Intervention of Public Policy in Ameliorating Dementia Risk Among Nigerian Women: A Sociopolitical and Structural Determinants Review
Keywords:
Dementia, developmental origins of health and disease (DOHaD), early-life adversity, gender inequality, Nigerian women, public policy, social determinants of healthAbstract
Dementia prevalence is rising globally and fastest in low- and middle-income countries (LMICs). Evidence indicates that low educational attainment, short adult stature which reflects early-life undernutrition, and chronic glucose dysfunction significantly elevate dementia risk among Nigerian women. These risk factors are deeply embedded within broader sociopolitical and structural determinants of health. This review examines sociological and political dimensions of dementia risk among Nigerian women, and highlight how gender inequality, educational disadvantage and structural poverty contribute to cognitive decline across the life course. Drawing on multidisciplinary evidence from epidemiology, endocrinology, developmental health science, gender studies, and the political economy of health, this article proposes an integrated conceptual framework linking health structural determinants to cognitive aging. A comprehensive reform agenda is proposed to include establishment of a national dementia action framework, strengthening gender-responsive education systems, expanding maternal and early-life nutrition programs, and improving diabetes prevention and management policies. This narrative review demonstrates that dementia in Nigerian women reflects structural inequities that require multisectoral policy responses to bridge the gap between biomedical care and social reform.
References
1. World Health Organization. Risk reduction of cognitive decline and dementia: WHO Guidelines Geneva: World Health Organization[Internet]. 2019 [cited 2026 Mar 23];13-45. Available from:https://iris.who.int/bitstream/handle/10665/ 312180/9789241550543-eng.pdf
2. Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020; 396(10248): 413-446.
3. Prince M, Comas-Herrera A, Knapp M, Guerchet M, Karagiannidou M. World Alzheimer Report 2016: Improving healthcare for people living with dementia: coverage, quality and costs now and in t h e future. Alzheimer's Disease International[Internet]. 2016 [cited 2026 Mar 23]. Available from: https://unilim.hal.science/hal03495463/document
4. Mbam KC, Halvorsen CJ, Okoye UO. Aging in Nigeria: A growing population of older adults requires the implementation of national aging policies. The Gerontologist. 2022; 62(9): 12431250.
5. Akinyemi RO, Yaria J, Ojagbemi A, Guerchet M, Okubadejo N, Njamnshi AK, et al. Dementia in Africa: current evidence, knowledge gaps, and future directions. Alzheimer's & Dementia. 2022; (4): 790-809.
6. Oghagbon EK, Giménez-Llort L. Short height and poor education increase the risk of dementia in Nigerian type 2 diabetic women. Alzheimers Dement (Amst). 2019; 11: 493-499.
7. Giménez-Llort L, Oghagbon E, Dogo F, Ogiator M, Prieto-Pino J. Nigerian women are more susceptible to the impact of diabetes-anddementia: State-of-art, Future perspectives and Directions. Int Psychogeriatr. 2020; 32(S1): 156.
8. Oghagbon EK, Prieto-Pino J, Dogoh F, Ogiator M, Giménez-Llort L. Diabetes/Dementia in SubSaharian Africa and Nigerian Women in the Eye of Storm. Curr Alzheimer Res. 2022; 19(2): 161-170.
9. Barbiellini Amidei C, Fayosse A, Dumurgier J, Machado-Fragua MD, Tabak AG, van Sloten T, et al. Association between age at diabetes onset and subsequent risk of dementia. Jama. 2021; 325(16): 1640-1649.
10. Jørgensen TS, Okholm GT, Christensen K, Sørensen TI, Osler M. Body height in young adult men and risk of dementia later in adult life. Elife. 2020; 9: e51168.
11. Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. The lancet. 2008; 371(9609): 340357.
12. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. The lancet. 2007; 369(9555): 60-70.
13. UNICEF Nigeria. Multiple Indicator Cluster Survey 2016–17: Key Findings[Internet]. Nigeria: UNICEF: 2017[cited 2026 Mar 23]. Available from:https://ngfrepository.org.ng:8443/handle/12 3456789/3142
14. Stern Y. Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurol. 2012; 11(11): 1006-1012.
15. Meng X, D'Arcy C. Education and dementia in the context of the cognitive reserve hypothesis: a systematic review with meta-analyses and qualitative analyses. PLoS One. 2012; 7(6): e38268.
16. Adedini SA, Somefun OD, Odimegwu C. Gender inequality and maternal and child healthcare utilization in sub-Saharan Africa. Gender and Behaviour. 2014; 12(4): 6050-6070.
17. Xue M, Xu W, Ou YN, Cao XP, Tan MS, Tan L, et al. Diabetes mellitus and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 144 prospective studies. Ageing research reviews. 2019; 55: 100944.
18. Biessels GJ, Despa F. Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications. Nat Rev Endocrinol. 2018; 14(10): 591-604.
19. Sędzikowska A, Szablewski L. Insulin and insulin resistance in Alzheimer's disease. International journal of molecular sciences. 2021; 22(18): 9987.
20. Adedini SA, Odimegwu C, Bamiwuye O, Fadeyibi O, Wet ND. Barriers to accessing health care in Nigeria: implications for child survival. Global health action. 2014; 7(1): 23499.
21. Ugwu E, Onung S, Ezeani I, Olamoyegun M, Adeleye O, Uloko A. Barriers to diabetes care in a developing country: exploratory evidence from diabetes healthcare providers. Journal of Advances in Medicine and Medical Research. 2020; 32(10): 72-83.
22. Farmer P. Pathologies of power: Health, human rights, and the new war on the poor [Internet]. Univ of California Press; 2004. Available from: https://www.ucpress.edu/book/9780520243262/p athologies-of-power
23. Marmot M, Wilkinson R, editors. Social determinants of health [Internet]. Oup Oxford; 2 0 0 5 . Ava i l a b l e f r o m : https://digital.library.tu.ac.th/tu_dc/frontend/Info/ item/dc:307024
24. World Health Organization. A conceptual framework for action on the social determinants of health, 2010.
25. Navarro V. The Political Economy of Social Inequalities: Consequences for Health and Quality of Life [Internet]. Routledge; 2002. Available from: https://www.routledge.com/The-PoliticalEconomy-of-Social-Inequalities-Consequencesf o r- H e a l t h- a n d- Q u a l i t y- o fLife/Navarro/p/book/9780895032522
26. Banks T, Dimond R. Nettleton, Sarah: The Sociology of Health and Illness 3rd. ed [Book Review]. Medical Sociology Online. 2013; 7(2): 78-79.
27. Ineichen B. The epidemiology of dementia in Africa: a review. Social Science & Medicine. 2000; 50(11): 1673-1677.
28. Ogunniyi A, Baiyewu O, Gureje O, Hall KS, Unverzagt F, Siu SH, et al. Epidemiology of dementia in Nigeria: results from the Indianapolis–Ibadan study. European Journal of Neurology. 2000; 7(5): 485-490.
29. Titus OB, Adebisola OA, Adeniji AO. Health-care access and utilization among rural households in Nigeria. Journal of development and agricultural economics. 2015; 7(5): 195-203.
30. Aboderin I. Intergenerational support and old age in Africa [Internet]. Routledge; 2017. Available from:https://www.routledge.com/Intergeneration a l- S u p p o r t- a n d- O l d- A g e- i nAfrica/Aboderin/p/book/9781138511026
31. Federation ID. IDF Diabetes Atlas 2021[Internet]. International Diabetes Federation. 2021. [cited
