Overlapping caregiving demands on older rural South Africans and their association with poor subjective health and wellbeing and food insecurity.

As care needs in rural sub-Saharan African communities grow, informal caregiving by older adults is a key and growing familial resource. However, such caregiving may generate unique challenges and consequences for the carers. We examined how caregiving is associated with health, food insecurity and subjective wellbeing among older adults in rural Mpumalanga province, South Africa. We used the first two waves of data from the HAALSI cohort study, containing 5059 participants aged 40 and older in wave 1, and 4176 in wave 2. Participants were categorized into four groups based on caregiving responsibilities for adult family members, grandchildren, both groups or neither. We assessed how caregiving responsibilities predicted three measures of wellbeing: self-rated health, life satisfaction and food security. We employed random effects ordered logit regression models (within interview respondents) and adjusted for socio-demographic potential confounders. Almost one-quarter of middle- and older- age adults in this setting provided care for children (23%) or other adults (3%). Caregivers were more likely to be female, older, have less formal education, were less often employed and live in larger households than non-caregivers. Carers consistently experienced higher food insecurity, lower life satisfaction and reported worse health compared to non-carers. Caregivers' responsibilities, both for older family members and grandchildren, are common and associated with worse wellbeing among older adults in rural South Africa. These findings emphasize the urgent need for targeted interventions addressing material and emotional needs of caregivers, including policies that enhance food security, improve access to healthcare, and provide economic support in resource-constrained settings.