Objectives: Informal caregivers play an indispensable role in and are often the sole source of care for older adults in low and middle-income settings worldwide. Intensive informal care predicts mortality and morbidity among caregivers in higher-income settings. However, there is limited evidence from poorer settings, including Africa countries, where caregiving is shared widely, including across generations. We therefore investigated caregivers health status in rural South Africa. Methods: We conducted quantitative interviews with all household members and all non-household caregivers aged 12 and above (n=1012) of 106 older adults in rural Mpumalanga, South Africa. We used multivariable regression with care-recipient random intercepts to assess the relationships between four caregiving characteristics and both self-reported chronic conditions and self-reported health status, considering how caregiver age moderated each association. Results: Over half of all caregivers reported at least one chronic health condition, despite half being aged under 40. Caregivers self-reporting the worst health status provided high hours of care. However, caregivers health status was not significantly associated with weekly care quantity or history of caring. Those aged 40 and below who reported being a main caregiver had 52% increased odds of reporting poorer health compared to other same-aged carers (95% confidence interval: 0.99, 2.35), while having more chronic conditions was associated with being expected to act as a sole caregiver more often among caregivers under 39. Discussion: Greater caring responsibilities for older adults were not consistently associated with caregivers health in a setting where poor health is common, and caregiving is spread widely. Longitudinal data is necessary to unpack possible explanations of these findings, and to determine whether intensive caregiving speeds downward health trajectories for carers.

The authors have declared no competing interest.

This research was supported by the National Institute on Aging of the National Institutes of Health (R21 AG059145, R01 AG054066, P01 AG0417410). GH is supported by a fellowship from the Wellcome Trust and Royal Society (Grant number Z/18/Z/210479). Disclaimer: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study received ethics approval from the University of the Witwatersrand Human Research Ethics Committee (REC) (Medical; M200373), University College London REC (152311/001) and Mpumalanga Province Health Research Committee, and letters of support from the Mpumalanga Department of Health and the Agincourt Community Advisory Board. All adult participants provided written informed consent; all minors provided written informed assent following parent/guardian written consent.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The study received ethics approval from the University of the Witwatersrand Human Research Ethics Committee (REC) (Medical; M200373), University College London REC (152311/001) and Mpumalanga Province Health Research Committee, and letters of support from the Mpumalanga Department of Health and the Agincourt Community Advisory Board. All adult participants provided written informed consent; all minors provided written informed assent following parent/guardian written consent.