Epidemiology of multimorbidity in low-income countries of sub-Saharan Africa: findings from four population cohorts

Price, A. J. et al. (2023) Epidemiology of multimorbidity in low-income countries of sub-Saharan Africa: findings from four population cohorts. PLoS Global Public Health, 3(12), e0002677. (doi: 10.1371/journal.pgph.0002677) (PMID:38055698) (PMCID:PMC10699623)

Abstract

We investigated prevalence and demographic characteristics of adults living with multimorbidity (≥2 long-term conditions) in three low-income countries of sub-Saharan Africa, using secondary population-level data from four cohorts; Malawi (urban & rural), The Gambia (rural) and Uganda (rural). Information on; measured hypertension, diabetes and obesity was available in all cohorts; measured hypercholesterolaemia and HIV and self-reported asthma was available in two cohorts and clinically diagnosed epilepsy in one cohort. Analyses included calculation of age standardised multimorbidity prevalence and the cross-sectional associations of multimorbidity and demographic/lifestyle factors using regression modelling. Median participant age was 29 (Inter quartile range-IQR 22–38), 34 (IQR25-48), 32 (IQR 22–53) and 37 (IQR 26–51) in urban Malawi, rural Malawi, The Gambia, and Uganda, respectively. Age standardised multimorbidity prevalence was higher in urban and rural Malawi (22.5%;95% Confidence intervals-CI 21.6–23.4%) and 11.7%; 95%CI 11.1–12.3, respectively) than in The Gambia (2.9%; 95%CI 2.5–3.4%) and Uganda (8.2%; 95%CI 7.5–9%) cohorts. In multivariate models, females were at greater risk of multimorbidity than males in Malawi (Incidence rate ratio-IRR 1.97, 95% CI 1.79–2.16 urban and IRR 2.10; 95%CI 1.86–2.37 rural) and Uganda (IRR- 1.60, 95% CI 1.32–1.95), with no evidence of difference between the sexes in The Gambia (IRR 1.16, 95% CI 0.86–1.55). There was strong evidence of greater multimorbidity risk with increasing age in all populations (p-value <0.001). Higher educational attainment was associated with increased multimorbidity risk in Malawi (IRR 1.78; 95% CI 1.60–1.98 urban and IRR 2.37; 95% CI 1.74–3.23 rural) and Uganda (IRR 2.40, 95% CI 1.76–3.26), but not in The Gambia (IRR 1.48; 95% CI 0.56–3.87). Further research is needed to study multimorbidity epidemiology in sub-Saharan Africa with an emphasis on robust population-level data collection for a wide variety of long-term conditions and ensuring proportionate representation from men and women, and urban and rural areas.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jani, Dr Bhautesh and Mair, Professor Frances and Crampin, Professor Mia

Creator Roles

Jani, B.: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review and editing
Mair, F.: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – review and editing
Crampin, A. C.: Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Resources, Supervision, Validation, Visualization, Writing – review and editing

• Authors: Price, A. J., Jobe, M., Sekitoleko, I., Crampin, A. C., Prentice, A. M., Seeley, J., Chikumbu, E. F., Mugisha, J., Makanga, R., Dube, A., Mair, F. S., and Jani, B. D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: PLoS Global Public Health
• Publisher: Public Library of Science
• ISSN: 2767-3375
• ISSN (Online): 2767-3375
• Copyright Holders: Copyright © 2023 Price et al.
• First Published: First published in PLoS Global Public Health 3(12): e0002677
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
309238		Multimorbidity in Africa - Increasing Understanding of the Patient Experience and Epidemiology (MAfricaEE)	Frances Mair	Medical Research Council (MRC)	MC_PC_MR/T037849/1	SHW - General Practice & Primary Care