Objective To expand the evidence base on the prevalence of non-communicable disease (NCD) risk factors in rural Africa, in particular among older adults aged 50 and older.

Methods Cross-sectional study in three rural sites in Malawi, Rwanda and Tanzania. One person was interviewed from each of 665 households selected through a stratified random sampling procedure across the three sites. The questionnaire included socio-demographic characteristics, smoking and alcohol intake as well as a food frequency questionnaire.

Results Smoking rates among older men and women were higher than among adults under 50. While only 2.3% of women under 50 were current smokers, 21.0% of older women smoked (P < 0.0001). Among men, 19.0% of men under 50 smoked versus 36.6% of older men (P = 0.001). Alcohol consumption among older women aged 50 and older (45.0%) was more common (P = 0.005) than among women under 50 (27.6%). Examining a set of five risk factors, more men aged 50 and older (49.5%) had two or more risk factors than men under 50 (25.5%) (P < 0.0001). Similarly, 52.0% of women aged 50 and older had two or more risk factors, versus 24.1% of women under 50 (P < 0.0001).

Conclusion Contrary to what is seen in developed country settings, this study reveals high rates of smoking and alcohol consumption among men and women aged 50 years and older in rural Africa that puts them at risk of NCDs. The health of older adults in rural Africa has been neglected, and these findings highlight the importance of reaching out to older adults with messaging regarding diet, smoking, alcohol use and general health.