GEITA, Tanzania —The first time 78-year-old Hadija Kisanji got lost on her way home, neighbors found her sitting under a baobab tree, staring blankly at the dusty road. When they asked where she was going, she whispered, “I think I live nearby.” That was three years ago. Today, Kisanji barely remembers her own name.

She’s amongst the many elderly Tanzanians silently battling dementia—a condition often mistaken for witchcraft. In a country where mental illness is stigmatized, dementia is not just an illness—it is a slow erasure of identity, leaving families struggling in isolation.

A life fading away

Kisanji’s daughter, Mariam, has watched helplessly as her mother plunges further into confusion. “She calls me ‘mother’ sometimes,” Mariam told Health Policy Watch. “She doesn’t remember I am her child. She asks if her parents are coming back, but they’ve been dead for 50 years.”

In rural Tanzania, where medical facilities are scarce, dementia and Alzheimer’s remain largely undiagnosed. Families struggle to manage symptoms – wandering, memory loss, aggression – without professional guidance. “Some believe that when old people start acting strangely, they are bewitched,” said Mfaume Kibwana, Chief Medical Officer at  Geita Regional Referral Hospital. “It’s heartbreaking because dementia is a disease, not a curse to dispel. Yet many remain blinded by mistaken beliefs in witchcraft, and changing their minds isn’t easy.”

For Kisanji, the disease has turned her life into a puzzle of lost time. Once a respected midwife, she now spends her days clutching a stuffed teddy bear, convinced it is her real baby. “Shhh, don’t wake him,” she whispered to this reporter, holding the doll firmly in her frail arms.

A town struggling to understand

Geita, a gold-mining region in north-western in Tanzania, near the Rwandan border and the shores of Lake Victoria, lacks specialized dementia care. The few health centres available are overstretched. Many families never seek medical attention, assuming dementia is a natural part of aging or fearing social stigma.

Even when families try to access care, the costs are prohibitive. “The doctor said my father needs special medicine,” says Juma Magesa, whose 82-year-old father, Mzee Rashid, was diagnosed with Alzheimer’s. “But where do I get 200,000 shillings ($80) every month when I can hardly feed my children?”

Magesa has resorted to tying a small bell to his father’s wrist. “At night, he tries to leave the house. If I hear the bell, I wake up and stop him.”

Social isolation worsens the situation. “People stopped visiting us,” says Rehema Komba, who takes care of her 89-year-old mother Joseline Kombe. “They say she is bewitched. Even my own relatives tell me to take her to a witch doctor instead of a hospital.”

A glimpse across Africa

The struggle of dementia patients in Tanzania reflects a broader crisis across Africa, where ageing populations are rising but geriatric healthcare remains underdeveloped. The World Health Organization estimates that by 2050, nearly 10% of Africa’s population will be over 60.

Dementia is already on the rise in Sub-Saharan Africa, with 2.13 million people affected in 2015—a figure projected to soar to 7.62 million by 2050.

A daring thief of memory and autonomy, dementia now affects over 55 million individuals globally, with nearly 10 million new cases emerging each year. Alarmingly, more than 60% of those living with dementia reside in low- and middle-income countries, where resources for care and support are often scarce. 

The economic toll of dementia is staggering. In 2019, the global cost was estimated at US$1.3 trillion, a figure projected to rise to US$1.7 trillion by 2030, and potentially US$2.8 trillion when accounting for increases in care costs. Informal caregivers, often family members, shoulder approximately half of these expenses, dedicating an average of five hours daily to care and supervision. 

People living with dementia could triple by 2050

Beyond the financial strain, dementia casts a profound shadow on human lives. It is currently the seventh leading cause of death worldwide and a major contributor to disability and dependency amongst older adults. Women are disproportionately affected, both as patients and caregivers; they account for 70% of care hours provided to those living with dementia. 

As the global population ages, projections indicate that the number of people living with dementia could triple by 2050, reaching 152 million. This looming crisis underscores the urgent need for comprehensive public health strategies, increased awareness, and robust support systems to address the multifaceted challenges posed by dementia. 

The World Health Organization’s member states recognized dementia as a public health priority in 2017, endorsing a Global Action Plan (2017-2025), due to come up for review at this year’s May World Health Assembly. This plan provides a comprehensive blueprint for action across seven strategic areas, including increasing awareness, reducing risk, and providing support for caregivers. 

But the growing burden of dementia also highlights potential opportunities for the African continent to innovate and develop interventions. Experts convening in Nairobi at last year’s inaugural Nature conference on brain health and dementia noted that researchers could gain valuable insights into risk factors through the study of Africa’s very diverse populations, leading to the development of more effective as well as affordable interventions for dementia worldwide. 

“With 80% of the people with dementia likely to be in the Global South by 2050, it’s imperative that we bring the high-resource communities and the Global South together to solve the problem,” said George Vradenburg, founder of the Davos Alzheimer’s Collaborative, which co-sponsored the event.

The burden of care

In many or most African households, caregiving typically falls on the shoulders of women—daughters, granddaughters, or wives. 

Mariam, for instance, quit her job as a teacher to care for her mother full-time. “It is like watching a candle burn out,” she says. “One day, she knows who I am. The next, she doesn’t even recognize her own face in the mirror.”

With no nursing homes or hospice care, families rely on each other. “I can’t leave her alone,” Mariam says. “She might wander into the street. She might fall into the fire while cooking.”

