When Dementia is mistaken for Witchcraft: An Integrated Missional Public Health Framework for Addressing Elder Abuse and Dementia Stigma in Rural Zambia

The burden of dementia in sub-Saharan Africa (SSA) is growing, with estimates projecting an increase from 2.13 million cases in 2015 to 7.62 million by 2050. However, limited research exists on dementia within this region, particularly concerning cultural beliefs and stigma affecting persons living with dementia and their caregivers. Behavioural changes associated with dementia are frequently attributed to supernatural causes such as witchcraft, curses, and ancestral retribution, leading to social exclusion, neglect, dispossession, and violence. In Zambia, dementia occurrence remains poorly documented due to low community awareness and a shortage of skilled healthcare providers capable of recognising and diagnosing the condition. What remains unknown is how the increasing burden of dementia intersects with prevalent witchcraft accusations. This article addresses this gap through an interdisciplinary approach grounded in critical medical anthropology, missio Dei theology, and Ubuntu philosophy, enabling examination of the Zambian context wherein dementia symptoms are perceived as evidence of witchcraft. The paper presents the Missional Public Health Dementia Response Framework (MPHDRF), developed through conceptual analysis and integrative literature review. This six-pillar, theory-informed and evidence-informed conceptual intervention framework encompasses community dementia literacy, church-based awareness, healthcare capacity building, traditional leader engagement, caregiver support systems, and policy and legal protection. The framework provides a culturally appropriate and potentially actionable means of alleviating dementia-related witchcraft accusations and safeguarding the wellbeing of older persons in rural Zambia.

Dementia, witchcraft, Zambia, older adults, missional public health

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