maternal and child health, and HIV and AIDS. Further, the older population are excluded from routine health surveillance which renders implementation of interventions and social programmes geared towards the welfare of older persons problematic (WHO, 2015). Goal 3 of the Sustainable Development Goals (SDGs) aims to 'ensure healthy lives and promote wellbeing for all at all ages' (UN, 2016) and achievement of successful and healthy ageing (WHO, 2015). Though pointers to poor health status of older persons exist, the patterning and drivers of health and wellbeing amongst older adults in Kenya is largely unknown. Furthermore, to date, no specific indicators and assessment measures exist to determine health status of older persons.
Study Aims and Objectives
This study is designed to develop a research framework for routine generation of evidence on the health and wellbeing of older people in Kenya and developing and piloting an essential research tool with key indicators to enable rapid and routine assessment of the health of older people.
The specific objectives of the study are to:
(1) Develop and validate a research tool to assess the health and wellbeing of older people in Kenya;
(2) Examine the disease and disability burden among older people in a selected county;
(3) Identify health and socio-economic concerns and needs that affect the wellbeing of the older persons;
(4) Identify strategies that will enhance the health, psycho-social and general wellbeing of old people;
(5) Strengthen the research capacity of the collaborating institutions through designing a policy-focused study and production of research outputs.
Study Site
The study will be conducted in Kiambu County. Kiambu County is located in the central region of Kenya and is one of the counties bordering Nairobi, the capital city. It is divided into 12 political administrative units and covers an area of 2,543 sq. KM with a population density of 638.23 making it the 6th most densely populated county. Kiambu County was selected as a case study for the project due to the proximity of the county to Nairobi City County and therefore populated by a fairly heterogeneous population composition with nearly all ethnic groups of Kenya. The proximity to the capital city also means that the resident population consists of those who are still actively participating in the formal as well as informal labour force and the retired workforce. The topography of Kiambu County, which comprise high and low altitude zones, offer a range of climatic zones consisting of rich agricultural areas to semi-arid zones with harsher climates and thus contrasting economic zones. Further, the county is made up mostly of urban and peri-urban communities as well as rural communities which provide diverse economic and livelihood opportunities (Kiambu County n.d.).
Study Design and Methodology
A cross-sectional survey design will be used where households will be selected through a multi-stage random sampling of households with older persons. The first stage will involve a random selection of 30 clusters in the National Sample Survey and Evaluation Programme (NASSEP) in Kiambu County. The second stage will involve the identification of households with older persons in each of the selected clusters and 10 households will be randomly selected from each cluster. About 300 households will be selected and random sampling with replacement to account for non-response. Data collection will be conducted electronically using tablets while collected data will be uploaded daily to central servers and monitored for completeness and quality. Household and population weights will be formulated for analysis.
Study Participants
The study participants are older people 60 years or older who are usual residents of Kiambu County (de jure population) or will be visiting the County and will have spent the night prior to the interview date (de facto population).
Participants will consist of individuals with ability to provide informed consent and those incapacitated will be interviewed through proxy respondents who will mainly be their caregivers. It is important to interview older people who are incapacitated and or unable to independently give informed consent as understanding the health needs and wellbeing of these older people is crucial in gaining wider knowledge of challenges faced by older people with severe disability or health conditions.
WorkPlan
The project consists of three phases. Phase I consists of inception meeting and methodology workshops to identify the concepts and indicators to answer the research questions and discuss the methodological issues to be considered in the study. The data collection is developed in phase one through consultative workshops with core-team of researchers and stakeholders and is then validated by a wider team of experts.
The fieldwork and data collection will be conducted in the Phase II (6 months). This phase will cover recruitment and training of research assistants, piloting of the research tool, and development of the analysis plan. The final phase will consist of writing workshops and discussion of the results of the project, drafting of the project report and planning for future and further research direction including publication of joint working paper and journal article in a peer-reviewed journals. Appendix 1 provides the Gantt chart of the workplan.
Ethics Considerations
The research does not present any ethical risks and none of the issues to be researched can be considered culturally or socially sensitive. The project will comply fully with the relevant research and ethics guidelines for conducting research in Kenya and international guidelines for research with human participants. All the staff working in the project who will collect or handle data will be mandated to undertake online courses on research ethics and research on human subjects.
The data will be stored in secure servers and no copies will be stored or transferred to external or portal devices until after the data has been anonymised. At the end of the project, the data will be archived in a secure servers.
Informed consent to participate in the research will be sought from all individuals after carefully explaining to each the purpose, why they have been chosen, and issues of confidentiality and freedom to not take part of withdraw from the study and contact information. A Participant Information Sheet (Appendix 2) will be provided to the participants along with a Consent Form (Appendix 3).
Budget
The budget for the 1 phase of the project is KES 2,619,750. This covers the cost of the planning meeting (KES 351,500), inception meeting (KES 4,680,000), workshops KES (352,300), recruitment of research assistants (KES 175,700) and administrative costs (KES 450,500).
Phase 2 of the project will consist of preparation meetings for fieldwork (KES 460,000), training of research assistants and piloting (KES 1,233,000), fieldwork (KES 4,988,500), and data preparation (KES 650,000). The total for phase 2 of the project is KES 7,331,500.
The final phase (KES 1,032,000) will comprise workshops and personnel costs relating to analysis and report writing (KES 762,000) and printing of report (KES 270,000).