Dr Kibwana warned that caregivers, too, suffer silently. “They develop anxiety, depression, even physical health problems from stress. But they don’t talk about it because, in our culture, taking care of your parents is a duty, not a choice.”

A mother forgotten

 An old woman sat on a wooden stool outside a crumbling mud-brick house, her faded khanga wrapped tightly around her frail shoulders. Her eyes, clouded with confusion, darted back and forth, as if searching for something just beyond reach. The late afternoon sun bathed her wrinkled face in gold, but there was no warmth in her expression – just an emptiness that had swallowed the person she used to be.

Her name is Rehema Magesa, or at least that’s what her family tells her. She does not remember. At 81, Alzheimer’s and dementia have stolen the sharp-witted woman who once ran a thriving fish stall at the Mwanza market, and raised six children with the strength of a lioness. Now, she barely recognizes them. She calls her eldest son “Baba” and mistakes her teenage granddaughter for the neighbor’s child. Some days, she accuses her own family of stealing her money – money she hasn’t earned in years.

Inside the house, her daughter Halima stirs a pot of thin maize porridge, her face drawn with exhaustion. “She wakes up at night and wanders,” Halima said, glancing toward the door, as if fearing her mother might slip out again. “Last week, we found her on the road to the lake, barefoot, shivering. A stranger had to bring her home.” There’s no money for a caretaker, no proper medication, no respite. The family struggles to make ends meet, and Magesa – once the pillar of the household – has become its heaviest burden.

At dusk, she sits quietly, tracing invisible patterns in the dust with her fingers. Her son, Rashid, watches from a distance. “She carried me on her back when I was a baby,” he said. “Now, she doesn’t even know who I am.”

Fighting a ‘big war with small weapons’ 

Tanzania’s healthcare system has made progress, but dementia care remains overlooked in national policy. There are no awareness campaigns, no government-funded housing for older people, and no formal support networks for caregivers, leaving families to navigate the challenges alone.

Experts warn that dementia cases will rise sharply as the country’s ageing population grows. “We are sitting on a time bomb,” said Dr Kibwana. “If we do nothing, thousands of elderly people will suffer in silence, and families will continue to bear a heavy burden.”

Some grass roots organizations are trying to fill the gap. A local NGO in the port-city of Dar es Salaam , The Good Samaritan Social Service Tanzania, has started training community health workers to identify and recognize dementia symptoms. “We go door to door, talking to families,” said volunteer Neema Kijazi. “We tell them, ‘Your mother is not possessed. She is sick.’”

But resources are limited. “We need more training, more medicine, more doctors,” Kijazi said. “Right now, we are fighting a big war with small weapons.”

Ageing in poverty

Dementia care is just one part of a larger crisis facing Tanzania’s elderly. In a country where more than half the population is under 18, older people are often overlooked. Life expectancy remains low—68.4 years for women and 65.2 for men—but those who surpass this threshold face a brutal reality, where survival is a daily battle.

“Our bodies are fragile. As  we grow old, our strength and vitality diminish while ill health set in with a devastating impact,”said Zena Mabeyo professor of social welfare at the Institute of Social Work in Dar Es Salaam.

But for most people she knows, retirement is a foreign concept. Nearly 96% of older Tanzanians keep working out of necessity, tending small farms, selling vegetables, or weaving mats. The fortunate ones own a few goats or chickens—their version of a “bank account.”

“Diminishing strength and stamina obviously affects the kind of work that elderly people can do and how long they can do it,” Mabeyo told Health Policy Watch.

Those too frail to work rely entirely on their families’ support. Tanzania has no universal pension system, and only former government employees receive stipends – although too small to sustain them.

The gradual breakdown of both traditional and modern support systems has left many elderly Tanzanians struggling to survive.

Although the country has recognized ageing in its national policy, this is a largely rhetorical gesture, critics say. Policies fail to effectively address the needs of older people, and particularly those suffering from dementia and Alzheimer’s.

“We haven’t seen meaningful interventions for older people with dementia and Alzheimer’s in Tanzania,” Mabeyo said. “Without a clear strategy for diagnosis, care, and support, many elderly people continue to suffer in silence.”

Prioritizing dementia in Africa

Public health experts like Dr Kibwana urge Tanzania and other African nations to prioritize dementia as a public health issue. They stress the need for awareness campaigns, caregiver support programs, and affordable medication. Without these measures, they warn, thousands of families will continue to struggle alone, and the silent suffering of the elderly will only worsen.

For now, Mariam and many others remain trapped in a cycle of care and grief, hoping for a future where their loved ones can live with dignity, not in the shadows.

Each day is a battle against the unknown. “I don’t know how long I can do this,” she admits. “I pray that one day, someone will help us.”

Juma echoes her fears. “We are drowning,” he says. “Nobody sees us, nobody hears us.”

As the darkness sets in Geita, Kisanji sits on the squeaking wooden bench, humming an old Sukuma(tribe) lullaby. For a brief moment, she looks at Mariam and smiles. “Mama,” she says softly.

Mariam squeezes her mother’s hand, holding onto that fleeting moment of clarity. Because tomorrow, Kisanji may forget again. And all Mariam can do is wait – and remember for both of them.

Image Credits: Kizito Makoye Shigela/HPW, Google Maps , Kizito Makoye Shigela/HPW, Muhidin Michuzi.