Witchcraft accusations against older women in Sub-Saharan Africa: a narrative review and community-based inclusive development framework synthesis

Witchcraft accusations against older women persist as a serious yet underexamined source of harm and exclusion in parts of sub-Saharan Africa, particularly in Ghana. While existing research has explored witchcraft beliefs and individual cases, comparatively less attention has been given to the longer-term health, social and participation impacts experienced by accused older women. This study addresses this gap through a two-stage qualitative evidence synthesis drawing on qualitative studies, ethnographies, policy documents, organizational reports, and human rights literature, primarily from Ghana and supported by comparative material from Nigeria and Malawi. Stage one employed a critical narrative review to synthesize fragmented evidence on the social, cultural and institutional processes shaping accusation and treatment. Stage two applied a framework synthesis, in which themes generated inductively were mapped onto the Community-Based Rehabilitation (CBR) Matrix to examine implications for participation and inclusion. The findings indicate that accusations disproportionately affect older women facing intersecting vulnerabilities related to gender, aging, poverty and social marginality, and are associated with violence, displacement, stigma, and prolonged exclusion from health services, livelihoods and community life. When interpreted through a community-based inclusive development lens, these patterns suggest constraints across health, education, livelihood, social and empowerment domains. The study highlights the potential importance of culturally informed, rights-oriented and participatory approaches that integrate advocacy, protection and rehabilitation, while strengthening institutional accountability and community-based support mechanisms. These findings are grounded in the contexts examined and offer implications for understanding and addressing witchcraft-related harm in similar settings.